Which diagnostic tests are performed following a CT/MRI scan suggesting primary central nervous system lymphoma (PCNSL) in an immunocompromised patient?

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

The following should be ordered in an HIV-infected or otherwise immunocompromised patient whose CT/MRI scan suggests PCNL:

  • Avoid corticosteroids

  • Chest radiograph

  • Toxoplasma gondii serology

  • Slit-lamp examination for vitreous lymphoma

  • Lumbar puncture for cells, glucose, protein, cytology, syphilis testing, and cryptococcal antigen

Fischer et al presented the first prospective comparison of the diagnostic value of cerebrospinal fluid (CSF) cytomorphology, polymerase chain reaction (PCR) assay of the rearranged immunoglobulin heavy-chain (IgH) genes, and MRI in conjunction with cell count and protein concentration for the detection of meningeal dissemination in patients with PCNSL treated in a large multicenter study. They found a low rate of meningeal dissemination in primary CNS lymphoma in this large prospective study. The rate of discordant PCR and cytomorphologic results was high. Thus, they feel that these methods should be regarded as complementary. CSF pleocytosis had predictive value for meningeal dissemination detection. [14]


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