Human immunodeficiency virus‐associated Hodgkin's disease. Clinicopathologic studies of 24 cases and preponderance of mixed cellularity type characterized by the occurrence of fibrohistiocytoid stromal cells

Abstract

Hodgkin's disease (HD) was diagnosed in 24 patients who were either seropositive for human immunodeficiency virus (HIV) (21) or members of a high-risk group (three), but had not developed acquired immune deficiency syndrome (AIDS). Clinical presentation of the disease was characterized by constitutional symptoms in all, especially fever (23/24) and disseminated disease (22/24) at diagnosis. Mediastinal adenopathy was rare. Bone marrow involvement was particularly frequent (12/24), and a positive bone marrow biopsy preceded lymph node biopsy in 5 of the 12. Histopathologic features of these tumors included an increased number of nonlymphoid stromal cells, i.e., histiocytic and/or fibroblastoid. In some tumors these fibrohistiocytoid stromal cells were arranged in bundles, but distinct nodule with birefringent collagen band formation was not observed. Twenty-two patients were treated, most with combination chemotherapy; one was untreated; one, unknown. Sixteen, including the one untreated, died with disease at 3 to 25 months; one died of an unrelated cause; four were alive at 3 to 24 months; three were lost to follow-up. Frequent bone marrow involvement at presentation suggests the usefulness of the bone marrow biopsy for diagnosis in subjects at risk, especially when they present with spiking fever of unknown origin. Contrary to most previous series, virtually all of our cases were of mixed cellularity type, characterized by increased fibrohistiocytoid stromal cells in place of depleting lymphocytes. The classic nodular sclerosing feature with birefringent collagen band formation was not observed. In conclusion, HIV-associated HD was characterized by advanced stage with fever at presentation, preponderance of mixed cellularity histologic type with increased fibrohistiocytoid stromal cells, and poor outcome. Hodgkin's disease in AIDS patients presents an intriguing biological model to study the role of stromal histiocytes in immunodeficient patients.

Expression profile of MUM1/IRF4, BCL-6, and CD138/syndecan-1 defines novel histogenetic subsets of human immunodeficiency virus–related lymphomas

“…27 The CD30 ϩ , CD45 Ϫ , CD15 ϩ , EMA Ϫ phenotypic profile was required for the diagnosis of classic HL. 22 The Rye modification of the Lukes and Butler [28][29][30] classification was used to classify the histologic subtypes of classic HL.…”

Isolated Bone Marrow Manifestation of HIV-Associated Hodgkin Lymphoma

“…The nodular pattern of involvement in some patients in our series raised differential diagnoses either with reactive polymorphous lymphohistiocytic lesions, a common feature in patients with immune disorders including HIV infection (18), and with other lymphoid neoplasms: the identification of classic Reed-Sternberg cells with the appropriate phenotype appeared critical in reaching a correct diagnosis and in excluding peripheral T-cell lymphomas, T-cell-rich large B-cell lymphomas, and lymphocytic-predominance HL. The lack of immunoreactivity of Reed-Sternberg cells for the immunoglobulin gene transcription regulator molecule Oct2 is similar to that observed in the majority of classical HIV-unrelated HL (10).…”

“…In addition, single cases from small series showing features potentially similar to IBM-HIV-HL as defined in the present study have been reported (17,18), although selection criteria were not clearly specified. All cases hereby reported were diagnosed on the basis of detection of classical ReedSternberg cells with typical immunophenotype in the bone marrow; furthermore, strict selection criteria for isolated bone marrow involvement were adopted, and the single patient (Case 2) who, despite the lack of clinically evident lymphadenopathy, underwent a lymph node biopsy failed to show nodal HL.…”

Surgical Pathology in HIV Infection in the Era of Antiretroviral Therapy

“…However the most frequent subytype in HIV patients comprises the most unfavorable variants such as mixed cellularity and depletion of lymphocytes of the clasical HL(p<0.01), other features published are the abundance of a proliferation of the fibrohistiocyte stroma and a higher perecentage of Reed-Sternberg cells (Ree et al 1991;Bellas et al 1996). Relation between EBV infection and the origin of LH seems to be tighter in HIV infected patients than in the reamainder LH cases (Ree et al 1991). The combined use of in situ hybridation techniques, immunohistochemistry to determine the expression of LMP-1, indicative of latent EBV infection, and other molecular biology techniques have demonstrated that 78 to 100% of HIV+HL cases are associated to the EBV.…”