Primary CNS lymphoma

Primary CNS lymphoma (PCNSL) affects 2-6% of HIV-positive individuals. It is usually a late manifestation of AIDS and the patients commonly have other serious opportunistic infections. The histology is similar to AIDS-related NHL, except almost all cases are associated with EBV. Patients often present with epileptic seizures, hemiparesis, or severe headaches. A CT or MRI is the investigation of choice. However, the scan appearances may be indistinguishable from cerebral toxoplasmosis and, for this reason, patients are often treated initially with a trial oftoxoplasmosis treatment. A histological diagnosis is ideal but not often possible.

Treatment involves whole-brain radiotherapy in combination with steroids and, sometimes, intrathecal chemotherapy. There is little evidence to support the use of systemic chemotherapy. In good performance status patients, the median survival is 12 months. If no treatment is given, the survival rate falls significantly to just a few months. Patients usually die from the late complications of AIDS.

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