Plasmablastic Lymphoma in a Previously Undiagnosed Aids Patient: A Case Report

Abstract

Background Plasmablastic lymphoma (PBL) is an unusual non-Hodgkin lymphoma (NHL) most commonly found in the head and neck region. The majority of cases are seen in adult HIV-positive patients, although PBL has been reported in HIV-negative patients. The diagnosis of PBL serves as an AIDS-defining illness. Methods We report a case of PBL localized to the oral cavity in a previously undiagnosed AIDS patient. The lesion manifested as solitary, ulcerated, and markedly tender. PBL was confirmed by immunohistochemical profile and subsequent tests confirmed AIDS diagnosis. The patient was prescribed highly active antiretroviral therapy (HAART) and concomitant local low dose radiation therapy prior to initiation of chemotherapy. Results Complete local clinical response was observed after 4 weeks of treatment with HAART and radiation therapy. The response sustained in this patient in the subsequent 11 months following diagnosis. Conclusions The diagnosis of PBL has a unique immunophenotypic profile and should raise suspicion for AIDS in these patients. HAART added to treatment has shown improved survival.

http://www.omicsonline.org/open-access/doc-i-just-cant-swallow-pills-hiv-infected-patients-and-pill-phagophobia-2155-6113.1000348.php?aid=32174

“…It is important to maintain a broad differential diagnosis for oral lesions, which may include: lymphoma (non-Hodgkin plasmablastic lymphoma), squamous cell carcinoma, melanoma, hemangioma, bacillary angiomatosis (bartonella henselae), pyogenic granuloma [12,13]. This has been demonstrated through the current case with the initial nondiagnostic pathology.…”

Non-Hodgkin’s Plasmablastic Lymphoma as Initial Presentation of Human Immunodeficiency Virus

“… 4 PBL is classified as a subtype of DLBCL frequently occurring in AIDS patients presenting as oral lymphomas, although PBL is now being increasingly reported in extra-oral sites. 2 , 4 EBV is the common factor in several proliferative B-cell lymphomas and has been strongly associated with AIDS-related PBL. 4 PBL’s immunohistochemistry notably displays plasma cell differentiation with a negative CD20 marker.…”

“… 1 Despite the efficacy of antiretroviral therapy in improving survival in AIDS patients, opportunistic infections and AIDS-associated malignancies remain the major cause of mortality. 2 Natural progression of PBL involves an oral, rapidly growing mass to extra-oral dissemination leading to death in 6 months. 2 , 3 The true prevalence of oromucosal PBL likely is unknown due to missed diagnoses; however, some studies report a 1.66% prevalence in immunocompetent patients and 7.3% in patients with HIV-positive status.…”

“… 2 Natural progression of PBL involves an oral, rapidly growing mass to extra-oral dissemination leading to death in 6 months. 2 , 3 The true prevalence of oromucosal PBL likely is unknown due to missed diagnoses; however, some studies report a 1.66% prevalence in immunocompetent patients and 7.3% in patients with HIV-positive status. The median age at presentation is 38 years, with a male predominance of 7:1, and the median CD4+ count was 178 cells/mm.…”

Oral plasmablastic lymphoma in a HIV‐positive woman: Literature review and case report

“…Thus, it is important to build a panel containing redundant markers. 30 Pan B-cell markers including CD20 and PAX-5 are frequently negative and are useful to exclude other tumours. As noted in previous reviews, 3,6,18,40,41 the cases of oral PBL revised showed minimal or no expression of common antigen leucocytes (LCA), and B-cell antigens (CD20 and CD79a).…”