RESUMO
TITLE: Neurolinfomatosis primaria de cola de caballo como manifestacion inicial del virus de la inmunodeficiencia humana.
Assuntos
Cauda Equina/patologia , Linfoma Relacionado a AIDS/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Neurolinfomatose/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Renais , Cauda Equina/diagnóstico por imagem , Citarabina/administração & dosagem , Transtornos Neurológicos da Marcha/etiologia , Humanos , Neoplasias Renais , Linfoma Relacionado a AIDS/líquido cefalorraquidiano , Linfoma Relacionado a AIDS/diagnóstico por imagem , Linfoma Relacionado a AIDS/tratamento farmacológico , Linfoma Difuso de Grandes Células B/líquido cefalorraquidiano , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/etiologia , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/diagnóstico por imagem , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/etiologia , Neurolinfomatose/líquido cefalorraquidiano , Neurolinfomatose/diagnóstico por imagem , Neurolinfomatose/tratamento farmacológico , Rituximab/administração & dosagemRESUMO
INTRODUCTION: Primary lymphoma is the most common neoplasm of the central nervous system (CNS) in AIDS patients. METHODS: We retrospectively reviewed the clinical manifestations, neuroimaging findings, diagnostic methods used, histological characteristics, detection of Epstein-Barr virus (EBV) DNA by PCR in cerebrospinal fluid (CSF) and brain smears, and outcome of 18 HIV/AIDS patients with primary CNS lymphoma. RESULTS: The overall incidence of primary CNS lymphoma was 2.6%. Fifteen were men and mean age was 33.6 years. The most frequent clinical findings were focal neurological deficits and seizures. The mean CD4 T cell count at the time of diagnosis was 44 cells/microl. Primary CNS lymphoma presented as single, large (> 2.5 cm) lesions in 14 patients (77.8%). All the lesions were associated with a mass effect and surrounding edema. EBV DNA was detected in nine brain smears. In seven of these nine cases, EBV DNA was also found in CSF by PCR. Median survival after specific diagnosis was 75 days. CONCLUSIONS: This study upholds a link between EBV and these tumors. Primary CNS lymphoma was associated with a poor prognosis and short survival in this cohort of patients.