AIDS-RELATED BRAIN LYMPHOMAS - CLINICAL-S TUDY AND CLINICOPATHOLOGICAL CORRELATIONS

We report the natural history of 17 brain lymphomas (11 primary, 6 dis seminated)from a post-mortem series of 130 patients with AIDS. Primary lymphomas appeared lately in the course of AIDS They were often assoc iated with a severe T-cell immunodepression and with more frequent opp ortunistic disorders than disseminated lymphomas. Associated Kaposi's sarcomas were surprisingly frequent All patients presented with neurol ogical manifestations. Heterogeneous features were seen at CT examinat ion. The CSF was abnormal in 12/13 cases, with an increase of protein contents and secretion of immunoglobulins; it contained activated lymp hocytes in 5/6 cases of disseminated lymphomas, and malignant cells in only one case. Cellular density never exceded 8/mm3 for primary lymph omas, and the lymphocytes were considered normal. The pre-mortem diagn osis of cerebral lymphomas was made in five patients, with a time laps e of 1 to 7 months between the first neurological symptoms and death, and of 5 to 30 days between the diagnosis and death. Cerebral biopsy w as diagnostic in 4 cases of primary cerebral lymphomas. In only 1/6 pa tients with disseminated lymphomas, the diagnosis had been made when t he patient was still alive, based on CSF and bone marrow lymphomatous infiltrations. The diagnosis of cerebral lymphoma (7 primary, 5 dissem inated) was post-mortem in 12 cases. It was made only at microscopic e xamination in 2/12 cases of primary lymphomas. The histopathological s tudy frequently showed a multicentric involvement, and always an immun oblastic cell type with plasmablastic differenciation and frequent med ium size cells. Marked gliosis and significant necrosis were often obs erved Neuropathological lesions associated with HIV-1 infection (toxop lasmosis, CMV and HIV-1 encephalitis) were seen in 8 cases with primar y lymphomas.