Leptomeningeal Lymphoma in a Child with Acquired Immune Deficiency Syndrome

Abstract

Primary non-Hodgkin lymphoma of the central nervous system is rare in pediatric AIDS patients. We report a seven-year-old HIV-infected boy, in stage C3 of the disease, who developed non-Hodgkin lymphoma in the central nervous system with a leptomeningeal location. The patient started with signs and symptoms of increased intracranial pressure, impaired consciousness and then became blind. The diagnosis was based on brain biopsy, immunophenotypic studies of B cells, and Epstein-Barr virus serology of the cerebrospinal fluid. The boy was treated with intrathecal and systemic chemotherapy. Fifteen months after diagnosis he had clinically improved, but he then relapsed with a thalamic tumor. He was treated with radiotherapy and he died four months later. In the present article, we discuss diagnostic difficulties, evolution, treatment, and the association of this neoplasm with the Epstein-Barr virus.

Key words

Central nervous system - non-Hodgkin lymphoma - leptomeningeal lymphoma - AIDS

References

• 1 Abuzaitoun O, Hanson I. Manifestaciones específicas para órgano de la enfermedad por virus de la inmunodeficiencia humana. Rogers M Clínicas Pediátricas de Norte América. 2000 1: 132
• 2 Alderson L, Fetell M R, Sisti M. et al . Sentinel lesions of primary CNS lymphoma.  J Neurol Neurosurg Psychiatry. 1996;  60 102-105
• 3 Anderson D W, Macher A M, Shanks D. et al . AIDS case for diagnosis series 1987 military medicine.  Milit Med. 1987;  152 M33-M40
• 4 Antinori A, De Rossi G, Ammassari A. et al . Value of combined approach with thallium-201 single photon emission computed tomography and Epstein Barr virus DNA polymerase chain reaction in CSF for the diagnosis of AIDS related primary CNS lymphoma.  J Clin Oncol. 1999;  17 554-560
• 5 Brecher K, Hochberg F H, Louis D N. et al . Case report of unusual leukoencephalopathy preceding primary CNS lymphoma.  J Neurol Neurosurg Psychiatry. 1998;  65 917-920
• 6 Centers for Disease Control and Prevention . Revised classification system for human immunodeficiency virus infection in children less than 13 years of age.  MMWR. 1994;  43 RR1
• 7 Cinque P, Brytting M, Vago L. et al . Epstein Barr virus DNA in cerebrospinal fluid from patients with AIDS related primary lymphoma of the central nervous system.  Lancet. 1993;  342 398-401
• 8 Cocchi P, Calabri G, Salvi G. et al . AIDS associated lymphoma of the brain in a child.  Pediatrics. 1988;  82 678-679
• 9 De Angelis L M. Primary brain tumors in the acquired immunodeficiency syndrome.  Curr Opin Neurol. 1995;  8 419-423
• 10 De Angelis L M, Yahalom J, Rosenblum M. et al . Primary CNS lymphoma: managing patients with spontaneous and AIDS related disease.  Oncology. 1987;  1 52-62
• 11 Epstein L, DiCarlo F, Vijay V. et al . Primary lymphoma of the central nervous system in children with acquired immunodeficiency syndrome.  Pediatrics. 1988;  82 355-363
• 12 Felice M, Zubizarreta P, Rossi J. et al . Brief report. Diagnosis and successful treatment of childhood primary leptomeningeal lymphoma.  Med Pediatr Oncol. 2000;  34 361-363
• 13 Fordyce E J, Singh T P, Nash D, Gallagher B, Forlenza S. Survival rates in NYC in the era of combination ART.  J Acquir Immune Defic Syndr. 2002;  30 111-118
• 14 Gilberto Gonzalez R, Ruiz A, Tracey I, Mc Connell J. Structural, functional and molecular neuroimaging in AIDS. Gendelman H, Lipton S, Epstein L, Swindells S The Neurology of AIDS, 1st edn. New York; Chapman and Hall Ed 1998: 339
• 15 Katz B, Berkman A, Shapiro E. Serologic evidence of active Epstein Barr virus infection in Epstein Barr virus associated lymphoproliferative disorders of children with acquired immunodeficiency syndrome.  J Pediatr. 1992;  120 228-232
• 16 Mac Mahon E, Glass J, Hayward S. et al . Epstein Barr virus in AIDS-related primary central nervous system lymphoma.  Lancet. 1991;  338 969-973
• 17 Moore P S, Chang Y. Detection of herpes virus-like DNA sequences in Kaposi's sarcoma in patients with and without HIV infections.  N Engl J Med. 1995;  332 1181-1185
• 18 Moulignier A, Galicier L, Mikol J. et al . Primary cerebral lymphoma presenting as diffuse leukoencephalopathy.  AIDS. 2003;  17 1111-1113
• 19 Mueller B U, Pizzo P A. Malignancies in pediatrics AIDS.  Curr Opin Pediatr. 1996;  8 45-49
• 20 Osborn A. Meningiomas y otras neoplasias no gliales. Osborn A Neuroradiología Diagnóstica. 1ra edn. Madrid; Mosby 1996: 620-623
• 21 Registro informático del Hospital de Pediatría “Prof. Juan P. Garrahan”. Ciudad de Buenos Aires, Argentina; 2002
• 22 Rodriguez M, Delgado P, Petito C. Epstein Barr virus associated primary central nervous system lymphoma in a child with the acquired immunodeficiency syndrome. A case record and review of the literature.  Arch Pathol Lab Med. 1997;  121 1287-1291
• 23 Safriel Y, Haller J, Lefton D, Obedian R. Imaging of the brain in the HIV-positive child.  Pediatr Radiol. 2000;  30 725-732
• 24 Skolasky R L, Dal Pan G J, Olivi A. et al . HIV associated primary CNS morbidity and utility of brain biopsy.  J Neurol Sci. 1999;  163 32-38