A Series of Patients with Primary Central Nervous System Lymphoma (PCNSL) and AIDS
JE Eisenstein, MB Mosunjac. Emory University School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
Background: Distinguishing toxoplasmosis from primary central nervous system lymphoma (PCNSL) radiologically in patients with AIDS is difficult. The gold standard for making the diagnosis of PCNSL is stereotactic biopsy with histological evaluation.
Design: A data search was performed at Grady Memorial Hospital's pathology records from 1989-2009 for biopsy proven PCNSL diagnoses. AIDS status, clinical presentation, and radiologic findings were correlated using laboratory and medical records.
Results: 25 cases of biopsy/autopsy proven PCSNL were identified. 22 of those patients had AIDS at the time of diagnosis. Mean patient age at the time of diagnosis was 38.9 yrs (range: 26-63 yrs). Of the 22 patients, 8 presented initially with altered mental status, 5 with motor symptoms including weakness and numbness, 5 with general malaise, and 4 with seizures. Brain imaging revealed multiple enhancing lesions in 12 patients, single enhancing lesions in 8 patients, and no documented historical imaging in 2 patients. Of the 22 patients with AIDS, within a year of their diagnosis of PCNSL, patients' CD4 counts averaged 17 (range: 1-88). Fourteen (64%) of these patients were documented to have been prescribed antiretroviral therapy. Of those on antiretrovirals the mean time of HIV/AIDS diagnosis to the diagnosis of PCNSL was 53.1 months (range: 6 – 168 months, SD = 50.66) compared to patients not documented to be on antiretrovirals [18.8 months (range: 1 – 60 months, SD=25.19)]. Death dates were documented in 9 patients, 3 of which had PCNSL histologically diagnosed at autopsy (1992 - 2005). Patients had a mean lifespan from diagnosis of HIV/AIDS of 32.3 months (range 2-84 months) and from diagnosis of PCNSL of 1.2 months (range: 0-5 months).
Conclusions: PCNSL at our institution over a 20 year period is a rare biopsy proven diagnosis, yet is highly associated with AIDS (22 of 25 cases). The presumptive diagnosis of PCNSL becomes main differential diagnosis when treatment for toxoplasmosis cases fails to show clinical and radiologic improvement. The dismal prognosis in our patients after the diagnoses of PCNSL is made is apparent, yet unknown death dates on those patients who received whole brain irradiation from 2006 – 2009 requires further investigation.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 215, Wednesday Afternoon