[Primitif cerebral lymphoma].

Primitif cerebral lymphoma is a rare disease but has increased in incidence over the past decades. Most of them are diffuse B cell lymphomas. An ocular lymphoma (uveitis) is frequently associated. The clinical and radiological features are often suggestive but the diagnostic must be confirmed by histology (either by cerebral biopsy or cytology analysis of the CSF or vitrous). Despite therapeutic advances the prognostic remains poor (median survival range from 3 to 4 years) with frequent recurrences. High dose methotrexate followed by whole brain irradiation is the standard treatment and achieves a high rate of remission but the risk of delayed neurotoxicity is high. This complication is more frequent and severe for patients older than 60 years and chemotherapy alone is usually proposed in elderly people. Immunodeficiency is a contributing factor to the development of primitive cerebral lymphoma; in this setting, differentiating them from infectious lesions (toxoplasmosis in particular) may be difficult. These lymphomas have a poorerprognosis and radiotherapy without chemotherapy is often debated.