HIV and plasmablastic lymphoma manifesting in sinus, testicles, and bones: A further expansion of the disease spectrum

IntroductionInfectious agents, mainly viruses, are among the few known causes of cancer and contribute to a variety of malignancies worldwide. The agents considered here, termed Epstein-Barr virus (EBV) and Kaposi sarcoma herpesvirus (KSHV-human herpesvirus 8 [HHV8]), are members of the gamma-herpesvirus subfamily. 1 Since its discovery as the first human tumor virus, EBV has been implicated in the development of a wide range of B-cell lymphoproliferative disorders, including Burkitt lymphoma (BL), nasopharyngeal carcinoma, and Hodgkin and non-Hodgkin lymphomas (NHLs). KSHV, one of the most recently discovered human tumor viruses and the cause of Kaposi sarcoma (KS), 2 also plays a role in the pathogenesis of primary effusion lymphoma [PEL], and multicentric Castleman disease [MCD]). [3][4][5][6] Intriguingly, EBV and KSHV have been shown to associate with distinct lymphoproliferative diseases occurring most often in persons with HIV infection/ AIDS 7,8 or in association with other immunodeficiency conditions, such as iatrogenic immunodeficiency following solid organ transplantation. 9,10 HIV-associated lymphoproliferative disorders are a heterogeneous group of diseases that arise in the presence of HIV-associated immunosuppression, a state that permits the unchecked proliferation of EBV-and KSHV-infected lymphocytes. Traditionally, these aggressive disorders mainly include both central nervous system and systemic lymphomas, 11 whereas lymphomas specifically occurring in the setting of HIV infection include PEL and its solid variant, plasmablastic lymphoma (PBL) of the oral cavity type and large B-cell lymphoma arising in KSHV-associated MCD. [12][13][14][15][16][17][18] Thus, HIV-related lymphomas are closely linked to EBV infection of the tumor clone or are associated with KSHV. PEL and its variants often involve EBV in addition to KSHV. 19 We review here the current knowledge on these gammaherpesvirus-associated lymphomas in the setting of HIV infection. The focus will be on pathology, diagnosis and classification, pathogenesis, and treatment of these lymphomas specifically occurring in HIV-induced immunodeficiency. Gamma-herpesvirus-associated lymphomas in the setting of HIV infection EBV-associated lymphomasEBV has been implicated in the development of a wide range of B-cell lymphoproliferative disorders, including BL, classic Hodgkin lymphoma (HL), and lymphomas arising in immunocompromised individuals (posttransplantation and HIV-associated lymphoproliferative disorders; Figure 1). 1,2 It is also associated with B-cell lymphomas in association with congenital immunodeficiencies, such as X-linked lymphoproliferative syndrome (XLP). T-cell lymphoproliferative disorders that have been reported to be EBV associated include a subset of peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphoma, extranodal nasal type natural killer/T-cell lymphoma, and other rare histotypes. 1,2 EBV-associated lymphomas in AIDS include BL, diffuse large B-cell lymphoma (DLBCL) with immunoblastic (IB) morphology, primary...

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“…[153][154][155] Similarly to PEL, the prognosis of PBLs of the oral cavity type remains poor despite the use of HAART and chemotherapy. 156,157 …”

Section: Treatment Of Unusual Entitiesmentioning

confidence: 99%

HIV-associated lymphomas and gamma-herpesviruses

Carbone¹,

Cesarman

Spina

et al. 2009

Blood

313

272

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“…Plasmablastic lymphoma is another unique lymphoma subtype that typically involves the jaw and oral cavity of HIV-infected individuals [93]. More recently, HIV-related plasmablastic lymphoma has been documented in other sites such as the anorectum, nasal and paranasal regions, skin, testes, bones, and lymph nodes [94,95]. The neoplasm is highly associated with EBV infection and is comprised of large plasmablasts, cells that retain the blastoid morphology of immunoblasts but have otherwise acquired immunophenotypic features of plasma cells.…”

Section: Clinical and Epidemiologic Featuresmentioning

confidence: 99%

AIDS-Related Malignancies: Emerging Challenges in the Era of Highly Active Antiretroviral Therapy

2005

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Human immunodeficiency virus (HIV)-infected patients are at increased risk of developing cancer, particularly in the later stages of acquired immune deficiency syndrome (AIDS). LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the pathogenesis and clinical presentation of Kaposi's sarcoma, with a special emphasis on Kaposi's sarcoma herpesvirus/human herpesvirus-8, and outline treatment approaches.2. Discuss the pathogenesis, epidemiology, and treatment of AIDS-related lymphomas.3. Discuss the increasing incidence of non-AIDS-defining malignancies such as Hodgkin's lymphoma and plasma cell disorders in patients with HIV infection.4. Explain how, in the era of highly active antiretroviral therapy, both AIDS-related lymphoma and Hodgkin's lymphoma patients may be treated with therapies previously reserved for their immunocompetent counterparts.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME by guest on May 11, 2018http://theoncologist.alphamedpress.org/ Downloaded fromThis material is protected by U.S.

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“…(4) bölge, omentum, testis, Kİ ve santral sinir sistemi (SSS) tutulumları değişik yayınlarda bildirilmiş-tir. 1,12,[18][19][20][21][22][23][24] HIV ile enfekte hastalarda bildirilen PBL olgularının tutulum yerleri ve İHK göstergeleri Tablo 1'de gösterilmiştir.…”

Section: Discussionunclassified

Oral Plasmablastic Lymphoma in a Case with HIV Infection

Ural¹,

Kaptan²,

Türker³

et al. 2012

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T Plazmablastik lenfoma (PBL) nadir görülen bir malignitedir ve en sık HIV (human immunodeficiency virus) ile enfekte olgularda ve yine sıklıkla oral kavitede saptanmaktadır. İlk kez 1997 yılında tanımlanmıştır. Diffüz büyük B-hücreli lenfomanın farklı bir alttipi olarak tarif edilmiştir. Son yıllarda sıklıkla oral kavite dışında da rapor edilmiştir. Gastrointestinal sistem ve deri, oral kavite dışında en sık tutulan organlardır. Plazmablastik lenfoma genellikle tipik B-hücre göstergelerinde (örnek olarak CD20) negatiflik, CD38, CD138 ve VS38c gibi plazma hücre göstergelerinde pozitiflik içeren karekteristik bir immunofenotip gösterir. Biz, bu makalede 44 yaşında, oral kavitede 30x30 mm boyutlarında kitle, akciğer tüberkülozu ve beyinde sol talamik bölgede 18x30 mm boyutlarında kitle lezyonu saptanan HIV ile enfekte bir erkek olgu sunduk. Oral kavitedeki lezyonun histopatolojik incelemesi PBL ile uyumlu idi. Neoplastik hücreler CD20 negatif bulundu. Hematoksilen eozin boyasında çok katlı yassı epitel altında plazmasitoid özellikte, iri eozinofilik nükleuslu, bazıları nükleolus içeren mitoz aktif neoplastik lenfoid infiltrasyon izlendi. Kemik iliği biyopsisinde non-Hodgkin lenfoma (NHL) tutulumu tespit edildi. Olguya HIV enfeksiyonu açısından HAART (Highly active antiretroviral therapy) tedavisi olarak stavudin + lamivudin + lopinavir/ritonavir; akciğer tüberkülozu tedavisi için dörtlü anti-tüberküloz tedavi olarak izoniazid + etambutol + rifampisin/streptomisin + morfoziamid; PBL için kemoterapi olarak siklofosfamid + doksorubisin + onkovin + prednizon (CHOP) ve radyoterapi verildi. Tedaviye rağmen olgu 7,5 ay izlendikten sonra kaybedildi. Erken tanı ve uygun tedavi olguların yaşam sürelerini uzatabileceği için HIV enfekte olguların nadir görülen maligniteler açısından taranmasına dikkati çekmek amacıyla ve ülkemizdeki ilk olgu olması nedeniyle bu olgu bildirilmiştir.A An na ah ht ta ar r K Ke el li im me el le er r: : HIV enfeksiyonları; lenfoma, Aids ile ilişkili; lenfoma, büyük B-hücreli, yaygın A AB BS ST TR RA AC CT T Plasmablastic lymphoma (PBL) is a rarely seen malignant lesion and it is most commonly detected in HIV (Human-immunodeficiency virus)-infected subjects predominantly in the oral cavity. It was first described in 1997. It has been recognized as a distinct entity, as a subtype of diffuse large B-cell lymphoma. Recently, PBL presentation has been reported frequently outside the oral cavity. Gastrointestinal tract and skin were the most commonly involved extra-oral organ systems. Plasmablastic lymphoma usually displays a characteristic immunophenotype that includes negativity for typical B-cell markers (eg, CD20), and positivity for plasma cell markers such as CD38, CD138 and VS38c. In this report, we described a case of PBL in a 44-year-old HIV infected male patient who presented with an expanding 30x30 mm oral lesion, pulmonary tuberculosis and an 18x30 mm cerebral left thalamic lesion. Histopathological evaluation of the lesion in oral cavity was consistent with PBL. The neoplastic c...

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HIV and plasmablastic lymphoma manifesting in sinus, testicles, and bones: A further expansion of the disease spectrum

Cited by 58 publications

References 31 publications

HIV-associated lymphomas and gamma-herpesviruses

HIV-associated lymphomas and gamma-herpesviruses

AIDS-Related Malignancies: Emerging Challenges in the Era of Highly Active Antiretroviral Therapy

Oral Plasmablastic Lymphoma in a Case with HIV Infection

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