Devita, Hellman, and Rosenberg's Cancer

LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35

Chapter 30•Lymphomas 421

Question 30.33. Which statement is FALSE regarding primary CNS lymphoma (PCNSL)?

A. PCNSL was once a rare tumor accounting for 0.5% to 1.25% of

intracranial neoplasms, usually associated with congenital, acquired,

or iatrogenic immunodeficiency states.

B. PCNSL has increased threefold from 1985 to 1997 in immunocom-

petent individuals. This increase was part of an overall increase in all

extranodal NHLs.

C. Frontal lobe presentation is the least frequent in brain PCNSL.

D. Brain lesions are multifocal in 40% of normal patients and 100% of

patients with AIDS. The frequency of AIDS PCNSL has dramatically

decreased since the institution of highly active antiretroviral therapy.

Question 30.34. Which statement is FALSE regarding PCNSL?

A. The eye distinct from the orbit is a direct extension of the brain, and

approximately 20% of patients with PCNSL have ocular involvement

at presentation.

B. Ocular lymphoma involves the vitreous, retina, or choroid, but optic

nerve infiltration does not occur.

C. Primary leptomeningeal lymphoma in the absence of a brain mass

is rare, approximately 7% of PCNSL. Symptoms of progressive leg

weakness, urinary incontinence or retention, cranial neuropathies,

and confusion may be present for months before diagnosis; delayed

therapy is common because of difficulty of diagnosis.

D. MRI should be the standard imaging technique for patients with

PCNSL. Prominent contrast enhancement is characteristic in 90%

of patients.

Question 30.35. Management and therapy of PCNSL include all, EXCEPT:

A. Corticosteroids should be avoided before diagnostic biopsy, and

resection should be avoided.

B. Polymerase chain reaction for EBV on cerebrospinal fluid in AIDS-

associated PCNSL.

C. RT must be whole brain (3600 to 4500 cGy) and may be deferred

in patients>60 years of age. Primary treatment of ocular disease is

3500 to 4500 cGy RT to both eyes.

D. Chemotherapy should be considered at diagnosis for every patient,

must penetrate the blood–brain barrier (high-dose methotrexate and

leucovorin rescue), must be lipophilic (procarbazine), and should be

administered after RT.