title: CD4-Positive T-Cell Primary Central Nervous System Lymphoma in an HIV Positive Patient.
abstract: OBJECTIVE
  Primary central nervous system lymphomas (PCNSLs) in patients with human immunodeficiency virus (HIV) are predominantly B-cell lymphomas associated with Epstein-Barr virus (EBV) and rarely CD8-positive T-cell PCNSLs.
  
  
  METHODS
  Patient history, laboratory results, cerebrospinal fluid (CSF), imaging, and brain biopsy specimens were reviewed and tested for T-cell receptor clonality.
  
  
  RESULTS
  A 64-year-old HIV-positive woman sought treatment for lethargy and left-sided weakness. Brain imaging showed regional increased T2 signal with restricted diffusion in cerebral hemispheres. CSF flow cytometry revealed CD4-positive T lymphocytes with loss of CD3, CD5, and CD7. EBV-positive T-cell lymphoma was immunohistochemically confirmed on brain biopsy specimens. Molecular analysis detected clonal T-cell receptor gene rearrangement. The patient received intrathecal methotrexate and whole-brain radiation. She did not respond to treatment and was eventually placed in hospice care.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of CD4-positive T-cell PCNSL in an HIV-positive patient and will help to raise clinical awareness of this previously unknown entity.
authors.affiliation: From Pathology and Laboratory Medicine, University of California, Irvine, CA.
authors.forename: Ali
authors.initials: A
authors.lastname: Nael
authors.affiliation: From Pathology and Laboratory Medicine, University of California, Irvine, CA.
authors.forename: Vighnesh
authors.initials: V
authors.lastname: Walavalkar
authors.affiliation: Pathology and Laboratory Medicine, Presbyterian Hospital/Weill Cornell Medical College, New York, NY.
authors.forename: William
authors.initials: W
authors.lastname: Wu
authors.affiliation: Medical Imaging, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Nael
authors.affiliation: From Pathology and Laboratory Medicine, University of California, Irvine, CA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Kim
authors.affiliation: From Pathology and Laboratory Medicine, University of California, Irvine, CA.
authors.forename: Sherif
authors.initials: S
authors.lastname: Rezk
authors.affiliation: From Pathology and Laboratory Medicine, University of California, Irvine, CA.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhao
mesh_terms: D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis* / Q000821:virology; D016399:Lymphoma, T-Cell / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D008875:Middle Aged
chemical_list: D004279:DNA, Viral
keywords: CD4-positive T-cell lymphoma; EBV; HIV; Primary central nervous system lymphoma