Primary CNS lymphoma

2% of NHL cases; incidence increased partly by HIV pandemic; non-HIV related aged 55-70; commonly involves frontal lobes, corpus callosum or deep periventricular structures; cognitive or personality change common; 10% seizures; 40% evidence of leptomeningeal spread; diagnosis by gadolinium-enhanced magnetic resonance and stereotactic needle biopsy; systemic lymphoma uncommon; poor prognosis improved by addition of systemic chemotherapy with high dose methotrexate to whole brain 206 radiotherapy; improves survival with >95% responses and median survival 30-60 months; 50% relapse risk; most relapses in CNS, others mainly leptomeningeal and ocular, <10% systemic; delayed neurotoxicity common, esp. >60 years: dementia, ataxia, urinary dysfunction.

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