A 43-year-old male with advanced HIV is hospitalized for evaluation of recent-onset headaches and personality changes. Imaging of the brain shows a solitary mass within the temporal lobe. Biopsy of the mass reveals uniform cells containing the Epstein-Barr virus genome. This patient most likely suffers from which of the following?

Question

A 43-year-old male with advanced HIV is hospitalized for evaluation of recent-onset headaches and personality changes.  Imaging of the brain shows a solitary mass within the temporal lobe.  Biopsy of the mass reveals uniform cells containing the Epstein-Barr virus genome.  This patient most likely suffers from which of the following?

Quizplus · Accepted Answer

The most frequent CNS tumor in immunosuppressed patients is a primary CNS lymphoma. This CNS tumor is commonly associated with AIDS. Primary CNS lymphomas appear microscopically as dense, cellular aggregates of uniform, atypical lymphoid cells. The majority of primary CNS lymphomas arise from B-cells. Diffuse large B-cell lymphoma is the most common subtype. The cells of CNS lymphomas are commonly positive for the B-cell markers CD20 and CD79a. Primary CNS lymphomas are universally associated with the Epstein-Barr virus (EBV). The clinical presentation is non-specific. Mental status changes, seizures, or progressive focal neurologic deficits may occur. Most of CNS lymphomas are high-grade and respond poorly to chemotherapy. (Choice G) Meningiomas are not associated with immunosuppressive diseases, nor are they associated with EBV. Meningiomas are located adjacent to the brain surface and are attached to the dura mater. (Choice H) Craniopharyngiomas are located in the suprasellar region and can be calcified. Craniopharyngiomas can cause visual disturbances and endocrinopathies (such as hypopituitarism). (Choice I) Intracranial schwannomas are most commonly located at the cerebellopontine angle. They cause symptoms of CN VIII compression (hearing loss, tinnitus, loss of balance). Educational Objective: Primary CNS lymphomas occur in immunosuppressed patients, such as those suffering from AIDS. These tumors arise from B cells and are universally associated with EBV. They are high-grade tumors with a poor prognosis.

A 43-Year-Old Male with Advanced HIV Is Hospitalized for Evaluation