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Ramyasri M, Singh V, Mohan Rangan N, Roy ID, Tomar K, Desai AP, Yadav R, Krishnan M. Oral Plasmablastic Lymphoma: A Rare Manifestation of HIV-Related Neoplasm-A Brief Clinical Study. J Craniofac Surg 2024; 35:e321-e325. [PMID: 38363301 DOI: 10.1097/scs.0000000000010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024] Open
Abstract
Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency virus-positive patients. Though the oral cavity is a common site for PBL, this condition is not commonly reported in the literature as an oral manifestation. Most oral PBLs presented as an asymptomatic swelling, frequently associated with ulcerations and bleeding. No standard treatment is yet advocated for oral PBL. Five-year survival rate was recorded not more than 33.5%. This presentation emphasizes on oral manifestation of plasmablastic lymphoma (PBL) as a rare entity, which was provisionally diagnosed for carcinoma (CA) oral cavity. A simple presentation of ulcerated growth in the upper jaw was excised for histopathologic evaluation. Subsequently, it turned out to be a rare oral manifestation of HIV-related lymphoma. It is imperative to understand simple oral presentation as a manifestation of an underlying systemic condition. With this interest, this case presentation is published with a literature review.
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Affiliation(s)
| | - Vikram Singh
- Department of Pathology, AFMC, Pune, Maharashtra, India
| | | | | | - Kapil Tomar
- Department of Dental Surgery and Oral Health Sciences, AFMC
| | - Ajay P Desai
- Department of Dental Surgery and Oral Health Sciences, AFMC
| | - Rekha Yadav
- Department of Dental Surgery and Oral Health Sciences, AFMC
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Alvarez E, Gunther M, Hernández P, Misad C, Fernandez MÁ, Donoso-Hofer F. Revisión sistemática del linfoma plasmablástico intraoral en paciente con virus de la inmunodeficiencia humana. A propósito de un caso. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.maxilo.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cajozzo M, Palumbo VD, Buscemi S, Damiano G, Florena AM, Cabibi D, Raffaele F, Anzalone AA, Fatica F, Cocchiara G, Dioguardi S, Bruno A, Caronia FP, Lo Monte AI. Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report. J Med Case Rep 2017; 11:75. [PMID: 28320457 PMCID: PMC5360031 DOI: 10.1186/s13256-016-1183-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/20/2016] [Indexed: 12/03/2022] Open
Abstract
Background Plasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects. Case presentation We describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allowed diagnosis of plasmoblastic lymphoma and establishment of an immediate chemotherapeutic regimen, with rapid remission of compression symptoms. Conclusions Plasmoblastic lymphoma is a very uncommon, difficult to diagnose, and aggressive disease. The presented case represents the first rare mediastinal plasmoblastic lymphoma in a human immunodeficiency virus-/human herpesvirus-8-negative patient. Pathologists should be aware that this tumor does appear in sites other than the oral cavity. Fine-needle aspiration biopsy is a low-cost, repeatable, easy-to-perform technique, with a high diagnostic accuracy and with very low complication and mortality rates. Fine-needle aspiration biopsy could represent the right alternative to surgery in those patients affected by plasmoblastic lymphoma, being rapid and minimally invasive. It allowed establishment of prompt medical treatment with subsequent considerable reduction of the neoplastic tissue and resolution of the mediastinal syndrome.
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Affiliation(s)
- Massimo Cajozzo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Vincenzo Davide Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy. .,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Damiano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Ada Maria Florena
- Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Daniela Cabibi
- Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Raffaele
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Antonino Alessio Anzalone
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Federica Fatica
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Gerlando Cocchiara
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Salvatore Dioguardi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Antonio Bruno
- Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
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Koizumi Y, Uehira T, Ota Y, Ogawa Y, Yajima K, Tanuma J, Yotsumoto M, Hagiwara S, Ikegaya S, Watanabe D, Minamiguchi H, Hodohara K, Murotani K, Mikamo H, Wada H, Ajisawa A, Shirasaka T, Nagai H, Kodama Y, Hishima T, Mochizuki M, Katano H, Okada S. Clinical and pathological aspects of human immunodeficiency virus-associated plasmablastic lymphoma: analysis of 24 cases. Int J Hematol 2016; 104:669-681. [PMID: 27604616 DOI: 10.1007/s12185-016-2082-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare AIDS-related malignancy with a poor prognosis. Little is known about this entity, and no standard treatment regimen has been defined. To establish an adequate treatment strategy, we investigated 24 cases of PBL arising in human immunodeficiency virus-positive individuals. Most of the patients were in the AIDS stage, with a median CD4 count of 67.5/µL. Lymph nodes (58 %), gastrointestinal tract (42 %), bone marrow (39 %), oral cavity (38 %), and CNS (18 %) were the most commonly involved sites. Histology findings for the following were positive at varying rates, as follows: CD10 (56 %); CD30 (39 %); CD38 (87 %); MUM-1 (91 %); CD138 (79 %); EBER (91 %); and LMP-1 (18 %). There was a marked increase in patients in 2011-12, and the cases found in that period appeared to be more aggressive, showing a higher rate of advanced-stage PBL. Fourteen cases were treated with CHOP, while the others were treated with more intensive regimens, including bortezomib and hematopoietic stem cell transplantation. The overall median survival time was 15 months. A CD4 count of >100/µL at diagnosis and attaining complete remission in the first-line chemotherapy were associated with better outcomes (P = 0.027 and 0.0016, respectively). Host immune status and chemosensitivity are associated with improved prognosis in PBL.
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Affiliation(s)
- Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan. .,Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
| | - Tomoko Uehira
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Yasunori Ota
- Department of Pathology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ogawa
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Keishiro Yajima
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Mihoko Yotsumoto
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shotaro Hagiwara
- Department of Hematology, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Satoshi Ikegaya
- Department of Hematology and Oncology, University of Fukui Hospital, Fukui, Fukui, Japan
| | - Dai Watanabe
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Hitoshi Minamiguchi
- Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiko Hodohara
- Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Hideho Wada
- Department of Hematology, Kawasaki Medical School, Kawasaki, Okayama, Japan
| | - Atsushi Ajisawa
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takuma Shirasaka
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Hirokazu Nagai
- Department of Hematology, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Yoshinori Kodama
- Department of Pathology, Osaka National Hospital, Osaka, Osaka, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Makoto Mochizuki
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Seiji Okada
- Center for AIDS Research, Kumamoto University, Kumamoto, Kumamoto, Japan
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Plasmablastic Lymphoma: A Review of Current Knowledge and Future Directions. Adv Hematol 2015; 2015:315289. [PMID: 26357515 PMCID: PMC4555447 DOI: 10.1155/2015/315289] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive subtype of non-Hodgkin's lymphoma (NHL), which frequently arises in the oral cavity of human immunodeficiency virus (HIV) infected patients. PBL shows diffuse proliferation of large neoplastic cells resembling B-immunoblasts/plasmablasts, or with plasmacytic features and an immunophenotype of plasma cells. PBL remains a diagnostic challenge due to its peculiar morphology and an immunohistochemical profile similar to plasma cell myeloma (PCM). PBL is also a therapeutic challenge with a clinical course characterized by a high rate of relapse and death. There is no standard chemotherapy protocol for treatment of PBL. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens have been the backbone while more intensive regimens such as cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, high-dose cytarabine (CODOX-M/IVAC), or dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) are possible options. Recently, a few studies have reported the potential value of the proteasome inhibitor bortezomib and thalidomide in PBL patients. The introduction of genes encoding artificial receptors called chimeric antigen receptors (CARs) and CAR-modified T cells targeted to the B cell-specific CD19 antigen have demonstrated promising results in multiple early clinical trials. The aim of this paper is to review the recent advances in epidemiology; pathophysiology; clinical, pathologic, and molecular characteristics; therapy; and outcome in patients with PBL.
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Clinicopathologic features of plasmablastic lymphoma: Single-center series of 8 cases from Saudi Arabia. Diagn Pathol 2015; 10:78. [PMID: 26108914 PMCID: PMC4479229 DOI: 10.1186/s13000-015-0315-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a rare subtype of non-Hodgkin's lymphoma. Characterized by its aggressive nature and plasmacytic differentiation, PBL remains a therapeutic and diagnostic challenge; it generally has a poor prognosis with very few long-term survivors and most patients dying within 2 years from initial presentation. PBL has been reported in several other countries; however, there have been no reported cases from Saudi Arabia. Here, we report 8 cases of PBL depicting the clinical presentation, immunocompetency, immunphenotypic characterization, diagnostic challenges and treatment outcome. METHODS The medical records were reviewed for clinical presentation, staging, laboratory data, radiological studies, treatments, and outcomes. A broad immunohistochemical panel consisting of CD45, CD3, CD20, CD79a, Pax5, CD38, CD138, MUM1, EMA, Kappa, Lambda, CD 56, CD30, Bcl-2, Bcl-6, Alk-1, Ki-67, EBV-LMP-1, and HHV8 was performed. RESULTS The tumors predominantly exhibited immunoblastic/plasmablastic or plasmacytic morphologic features and had a plasma cell-like immunophenotype. All cases were immunoreactive for CD38, CD138 and MUM1 confirming plasma cell differentiation of the tumor cells. CD20 was negative for all cases; whereas CD79a and Pax5 were weakly positive in 2cases. All 8 cases were EBV-LMP-1/EBER-1 negative, and 1 case was HHV8 positive. Similar to previously published studies, PBL in Saudi Arabia is characterized by male predominance (6/8), median age 51.5 years (mean age 46 years), associated with early dissemination, poor response to therapy, and limited survival (average survival time, 6.4 months, median overall survival 5.5 months). However, it does have some unique features. It occurs more commonly in immunocompetent persons (6/8, 75%), is not associated with EBV infection (0/8), and nodal involvement (either primary or secondary) is common among patients (6/8). In addition, extra-oral sites are more common than oral/nasal cavities (7/8) and the c-myc gene is not common (1/8, 12.5%). CONCLUSION It appears that PBL is heterogeneous in terms of clinical presentation and morphology. PBL is a therapeutic challenge with a clinical course that is characterized by its high rate of relapse and death. To date, treatment responses are usually partial and temporary. Therapies that are more intensive than CHOP do not seem to prolong survival. Further research is needed to understand the biology and molecular pathogenesis of PBL in order to improve therapies. VIRTUAL SLIDES The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1465801416161912.
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Vaubell JI, Sing Y, Ramburan A, Sewram V, Thejpal R, Rapiti N, Ramdial PK. Pediatric plasmablastic lymphoma: a clinicopathologic study. Int J Surg Pathol 2014; 22:607-16. [PMID: 24771257 DOI: 10.1177/1066896914531815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Plasmablastic lymphoma (PBL) is reported rarely in children. To date, 10 cases are documented in the English-language literature. This study, based on 13 biopsies from 11 HIV-positive children (9 males, 2 females), documents the clinicopathologic features of PBL. The CD4 count ranged from 9 to 800 cells/mm(3). All biopsies demonstrated exclusive plasmablastic morphology; CD20 immunonegativity; and VS38c, EMA, CD31, MUM-1, CD45, and CD79a immunopositivity. B-cell monoclonality was confirmed in all biopsies. Of 3 biopsies subjected to FISH investigation, 2 had a t(8,14) translocation. Nine patients with follow-up details were treated exclusively with HAART (highly active antiretroviral therapy) or with combinations of HAART, chemotherapy, and radiotherapy. Seven patients died. PBL histomorphology, disease stage, and treatment modalities employed were not predictive of outcome. The survival of 2 stage 4 patients for 3 and 8 years each, managed on HAART, chemotherapy, and radiotherapy, however, may justify a role for combined therapeutic modalities for PBL.
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Affiliation(s)
- Jalaludin I Vaubell
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Yetish Sing
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Amsha Ramburan
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Vikash Sewram
- Oncology Research Unit, Medical Research Council, Durban, South Africa
| | - Rajendra Thejpal
- Department of Paediatrics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Nadine Rapiti
- Department of Haematology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Pratistadevi K Ramdial
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
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Sharma A, Tilak TVSVGK, Lodha R, Sharma MC, Dabkara D. Long-term survivor of human immunodeficiency virus-associated plasmablastic lymphoma. Indian J Med Paediatr Oncol 2013; 34:96-8. [PMID: 24049295 PMCID: PMC3764752 DOI: 10.4103/0971-5851.116187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Plasmablastic lymphoma (PL) is a type of non-Hodgkin's lymphoma (NHL) having a strong association with immunosuppression, especially, human immunodeficiency virus (HIV) infection. It generally has a poor prognosis with most patients dying within 2 years from initial presentation, and long-term survivors are very few. We report the case of a 10-years-old child, presenting in 2003 with swelling on the right side of the face and fever of 2 months. Evaluation revealed a mass in the right palatal and upper alveolar region with extensive spread and bone destruction, regional adenopathy, mass lesion in the liver and hepatosplenomegaly without bone marrow involvement. Histopathology was suggestive of the PL and patient tested positive for HIV. He was started on high grade NHL chemotherapy protocol along with highly-active anti-retroviral therapy HAART. He responded well and is in complete remission since 8 years of completion of treatment and is on HAART.
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Affiliation(s)
- Atul Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
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Response of Human Immunodeficiency Virus–Associated Oral Plasmablastic Lymphoma to Highly Active Antiretroviral Therapy Without Chemotherapy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e31821618a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Corti M, Villafañe MF, Bistmans A, Campitelli A, Narbaitz M, Baré P. Oral cavity and extra-oral plasmablastic lymphomas in AIDS patients: report of five cases and review of the literature. Int J STD AIDS 2011; 22:759-63. [DOI: 10.1258/ijsa.2011.011235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Plasmablastic lymphoma (PBL) is a distinct disease entity of the diffuse large B-cell lymphoma, which often occurs in HIV-positive patients. The immunophenotype of this lymphoid neoplasm is characterized by the presence of plasma cell-associated markers VS38c and CD138 antigens and the absence of B-cell markers such as CD20 and CD45. The most frequent site of involvement is the oral cavity and the jaw, while several reports describe the development of PBL in extra-oral sites including the lymph nodes, the anal canal, the soft tissue, the skin and the gastrointestinal tract as less frequent. Epstein−Barr virus is often associated with PBL pathogenesis and the neoplastic cells contain this virus genome. Here we review the epidemiological, clinical, immunological, histopathological and virological characteristics and their prognosis and outcome in a series of five patients with diagnoses of HIV/AIDS and PBL.
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Affiliation(s)
| | | | | | - A Campitelli
- Histopathological Laboratory Infectious Diseases FJ Muñiz Hospital
| | - M Narbaitz
- Histopathological Laboratory National Academy of Medicine
| | - P Baré
- Virology Laboratory, National Academy of Medicine, Buenos Aires, Argentina
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Makis W, Ciarallo A, Lisbona R. Plasmablastic lymphoma of the oral cavity in an HIV-positive patient: staging with 18F-FDG PET/CT. Acta Radiol 2011; 52:970-2. [PMID: 21911839 DOI: 10.1258/ar.2011.110123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Plasmablastic lymphoma of the oral cavity is a very rare and only recently recognized entity that has been identified almost exclusively in HIV-infected individuals. It has a predilection for the oral cavity, often exhibits very aggressive behavior and has a poor prognosis. The use of 18F-FDG PET/CT in the evaluation of HIV-associated lymphomas is a recent development, and its use in the staging of plasmablastic lymphoma of the oral cavity has not been previously reported. This rare report highlights the usefulness of 18F-FDG PET/CT in the staging of plasmablastic lymphoma of the oral cavity.
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Affiliation(s)
- William Makis
- Department of Nuclear Medicine, Brandon Regional Health Centre, Brandon, MB
| | - Anthony Ciarallo
- Department of Nuclear Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Lisbona
- Department of Nuclear Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Chapman-Fredricks J, Montague N, Akunyili I, Ikpatt O. Extraoral plasmablastic lymphoma with intravascular component and MYC translocation. Ann Diagn Pathol 2011; 16:48-53. [PMID: 21239197 DOI: 10.1016/j.anndiagpath.2010.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/09/2010] [Indexed: 12/14/2022]
Abstract
Plasmablastic lymphoma (PBL) is an uncommon, clinically aggressive, Epstein-Barr virus-driven B-cell lymphoma that was initially described in tumors of relatively young human immunodeficiency virus-positive men. Subsequent to initial reports, the clinical and pathological spectrum of this disease has been expanded such that, now, PBL is recognized to be a heterogeneous disease entity. Plasmablastic lymphoma has been seen in clinical settings outside those initially reported and has been shown to demonstrate a variety of morphologic patterns. We describe a case of extraoral PBL in an human immunodeficiency virus-infected patient with a computed tomography-identified heterogeneously enhancing mass in the stomach. Histologically, a prominent intravascular component was identified. Fluorescent in situ hybridization analysis for MYC/IGH (immunoglobulin heavy chain) rearrangement t(8;14) identified fusion signals, confirming the presence of MYC rearrangement. The presence of a prominent intravascular in our case is unique. To our knowledge, these findings have not been observed in the previous reports of PBL. The observation of this vascular component supports the heterogeneity of PBL and may be an indicator of tumor aggressiveness. We were able to demonstrate the MYC/IGH rearrangement in our case of PBL. The interplay between Epstein-Barr virus and this MYC rearrangement may be similar to what is observed in Burkitt lymphoma, another clinically aggressive non-Hodgkin lymphoma.
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Hansra D, Montague N, Stefanovic A, Akunyili I, Harzand A, Natkunam Y, de la Ossa M, Byrne GE, Lossos IS. Oral and extraoral plasmablastic lymphoma: similarities and differences in clinicopathologic characteristics. Am J Clin Pathol 2010; 134:710-9. [PMID: 20959653 DOI: 10.1309/ajcpjh6keusecqlu] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Plasmablastic lymphoma (PBL), initially characterized as an aggressive lymphoma arising in the jaw and oral mucosa in HIV-infected patients, was recently reported to occur with extraoral manifestations, heterogeneous histologic findings, and variable association with immunodeficiency states. We reviewed clinical, morphologic, and immunophenotypic features of 13 cases of PBL to determine whether these different subtypes represent distinct morphologic and clinical entities. Two distinct subtypes of PBL were identified and classified as oral and extraoral PBL. The oral PBLs were strongly associated with HIV infection and commonly demonstrated plasmablastic morphologic features without plasmacytic differentiation. Extraoral PBLs tended to occur in patients with underlying non-HIV-related immunosuppression and universally demonstrated plasmacytic differentiation. The patients with oral PBL demonstrated better overall survival compared with patients with extraoral PBL (P = .02). Our findings suggest that PBL with oral and extraoral manifestation represent 2 distinct clinicopathologic entities.
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Lipstein M, O'Connor O, Montanari F, Paoluzzi L, Bongero D, Bhagat G. Bortezomib-Induced Tumor Lysis Syndrome in a Patient With HIV-Negative Plasmablastic Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2010; 10:E43-6. [DOI: 10.3816/clml.2010.n.074] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 11/20/2022]
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Spina M, Gloghini A, Tirelli U, Carbone A. Therapeutic options for HIV-associated lymphomas. Expert Opin Pharmacother 2010; 11:2471-81. [DOI: 10.1517/14656566.2010.502528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Castillo JJ, Winer ES, Stachurski D, Perez K, Jabbour M, Milani C, Colvin G, Butera JN. Prognostic factors in chemotherapy-treated patients with HIV-associated Plasmablastic lymphoma. Oncologist 2010; 15:293-9. [PMID: 20167839 DOI: 10.1634/theoncologist.2009-0304] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a variant of diffuse large B-cell lymphoma commonly seen in the oral cavity of HIV-infected individuals. PBL has a poor prognosis, but prognostic factors in patients who have received chemotherapy have not been adequately evaluated. METHODS An extensive literature search rendered 248 cases of PBL, from which 157 were HIV(+). Seventy cases with HIV-associated PBL that received chemotherapy were identified. Whenever possible, authors of the original reports were contacted to complete clinicopathological data. Univariate analyses were performed calculating Kaplan-Meier estimates and compared using the log-rank test. RESULTS The mean age was 39 years, with a male predominance. The mean CD4(+) count was 165 cells/mm(3). Advanced clinical stage was seen in 51% and extraoral involvement was seen in 43% of the cases. The expression levels of CD20 and Epstein-Barr virus-encoded RNA were 13% and 86%, respectively. The overall survival duration was 14 months. In a univariate analysis, early clinical stage and a complete response to chemotherapy were associated with longer survival. There was no apparent difference in survival with regimens more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). CONCLUSIONS Patients with HIV-associated PBL have a poor prognosis. Prognosis is strongly associated with achieving a complete clinical response to CHOP or CHOP-like chemotherapy. The role of more intensive regimens is currently unclear. Further research is needed to improve responses using novel therapeutic agents and strategies.
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Affiliation(s)
- Jorge J Castillo
- 164 Summit Avenue, Fain Building, Providence, Rhode Island 02906, USA.
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17
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Francischini E, Martins FM, Braz-Silva PH, Magalhães MHCG, Ortega KL. HIV-associated oral plasmablastic lymphoma and role of adherence to highly active antiretroviral therapy. Int J STD AIDS 2010; 21:68-70. [DOI: 10.1258/ijsa.2008.008476] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Plasmablastic lymphoma (PBL) is an HIV-associated non-Hodgkin's lymphoma that primarily affects the oral cavity. We describe the case of an HIV patient with a lesion in the maxilla that lasted four months. He was diagnosed with PBL and received highly active antiretroviral therapy as well as chemotherapy and local radiotherapy. The lesion regressed after the third cycle of chemotherapy. The patient interrupted antiretroviral treatment and the lesion recurred. The immune reconstitution secondary to the use of antiretroviral therapy seems to participate in the regression of PBL and maintains the remission of the tumour, but it might not be enough to prevent the development of PBL.
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Affiliation(s)
- E Francischini
- Department of Oral Pathology, Special Care Dentistry Center, University of São Paulo, São Paulo, Brazil
| | - F M Martins
- Department of Oral Pathology, Special Care Dentistry Center, University of São Paulo, São Paulo, Brazil
| | - P H Braz-Silva
- Department of Oral Pathology, Special Care Dentistry Center, University of São Paulo, São Paulo, Brazil
| | - M H C G Magalhães
- Department of Oral Pathology, Special Care Dentistry Center, University of São Paulo, São Paulo, Brazil
| | - K L Ortega
- Department of Oral Pathology, Special Care Dentistry Center, University of São Paulo, São Paulo, Brazil
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18
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Abstract
Plasmablastic lymphoma (PBL) has been recently characterised as an aggressive subtype of non-Hodgkin's lymphoma, most frequently arising in the oral cavity of HIV-infected patients. To date, approximately 60 cases fulfilling the clinico-pathological characteristics of PBL have been reported. PBLs are composed of large cells with eccentrically located nuclei and deeply basophilic cytoplasm with a paranuclear hof. The tumour cells are invariably immunoreactive for the plasma cell marker CD138, and show monoclonal rearrangement of the immunoglobulin heavy chain gene (IgH) and/or clonal restriction of the Ig light chain (IgL) gene expression in most of the cases. Similar to other types of AIDS-related lymphomas, there is evidence that Epstein-Barr virus and Kaposi-sarcoma associated Human Herpes Virus 8 may play a relevant role in the pathogenesis of PBL. PBL patients have been treated heterogeneously, with a combination of chemotherapy, radiotherapy and/or surgery, and their prognosis is usually poor, with a death rate of approximately 60% at 1 year.
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Affiliation(s)
- P Rafaniello Raviele
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Milan, Italy
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19
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Castillo J, Pantanowitz L, Dezube BJ. HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases. Am J Hematol 2008; 83:804-9. [PMID: 18756521 DOI: 10.1002/ajh.21250] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Plasmablastic lymphoma (PBL) is a distinct subtype of non-Hodgkin B-cell lymphoma, originally described with a strong predilection to the oral cavity of human immunodeficiency virus (HIV)-infected individuals. Data regarding patient age and gender, HIV status, initiation of and response to highly active antiretroviral therapy (HAART), tumor extent, pathology, treatment, and outcome were extracted from 112 cases of PBL identified in the literature. The median age at presentation was 38 years with a male predominance of 7:1, and the median CD4+ count was 178 cells/mm(3). PBL presented on average 5 years after diagnosis of HIV. Common primary sites of presentation included the oral cavity, gastrointestinal tract, and lymph nodes. Most cases presented with either stage I or stage IV disease. There was a variable expression of B-cell markers in tumor cells, but plasma cell markers were expressed in all cases. EBV was detected in 74%. Chemotherapy was used to treat 55% patients and was combined with radiotherapy in 21% cases. Complete response was obtained in 66% of treated cases; the majority of these responses were seen after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). The refractory/relapsed disease rate was 54%. Death occurred in 53% of patients, with a median overall survival of 15 months. Sex, CD4+ count, viral load, clinical stage, EBV status, primary site of involvement, and use of CHOP failed to show an association with survival. PBL is an aggressive B-cell lymphoma that presents in both oral and extra-oral sites of chronically HIV-infected immunosuppressed young men.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active/methods
- CD4 Lymphocyte Count
- Combined Modality Therapy/statistics & numerical data
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma, AIDS-Related/epidemiology
- Lymphoma, AIDS-Related/mortality
- Lymphoma, AIDS-Related/therapy
- Lymphoma, Large-Cell, Immunoblastic/complications
- Lymphoma, Large-Cell, Immunoblastic/epidemiology
- Lymphoma, Large-Cell, Immunoblastic/mortality
- Lymphoma, Large-Cell, Immunoblastic/therapy
- Prednisone/therapeutic use
- Survival Analysis
- Vincristine/therapeutic use
- Viral Load
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Affiliation(s)
- Jorge Castillo
- Division of Hematology/Oncology, The Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island 02906, USA.
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Plasmablastic lymphoma: CNS involvement, coexistence of other malignancies, possible viral etiology, and dismal outcome. Ann Hematol 2008; 88:351-8. [DOI: 10.1007/s00277-008-0601-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 08/21/2008] [Indexed: 11/27/2022]
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21
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Riedel DJ, Gonzalez-Cuyar LF, Zhao XF, Redfield RR, Gilliam BL. Plasmablastic lymphoma of the oral cavity: a rapidly progressive lymphoma associated with HIV infection. THE LANCET. INFECTIOUS DISEASES 2008; 8:261-7. [PMID: 18353267 DOI: 10.1016/s1473-3099(08)70067-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Plasmablastic lymphoma of the oral cavity is a form of non-Hodgkin lymphoma (NHL) and was first described in 1997. We describe a case of plasmablastic lymphoma in an HIV-infected patient who presented with an expanding oral lesion and symptoms of a toothache. We review all cases of plasmablastic lymphoma that have been reported in the literature. Plasmablastic lymphoma is strongly associated with immunodeficiency, and most particularly, with HIV infection. The pathophysiological origin of plasmablastic lymphoma has not been fully characterised, but the presence of Epstein-Barr virus (EBV) has often been documented in biopsy specimens, supporting a role for EBV in the pathogenesis of this lymphoma. The differential diagnosis for an expanding oral lesion includes both infectious and malignant processes. Biopsy is essential for making a correct and prompt diagnosis. Treatment usually involves chemotherapy, but antiretroviral therapy may also have an important role. Infectious disease clinicians should be aware of this newly described and increasingly encountered lymphoma, since it is prominently associated with immunosuppression and may be mistaken for other entities.
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Affiliation(s)
- David J Riedel
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Lee SC, Kim HJ, Bae SB, Kim CK, Lee NS, Lee KT, Park SK, Hong DS, Park HS, Jin SY, Won JH. Plasmablastic Lymphoma Mistaken for Perianal Abscess in Patient with AIDS. THE KOREAN JOURNAL OF HEMATOLOGY 2008. [DOI: 10.5045/kjh.2008.43.3.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sang-Cheol Lee
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Hyun-Jung Kim
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sang-Byung Bae
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Chan-Kyu Kim
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Nam-Su Lee
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Kyu-Taek Lee
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sung-Kyu Park
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Dae-Sik Hong
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Hee-Sook Park
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Jong-Ho Won
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
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