Cerebral lymphomas in AIDS. Neuropathological study

A morphological analysis was done of 15 cases of malignant cerebral lymphomas selected from the material of 160 brains of patients, who died in the course of full-blown acquired immune deficiency syndrome (AIDS) during the period of 1987-1997. Cases with cerebral lymphomas comprised 9.4% of the whole collection. There were 13 males and 2 females in the studied group. The patients age ranged from 25 to 61 years. In 10 cases lymphomas were localized solely in the central nervous system, and in further 4 they were accompanying systemic neoplastic process. In one case lack of clinical and autopsy data did not permit classification of neoplasm to the primary or to the secondary group. In 13 cases immunophenotype of the lymphomas was characterized by immunohistochemical methods. In 11 cases neoplastic cells originated from B cells line and in 2--from T cells line. In 10 cases lymphomas were found in macroscopic examination, in the remaining 5 cases they were disclosed at the brain histopathology. The dynamics and extensiveness of the neoplastic process were different in particular cases. In most of them the process was multifocal and manifested in the form of diffuse proliferation, formed tumors with changing nature of their delineation and as multilayer perivascular cuffs. The characteristic feature of diffuse neoplasmatic growth was the appearance of large coagulative necroses in the central parts of tumors. Neoplastic foci were localized most often in the cerebral hemispheres (white matter, basal ganglia, periventricular regions), less frequently in the brain stem and cerebellum. In one case diffuse lymphoid growth involved selectively leptomeninges. In most of the cases leptomeningeal infiltrations accompanied large parenchymal neoplastic foci. The most striking feature of our collection consisted in concomitance of cerebral lymphomas with HIV-specific brain pathology and/or opportunistic infections mostly of viral etiology. Their frequency was much higher than in cases of AIDS without cerebral lymphomas. Another finding which seems to be worth mentioning was the appearance of morphological exponents of various pathological processes such as for instance multinuclear giant cells, CMV inclusions within neoplastic tissue. The relatively frequent presence of numerous HIV-specific giant cells on the periphery of lymphomatous tumors suggests pathogenetic participation of immune deficiency virus in the blastomatous transformation of lymphoid cells within the central nervous system.