Cytomegalovirus infection of cerebral astrocytoma in an AIDS patient.

Association of glioma with AIDS is unusual. Cytomegalovirus (CMV) infection of glioma has not been documented in AIDS or non-AIDS patients. We present the case of a 37-year-old homosexual, HIV positive man who had a history of pneumocystis pneumonia and died of disseminated CMV infection and an anaplastic astrocytoma (5 x 5 x 4 cm) of the left temporal lobe. Part of the tumor was severely infected by CMV as demonstrated by immunohistochemical stain. Intranuclear and intracytoplasmic CMV inclusions were present in the cytomegalic cells whose astrocytic nature was identified by immunostain for GFAP. CMV-bearing cells were scattered throughout the astrocytoma but were rarely seen outside the tumor. CMV-bearing endothelial cells were seen in several capillaries within the tumor. Microglial nodules were scattered within the tumor and some contained CMV-infected cells. Many multinucleated giant cells (MNGC) with circularly arranged small nuclei were present in the infected area of the tumor and some showed fusion with cytomegalic cells. MNGC were absent outside the tumor. CMV ependymitis was not seen. The findings suggest that a) astrocytoma cells are permissive to CMV infection, b) that they may be more susceptible to CMV infection and replication than normal brain tissue, and c) the hyperplastic endothelia and abnormal blood brain barrier of the astrocytoma may facilitate the entry of CMV itno the tumor.