Which factors determine the conditions included in the differential diagnoses of primary central nervous system lymphoma (PCNSL)?

Updated: Jan 19, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Differential diagnosis of a patient with suspected PCNSL depends on the patient's immune status and the radiographic appearance of the lesions. For example, the major differential diagnostic possibilities raised in an immunocompetent patient with a solitary lesion (besides PCNSL) are high-grade primary brain tumor, such as glioblastoma, and isolated metastasis.

In patients with AIDS, multifocal, ring-enhancing lesions raise the question of toxoplasmosis or another opportunistic infection. More diffuse cognitive and MRI abnormalities suggest the possibility of some infectious encephalitic process, such as herpes zoster, cytomegalovirus encephalitis, cryptococcal meningitis, or AIDS/dementia complex.


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