Flowchart of management of HIV-negative patients with brain masses suspected for lymphoma from presentation to therapeutic decision in ordinary clinical practice. 1Despite a strong suspicion of PCNSL, some patients suffering from large space-occupying lesions with acute symptoms of brain herniation could be eligible for surgical resection to reduce rapidly increased intracranial pressure; biopsy of extra-CNS organs is usually prefered in patients with positive staging as this procedure is associated with lower risk of severe complications. 2Ocular examination should include slit-lamp examination, indirect ophthalmoscopy, and ophthalmic ultrasonography. 3CSF evaluation should include cell counts, protein and glucose levels, cytology, and flow cytometry. IgHV gene rearrangement studies are optional. ADC, average diffusion coefficient; CT, computed tomography; Deep regions, basal ganglia, corpus callosum, periventricular areas, brain stem, and/or cerebellum; DLBCL, diffuse large B-cell lymphoma; 18FDG, 18F-fluorodeoxyglucose; IgHV, immunoglobulin heavy chain variable region; LDH, lactate dehydrogenase serum level; MRI, magnetic resonance imaging; sym., symptoms.
