[艾滋病患者的原发性中枢神经系统淋巴瘤]

[Primary central nervous system lymphomas in AIDS patients].

作者信息

Corti Marcelo, Villafañe Florencia, Trione Norberto, Schtirbu Ricardo, Yampolsky Claudio, Narbaitz Marina

机构信息

Unidad 10 y Laboratorio de Anatomía Patológica, Hospital de Enfermedades Infecciosas F.J. Muñiz, Instituto de Investigaciones Oncohematológicas, Academia Nacional de Medicina, Buenos Aires, Argentina.

出版信息

Enferm Infecc Microbiol Clin. 2004 Jun-Jul;22(6):332-6. doi: 10.1016/s0213-005x(04)73105-5.

DOI:10.1016/s0213-005x(04)73105-5

PMID:15228900

Abstract

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.

摘要

引言

原发性淋巴瘤是艾滋病患者中枢神经系统（CNS）最常见的肿瘤。

方法

我们回顾性分析了18例患有原发性中枢神经系统淋巴瘤的HIV/AIDS患者的临床表现、神经影像学检查结果、所采用的诊断方法、组织学特征、通过聚合酶链反应（PCR）检测脑脊液（CSF）和脑涂片中的爱泼斯坦-巴尔病毒（EBV）DNA以及预后情况。

结果

原发性中枢神经系统淋巴瘤的总体发病率为2.6%。15例为男性，平均年龄为33.6岁。最常见的临床表现为局灶性神经功能缺损和癫痫发作。诊断时的平均CD4 T细胞计数为44个/微升。14例患者（77.8%）的原发性中枢神经系统淋巴瘤表现为单个大（>2.5 cm）病变。所有病变均伴有占位效应和周围水肿。在9例脑涂片中检测到EBV DNA。在这9例中的7例中，通过PCR在脑脊液中也发现了EBV DNA。明确诊断后的中位生存期为75天。