Collective evidence points to a prominent role of stress in cancer growth and metastasis. Despite these results an etio-pathogenetic role has not been widely accepted. Reasons of controversies are the coexistence in stressed patients of high risk habits, the sample size, the heterogeneity and the retrospective origins of these studies. Experimental data and clinical observations argue about the possibility of an interaction between psychosocial events and tumours. However the number of involved variables and the long period of observation prevent with current technologies the definition of causal versus chaotic sequences of this hypothetical relationship. Psychotherapy may help to face up to stressful events, but its role e remains uncertain. Stress works through sympathetic nervous system and hypothalamicpituitary-adrenal axis activation, along with related hormones, that have functionally and biologically significant impacts on the tumor microenvironment. This paper collects evidences through the hypothesis of correlation between stress, psychological factors and cancer focusing both on psychology and on molecular biology. Knowledge on stress induced neuroendocrine dynamics in the tumor microenvironment might allow the development of integrated pharmacological and bio-behavioral strategies to create more successful cancer therapies.

Hemophagocytic lymphohistiocytosis (HLH) is a life threatening systemic disease characterized by proliferation of activated lymphocytes/macrophages leading to an exaggerated but ineffective immune response. HLH clinically presents with fever, pancytopenia, splenomegaly and hemophagocytosis in the bone marrow, lymph nodes or liver. HLH has been associated with viral, bacterial, fungal, parasitic infections, and malignancies, particularly T-cell lymphomas, and collagen-associated vascular diseases. We describe a case of an HIV positive patient who presented to the emergency department with fever, cough, diarrhea and abdominal pain. A CT scan revealed diffuse lymphadenopathy. Excisional biopsy of the lymph node showed almost complete effacement of the normal lymph node architecture. The effaced areas were composed of small lymphocytes, medium size cells with features of centroblasts, several immunoblasts and ReedSternberg like cells. Increased number of histiocytes with hemophagocytosis was also observed. Diagnosis of EBV positive diffuse large B cell lymphoma was made. In addition, clinical presentation, laboratory results and morphology led to the diagnosis of HLH. This is a unique case describing a well-controlled HIV positive patient who developed HLH triggered by reactivation of EBV with diffuse large B cell lymphoma. The patient underwent allogeneic homozygous CCR5-transplant with a possibility of curing his large B cell lymphoma and HIV. He is currently under surveillance for his HIV status and lymphoma.