T-Cell Lymphoma of the Rectum in a Patient with AIDS and Hepatitis C: A Case Report and Discussion

Abstract

Primary T-cell non-Hodgkin's lymphoma (NHL) occurring in the context of acquired immune deficiency syndrome (AIDS) is uncommon.Here, we report and discuss such a case presenting in the rectum, and review relevant literature. Although typical in some respects, the case is, in other ways, somewhat unusual for an AIDS-related NHL (ARL); ARL tends to be B cell and advanced stage and our case was T cell and stage IE. In addition, the patient suffered from concomitant cirrhosis related to hepatitis C. Chemotherapeutic options for ARL were limited early in the AIDS epidemic due to poor tolerability. Although this has largely been mitigated by the advent of highly active antiretroviral therapy, our patient eventually suffered complications of chemotherapy, apparently related more to his liver disease than to either his lymphoma or AIDS, that ultimately brought about his demise. INTRODUCTIONThe gastrointestinal (GI) tract generally is the most common site for extranodal non-Hodgkin's lymphoma (NHL), usually of the B-cell type. These NHLs may be EpsteinBarr virus (EBV) related and have long been known to be associated with immunodeficiency. Various immunodeficient states, including ataxia telangectasia, Wiskott-Aldrich syndrome, and X-linked lymphoproliferative disorder, all exhibit increased incidences of NHL. NHL is 60-100 times more common in HIV-infected patients, and B-cell NHL is an AIDS-defining illness. AIDS-related lymphomas (ARLs) show a high incidence (about 95%) of extranodal involvement, and >50% may be exclusively extranodal.

Prognostic factors in patients with HIV‐associated peripheral T‐cell lymphoma: A multicenter study

“…Recent published data from the International Peripheral T‐cell Lymphoma Project showed that these entities carry a poor prognosis despite modern therapeutic approaches [25]. HIV infection has been associated with an increased risk of developing aggressive subtypes of NHL; however, data on HIV‐associated PTCL are largely limited to case reports [4–13] and small case series [14–17]. Here we present data on 51 patients with HIV‐associated PTCL with a median follow‐up of 59 months, and this is, to the best of our knowledge, the largest study reported to date.…”

“…In this study, individuals infected with HIV had an increased risk of developing primary cutaneous as well as systemic PTCL. However, data on HIV‐associated PTCL are largely limited to case reports [4–13] and small case series [14–17]. Hence, data on clinicopathological characteristics and prognostic factors in HIV‐associated PTCL are lacking.…”