The lymphoma nodules were similar to those described in the literature. They were hypoechoic and homogeneous, with no necrotic center. The incidence of primary central nervous system lymphomas is increased several 1000-fold in AIDS patients. They typically occur late in the course of HIV infection and are associated with a very short median survival. Radiographic differentiation from toxoplasmosis remains a problem.
Occasional patients have long remissions after therapy but most patients die within a few months.
A possible role for combined modality therapy, including combination chemotherapy, is being explored. In addition, chronic antigenic stimulation may correlate with elevated serum CD22 levels and may serve as a tool for early detection. Novel investigational therapies in clinical development include new chemotherapy-based regimens, immune modulators, antibody therapy, as well as cellular therapy. Similar to the Ig heavy chain genes, the corresponding Ig light chain genes showed significant deviation from known germline gene sequences. Further support for this hypothesis is provided by sequential Ig sequence analysis in 1 patient with large-cell lymphoma.