Malignant Gastrointestinal Lymphomas in Patients with AIDS

Abstract

HIV-associated malignant lymphomas are a common complication in late HIV infection, and there is a high percentage of gastrointestinal tract involvement. Non-Hodgkin’s lymphoma was found in 108 of 2,750 HIV-positive patients (3.9%) in our institution, whereas gastrointestinal manifestation was diagnosed in 48 of 108 patients (44.4%). 44 of these cases were found during endoscopy of the upper and lower gastrointestinal tract (or by laparotomy or laparoscopy in 4 cases). Endoscopy is a reliable procedure for the diagnosis of lymphoma. Unusual manifestations such as oral, esophageal or perianal lesions and multifocal disease were common findings. Life-threatening complications such as gastrointestinal bleeding, perforation, and obstruction occurred in 37.5%. High-grade B-cell lymphomas were found in all cases including mainly lymphoblastic, immunoblastic, centroblastic and Burkitt subtypes. 52% of the patients had disseminated lymphoma with Ann Arbor stage III or IV. Standard chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisone was started in 25 patients and resulted in a mean survival time of 4.8 months. The prognosis of AIDS patients presenting with malignant gastrointestinal lymphoma depends mainly on the presence or absence of previous AIDS-defining diseases, not CD4 cells, lymphoma-associ-ated gastrointestinal complications or the histopathologic lymphoma type at the time of diagnosis.

Clinical, endoscopic and prognostic aspects of primary gastric non-hodgkin's lymphoma associated with acquired immunodeficiency syndrome

“…In this population, the GIT sites most frequently involved are the stomach (24% of cases), the small bowel (10% of cases), and the colon and rectum (7% of cases) [2,5,6]. The frequency distribution of GIT involvement by NHL in immunocompetent patients is similar, even more frequent in the stomach (50% to 80% of cases) and rarely affecting the small intestine, colon and perianal region [2,5,14]. In our study, among the 243 HIV-positive patients evaluated by UDE, six (2.5%) had primary gastric NHL.…”

“…Gastrointestinal tract (GIT) involvement by NHL is frequent in HIV-positive individuals, occurring in 15% to 75% of all cases [1,2,[9][10][11][12][13]. In this population, the GIT sites most frequently involved are the stomach (24% of cases), the small bowel (10% of cases), and the colon and rectum (7% of cases) [2,5,6].…”

“…Gastrointestinal tract (GIT) involvement by NHL is frequent in HIV-positive individuals, occurring in 15% to 75% of all cases [1,2,[9][10][11][12][13]. In this population, the GIT sites most frequently involved are the stomach (24% of cases), the small bowel (10% of cases), and the colon and rectum (7% of cases) [2,5,6]. The frequency distribution of GIT involvement by NHL in immunocompetent patients is similar, even more frequent in the stomach (50% to 80% of cases) and rarely affecting the small intestine, colon and perianal region [2,5,14].…”

“…The immunosuppression triggered by acquired immunodeficiency syndrome (AIDS) predisposes to a series of opportunistic infections and neoplasias, such as Kaposi's sarcoma and non-Hodgkin's lymphoma (NHL) [1,2]. Individuals infected with human immunodeficiency virus (HIV) are at high risk to develop NHL; i.e., they are about 50 times more likely to develop NHL than the HIV-negative population [3,4].…”

“…NHL is a common complication in the late phase of HIV infection, with a high frequency of involvement of the gastrointestinal tract (GIT) [2,5]. The occurrence of primary GIT NHL has been associated with reduced survival of HIVinfected patients [3,6].…”