1
|
Carter BW, Wu CC, Khorashadi L, Godoy MCB, de Groot PM, Abbott GF, Lichtenberger JP. Multimodality imaging of cardiothoracic lymphoma. Eur J Radiol 2014; 83:1470-82. [PMID: 24935137 DOI: 10.1016/j.ejrad.2014.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/02/2014] [Accepted: 05/09/2014] [Indexed: 01/15/2023]
Abstract
Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and (18)F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response.
Collapse
Affiliation(s)
- Brett W Carter
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA.
| | - Carol C Wu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA
| | - Leila Khorashadi
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Myrna C B Godoy
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA
| | - Patricia M de Groot
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA
| | - Gerald F Abbott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA
| | | |
Collapse
|
2
|
Booth TC, Chhaya NC, Bell JRG, Holloway BJ. Update on imaging of non-infectious musculoskeletal complications of HIV infection. Skeletal Radiol 2012; 41:1349-63. [PMID: 22618760 DOI: 10.1007/s00256-012-1425-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/27/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
Acquired immunodeficiency syndrome (AIDS) results from infection with human immunodeficiency virus (HIV), producing an immunodeficient state and severe pathology across multiple organ systems. Musculoskeletal involvement is particularly prevalent in this population with both infectious and non-infectious complications encountered, but it is suggested that the latter will affect 72% of HIV-infected individuals. In this review we aim to provide an update on the imaging characteristics of the non-infectious manifestations. The conditions include HIV-related arthritis as well as various malignancies, myositis, anaemia, osteonecrosis, rhabdomyolysis, hypertrophic osteoarthropathy and therapy-related side effects. For the clinician, the diagnostic challenge lies in differentiating disease-related symptoms from therapy-related side effects, particularly when clinical and laboratory features can be non-specific. This is especially difficult following the widespread introduction of highly active anti-retroviral therapy (HAART). Imaging investigations and MRI in particular have proven vital for facilitating early diagnosis and enabling prompt treatment. Furthermore, wider availability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has allowed whole-body assessment for staging and treatment response of malignancy. Understanding the pathogenesis of the various conditions and recognising their imaging features is essential for the clinical radiologist.
Collapse
Affiliation(s)
- T C Booth
- Department of Radiology, The Royal Free Hospital, London, UK.
| | | | | | | |
Collapse
|
3
|
Hare SS, Souza CA, Bain G, Seely JM, Frcpc, Gomes MM, Quigley M. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol 2012; 85:848-64. [PMID: 22745203 DOI: 10.1259/bjr/16420165] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pulmonary lymphoproliferative disorders (LPD) are characterised by abnormal proliferation of indigenous cell lines or infiltration of lung parenchyma by lymphoid cells. They encompass a wide spectrum of focal or diffuse abnormalities, which may be classified as reactive or neoplastic on the basis of cellular morphology and clonality. The spectrum of reactive disorders results primarily from antigenic stimulation of bronchial mucosa-associated lymphoid tissue (MALT) and comprises three main entities: follicular bronchiolitis, lymphoid interstitial pneumonia and (more rarely) nodular lymphoid hyperplasia. Primary parenchymal neoplasms are most commonly extranodal marginal zone lymphomas of MALT origin (MALT lymphomas), followed by diffuse large B-cell lymphomas (DLBCLs) and lymphomatoid granulomatosis (LYG). Secondary lymphomatous parenchymal neoplasms (both Hodgkin and non-Hodgkin lymphomas) are far more prevalent than primary neoplasms. Acquired immune deficiency syndrome (AIDS)-related lymphoma (ARL) and post-transplantation lymphoproliferative disorder (PTLD) may also primarily affect the lung parenchyma. Modern advances in treatments for AIDS and transplant medicine are associated with an increase in the incidence of LPD and have heightened the need to understand the range of imaging appearance of these diseases. The multidetector CT (MDCT) findings of LPD are heterogeneous, thereby reflecting the wide spectrum of clinical manifestations of these entities. Understanding the spectrum of LPD and the various imaging manifestations is crucial because the radiologist is often the first one to suggest the diagnosis and has a pivotal role in differentiating these diseases. The current concepts of LPD are discussed together with a demonstration of the breadth of MDCT patterns within this disease spectrum.
Collapse
Affiliation(s)
- S S Hare
- Department of Radiology, The Ottawa Hospital, Ottawa, ON, Canada.
| | | | | | | | | | | | | |
Collapse
|
4
|
Krause JR, Aburiziq I. Granulocytic sarcoma and HIV. Proc (Bayl Univ Med Cent) 2011; 24:306-8. [PMID: 22046064 DOI: 10.1080/08998280.2011.11928745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Hematopoietic neoplasms are known to occur in the setting of HIV. Excluding Kaposi's sarcoma, the neoplasms are generally high-grade lymphoproliferative disorders. Granulocytic sarcoma, an extramedullary hematopoietic malignancy that may precede or occur during the course of acute myeloid leukemia, has rarely been described in the HIV population. We present the fourth documented case, to our knowledge, of a granulocytic sarcoma occurring in an HIV-positive individual. This has been associated with a very poor prognostic outcome.
Collapse
Affiliation(s)
- John R Krause
- Department of Pathology, Section of Hematopathology, Baylor University Medical Center at Dallas
| | | |
Collapse
|
5
|
Abstract
CONTEXT The anal canal possesses complex anatomy and histology and gives rise to a variety of tumor types. Challenging issues remain with regard to both the pathologic diagnosis and the clinical management of these tumors. OBJECTIVES To provide an updated overview of the histogenesis, clinical and pathologic characteristics, diagnostic terminology, and relevant clinical management of the various types of anal canal tumors. DATA SOURCES Recent literature on clinical and pathologic characteristics of anal canal tumors. CONCLUSIONS Although most anal canal tumors are of squamous lineage, a complex variety of other tumors also occurs. Recognition of such diverse tumor entities will allow accurate pathologic diagnosis and most optimal clinical management.
Collapse
Affiliation(s)
- Jinru Shia
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| |
Collapse
|
6
|
Modern techniques for the diagnostic evaluation of the trephine bone marrow biopsy: Methodological aspects and applications. ACTA ACUST UNITED AC 2008; 42:203-52. [DOI: 10.1016/j.proghi.2007.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 10/08/2007] [Indexed: 12/19/2022]
|
7
|
Corti M, Villafañe MF, Souto L, Schtirbu R, Narbaitz M, Soler MDD. Burkitt's lymphoma of the duodenum in a patient with AIDS. Rev Soc Bras Med Trop 2007; 40:338-40. [PMID: 17653472 DOI: 10.1590/s0037-86822007000300017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 05/02/2007] [Indexed: 11/22/2022] Open
Abstract
Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma, among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of primary lymphoma of the duodenum in a patient with AIDS. Upper gastrointestinal endoscopy revealed pseudopolypoid masses found in the second portion of the duodenum. A complete diagnostic study including histological, immunohistochemical and virological analyses showed high-grade B-cell Burkitt's lymphoma. The Epstein-Barr virus genome was detected in biopsies by immunohistochemical and in situ hybridization.
Collapse
Affiliation(s)
- Marcelo Corti
- Division of HIV/AIDS disease, F. J. Muñiz Infectious Diseases Hospital, Buenos Aires, Argentina.
| | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Cox DP, Treseler P, Dong R, Jordan RCK. Rare oral cavity presentation of a B-cell lymphoblastic lymphoma. A case report and review of the literature. ACTA ACUST UNITED AC 2007; 103:814-9. [PMID: 17531941 DOI: 10.1016/j.tripleo.2005.11.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 11/18/2005] [Accepted: 11/23/2005] [Indexed: 11/21/2022]
Abstract
Lymphoblastic lymphoma is an uncommon malignancy, with most cases showing a T-cell phenotype and presenting as a mediastinal mass. By contrast, B-cell lymphoblastic lymphoma/leukemia is a rare high-grade malignancy that comprises approximately 10% of all lymphoblastic lymphomas. Lymphomas of the oral cavity are rare and typically present as intraosseous lesions that are most commonly diffuse large B-cell type. Here we present what we believe is the first B-cell lymphoblastic lymphoma initially presenting in the oral cavity. The case involves a 46-year-old white woman who presented with a mass in the right mandible. This report discusses this rare malignancy, including clinical presentation, histopathologic features, immunologic profile, treatment, and prognosis. This case emphasizes the importance of recognizing rare entities that may present in the oral cavity and the impact of the disease and its management.
Collapse
Affiliation(s)
- Darren P Cox
- Department of Orofacial Sciences, University of California, San Francisco, California, USA
| | | | | | | |
Collapse
|
10
|
Balachandra B, Marcus V, Jass JR. Poorly differentiated tumours of the anal canal: a diagnostic strategy for the surgical pathologist. Histopathology 2007; 50:163-74. [PMID: 17204029 DOI: 10.1111/j.1365-2559.2006.02550.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poorly differentiated malignancies affecting the anal canal are uncommon but pose diagnostic difficulties because of the wide range of normal cell types that may occur within a limited anatomical region. The range of lesions that may present as poorly differentiated tumours includes squamous cell carcinoma, adenocarcinoma, small and large cell neuroendocrine carcinoma, neuroendocrine carcinoma expressing epithelial cytokeratins and other patterns of mixed differentiation, undifferentiated carcinoma, malignant melanoma, lymphoma and secondary tumours. This review discusses the differential diagnosis of these neoplasms with the aid of short illustrative case studies.
Collapse
Affiliation(s)
- B Balachandra
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | | | | |
Collapse
|
11
|
Kremer M, Quintanilla-Martínez L, Nährig J, von Schilling C, Fend F. Immunohistochemistry in bone marrow pathology: a useful adjunct for morphologic diagnosis. Virchows Arch 2005; 447:920-37. [PMID: 16231177 DOI: 10.1007/s00428-005-0070-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 08/23/2005] [Indexed: 12/11/2022]
Abstract
Pathomorphological examination of trephine biopsies of the bone marrow (BM) represents a standard method for the diagnosis and staging of hematologic neoplasms and other disorders involving the BM. The increasing knowledge about the genetic basis and biology of hematologic neoplasms, as well as the recently proposed WHO classification system, provide the framework for an accurate diagnosis. Although conventional morphology remains the gold standard for paraffin-embedded BM trephines, immunohistochemical stainings have become an integral part of the diagnostic workup. Antibodies suitable for paraffin sections are generally applicable to BM trephines, but modifications of staining protocols may be necessary due to the alternative fixatives and decalcification procedures used for BM biopsies. The indications for immunostainings range from confirmation and classification of lymphoma involvement, subclassification of acute leukemias, and estimating blast counts in myelodysplastic and myeloproliferative syndromes to characterization of BM involvement in nonhematologic neoplasms. Although subtyping of NHL in the BM is more difficult from the point of morphology, classification of the entities that frequently involve the BM, especially the small B-cell lymphomas, can easily be achieved with the help of immunohistochemistry. In this review, we try to summarize the current state of the art in BM immunohistochemistry for the diagnosis of hematologic disorders. Moreover, diagnostic algorithms and useful antibody panels are proposed for a rational and cost-effective approach.
Collapse
Affiliation(s)
- Marcus Kremer
- Institute of Pathology, Technical University Munich, Ismaningerstrasse 22, 81675 Munich, Germany
| | | | | | | | | |
Collapse
|
12
|
Abstract
This work reviews the current status of non-Hodgkin's lymphoma (NHL) in HIV infected patients. HIV infection remains at significantly increased risk for the development of NHL. The great majority of these lymphomas are high-grade monoclonal B-cell neoplasms often occurring in unusual sites. A number of genetic abnormalities have been found but additional studies are necessary to understand the etiology and pathogenesis of NHL in the setting of HIV infection. The cases in this paper have been seen on the Hematopathology service of the Tulane Health Sciences Center.
Collapse
Affiliation(s)
- John Krause
- Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, School of Medicine, New Orleans, Louisiana 70112, USA.
| |
Collapse
|
13
|
Restrepo CS, Lemos DF, Gordillo H, Odero R, Varghese T, Tiemann W, Rivas FF, Moncada R, Gimenez CR. Imaging Findings in Musculoskeletal Complications of AIDS. Radiographics 2004; 24:1029-49. [PMID: 15256627 DOI: 10.1148/rg.244035151] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are susceptible to a variety of complications that can affect the musculoskeletal system. These complications can be infectious, inflammatory, or neoplastic or can take some other form. Infection (cellulitis, necrotizing fasciitis, soft-tissue abscess, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory processes include various arthritides as well as polymyositis. Non-Hodgkin lymphoma and Kaposi sarcoma are the two most common neoplasms in this patient population. Miscellaneous disorders include osteonecrosis, osteoporosis, rhabdomyolysis, anemia-related abnormal bone marrow, and hypertrophic osteoarthropathy. The underlying mechanisms leading to these diseases are complex and not fully understood but are thought to be multifactorial. Radiology may play an important role in early diagnosis and treatment planning in this population, in whom clinical and laboratory findings are commonly equivocal and nonspecific. Although biopsy is often necessary for the final diagnosis, it is important for the radiologist to be familiar with the different types of musculoskeletal disease in HIV-positive and AIDS patients so that an appropriate differential diagnosis can be established.
Collapse
Affiliation(s)
- C Santiago Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Rm 212, New Orleans, LA 70112, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Cioc AM, Allen C, Kalmar JR, Suster S, Baiocchi R, Nuovo GJ. Oral plasmablastic lymphomas in AIDS patients are associated with human herpesvirus 8. Am J Surg Pathol 2004; 28:41-6. [PMID: 14707862 DOI: 10.1097/00000478-200401000-00003] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human herpes virus type 8 (HHV8) has been strongly associated with Kaposi sarcoma, primary effusion lymphoma (PEL), and Castleman's disease. To our knowledge, infection by this virus has not been strongly associated with other hematopathologic malignancies. We examined five oral cavity lymphomas from men with AIDS for HHV8 and HIV-1 by reverse transcriptase in situ polymerase chain reaction, as well as for Epstein-Barr virus (EBV) (EBER-1, -2) using in situ hybridization and HHV8 protein with immunohistochemistry. Four of these tumors were plasmablastic lymphomas; the final case was diffuse large B-cell lymphoma. Most of the neoplastic cells in these five lymphomas contained HHV8 RNA and protein. Further, the four plasmablastic lymphoma cases had tumor cells that contained EBV. HIV-1 RNA was not detected in the tumor cells but was noted in surrounding benign T cells. In comparison, HHV8 RNA was not detected in any of the five oral cavity lymphomas from people who did not have acquired immunosuppression nor in five lymphomas from AIDS patients that were located at a site other than the oral cavity. It is concluded that oral cavity lymphomas from people with AIDS are strongly associated with infection by HHV8 and EBV. Given the poor prognosis of oral cavity lymphomas in immunocompromised patients, therapy directed against the HHV8 and EBV infection may be of therapeutic value.
Collapse
Affiliation(s)
- Adina M Cioc
- Department of Pathology, Ohio State University Medical Center and College of Dentistry, Columbus, OH 43210, USA
| | | | | | | | | | | |
Collapse
|
15
|
Hoffmann C, Wolf E, Fätkenheuer G, Buhk T, Stoehr A, Plettenberg A, Stellbrink HJ, Jaeger H, Siebert U, Horst HA. Response to highly active antiretroviral therapy strongly predicts outcome in patients with AIDS-related lymphoma. AIDS 2003; 17:1521-9. [PMID: 12824790 DOI: 10.1097/00002030-200307040-00013] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AIDS-related lymphoma (ARL) remains a frequent complication of HIV infection. We analyzed the outcome of patients with ARL with respect to the use and efficacy of highly active antiretroviral therapy (HAART) and to potential prognostic factors. METHODS This multicenter cohort study included patients with systemic ARL diagnosed between 1990-2001. We evaluated overall survival and the effects of several variables on overall survival using the Kaplan-Meier method and the extended Cox proportional hazards model. Response to HAART was used as a time-dependent variable and was defined as a CD4 cell count increase of >/= 100 x 106 cells/l and/or at least one viral load < 500 copies/ml during the first 2 years following diagnosis of ARL. RESULTS Among 203 patients with ARL, median overall survival was 9.0 months [95% confidence interval (CI), 7.6-12.4 months]. In the univariate analyses, age < 60 years, no previous AIDS, CD4 cell counts >/= 200 x 106 cells/l, hemoglobin > 11 g/dl, Ann Arbor stages I-II and A, no extranodal lesion, response to HAART, and complete remission showed statistically significant association with prolonged overall survival. In the multivariate Cox model, the only factors independently associated with overall survival were response to HAART [relative hazard (RH), 0.32; 95% CI, 0.16-0.62], complete remission (RH, 0.24; 95% CI, 0.15-0.36), previous AIDS (RH, 1.92; 95%CI, 1.23-3.01) and extranodal involvement (RH, 2.85; 95% CI, 1.47-5.51). CONCLUSIONS Efficacy of HAART was independently associated with prolonged survival in this large cohort of patients with ARL. Information on patient's response to HAART is crucial for the evaluation of future treatment strategies.
Collapse
|
16
|
Abstract
Immunodeficiency alters the risk of cancer. Specific types of immune dysfunction are associated with different tumor risks, but most tumors are related to oncogenic viruses. In acquired immunodeficiency due to the human immunodeficiency virus (HIV), HIV itself rarely directly causes cancer; rather, it provides the immunologic background against which other viruses can escape immune control and induce tumors. The most common malignancies are Kaposi's sarcoma and non-Hodgkin's lymphoma. This chapter discusses the pathophysiologic background of these tumors, how they have been affected by the use of anti-HIV medications, and their clinical management.
Collapse
Affiliation(s)
- David T Scadden
- AIDS Research Center and Cancer Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Room 5212, Boston, Massachussetts 02129, USA.
| |
Collapse
|
17
|
Abstract
The incidence of NHL is greatly increased in HIV-infected individuals; malignant lymphoma is the second most common neoplasm that occurs in association with AIDS. The vast majority of neoplasms are clinically aggressive, monoclonal B-cell neoplasms that exhibit Burkitt's, immunoblastic, large cell, or transitional histopathology. Approximately 80% arise systemically (nodal or extranodal) and 20% arise as primary CNS lymphomas. A small proportion of neoplasms are body cavity-based, primary effusion lymphomas that are uniquely associated with KSHV infection. Recently, HIV-associated polymorphic lymphoproliferative disorders have been described as well. AIDS-related NHLs appear to exhibit distinctive clinical characteristics according to their histopathology and anatomic site of origin. Factors that contribute to lymphoma development include HIV-induced immunosuppression, impaired immune surveillance, cytokine release and deregulation, and chronic antigenic stimulation. This environment is associated with the development of oligoclonal B-cell expansions. The appearance of NHL is characterized by the presence of a monoclonal B-cell population that displays a variety of genetic lesions, including, for example, EBV infection, MYC gene rearrangement, BCL6 gene rearrangement, P53 mutations and deletions, and RAS gene mutations. The number and type of genetic lesions vary somewhat among AIDS-related NHLs according to their histopathologic category and anatomic site of origin. These findings suggest that more than one pathogenetic mechanism is operational in the development and progression of AIDS-related NHLs. Further work is necessary to develop a complete understanding of the etiology and pathogenesis of NHL in the setting of HIV infection. AIDS-related NHL is an important biologic model for investigating the development and progression of high-grade NHLs and NHLs that develop in immunedeficient hosts.
Collapse
Affiliation(s)
- Daniel M Knowles
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
| |
Collapse
|
18
|
Vicente-Barrero M, García-Castro I, Knezević M, Castellano-Reyes JJ, García-Jimenez F, Camacho-García MDC, Baez-Acosta B, Loncarević S. Non-Hodgkin lymphomas of oral cavity. VOJNOSANIT PREGL 2002; 59:669-73. [PMID: 12557626 DOI: 10.2298/vsp0206669v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Non-Hodgkin lymphomas (NHL) often show up in an extranodal pattern, especially in the head and neck. Intraoral locations are much less frequent, particularly when they are single. This, in turn, can lead to a prolonged diagnosis and even to inadequate treatment. Different patients with initial extranodal location of NHL which were not previously diagnosed and in which it was manifested only intraorally are presented in this paper. These cases are presented together with the additional examinations used for the early diagnosis and with the corresponding clinical pictures, as well as with the overview of other cases from the available literature.
Collapse
|
19
|
Miralles P, Rubio C, Berenguer J, Ribera JM, Calvo F, Diaz Mediavilla J, Diez-Martín JL, López Aldeguer J, Valencia E, Rubio R, Felipe C. [GESIDA/PETHEMA guidelines for the diagnosis and treatment of lymphomas in HIV-infected patients]. Med Clin (Barc) 2002; 118:225-36. [PMID: 11864547 DOI: 10.1016/s0025-7753(02)72342-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Pilar Miralles
- Hospital General Gregorio Marañón, Madrid, Spain. pmiralles@eresmas-net
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
|
22
|
Abstract
Pulmonary disorders remain an important complication of HIV infection, even in the current era of potent antiretroviral therapy. Using an integrated approach that combines radiographic pattern recognition with knowledge of a patient's clinical symptoms, laboratory data, immune status level, demographic information, and drug therapy can enhance the interpretation of imaging studies in HIV-infected patients. Although chest radiography remains the mainstay of imaging the HIV-positive patient with respiratory symptoms, CT plays an increasingly important secondary role in selected cases.
Collapse
Affiliation(s)
- Phillip M Boiselle
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | | | | |
Collapse
|
23
|
Leong IT, Fernandes BJ, Mock D. Epstein-Barr virus detection in non-Hodgkin's lymphoma of the oral cavity: an immunocytochemical and in situ hybridization study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:184-93. [PMID: 11505266 DOI: 10.1067/moe.2001.116155] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to histologically characterize a series of oral non-Hodgkin's lymphomas (NHLs) and to investigate latent and lytic Epstein-Barr virus (EBV) infection in these. STUDY DESIGN The revised European-American Lymphoma classification system (41) was used to categorize 58 cases of oral NHL, which included 9 immunosuppression-related NHLs. EBV infection was determined by in situ hybridization for Epstein-Barr virus-encoded RNA and by immunohistochemistry for the EBV antigens latency membrane protein, Epstein-Barr nuclear antigen-2 (EBNA2) and Z EBV replication activator protein. RESULTS Most tumors were B-cell lymphomas (78%), but the proportion of T-cell lymphomas was surprisingly high (22%). The most common histologic subtypes were diffuse large B-cell lymphomas (45%), peripheral T-cell lymphomas (19%), and follicle center lymphomas (14%). Two thirds of the known immunosuppression-related NHLs were T-cell lymphomas. All of the immunosuppression-related tumors were EBV-infected, whereas the EBV infection rate in the NHLs of the remaining patients presumed to be immunocompetent was only 9%. Most EBV-positive tumors expressed neither of the latent antigens (ie, latency membrane protein and Epstein-Barr nuclear antigen-2), and coexpression of the 2 was observed only in immunosuppressed patients. Z EBV replication activator protein expression, which is indicative of replicative infection, occurred only in immunosuppressed individuals. CONCLUSIONS Diffuse large B-cell lymphomas were the most common histologic subtype of oral NHLs, but T-cell lymphomas were relatively common and frequently occurred in states of immunosuppression. EBV may play a limited role in the initiation of lymphoma in the immunocompetent patient, but the virus may be of importance in progression of the disease in those patients with more aggressive tumors, as immunosuppression occurs.
Collapse
MESH Headings
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Antigens, Viral/analysis
- Chi-Square Distribution
- DNA Replication
- DNA-Binding Proteins/analysis
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Nuclear Antigens/analysis
- Female
- Herpesvirus 4, Human/classification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/immunology
- Humans
- Immunocompromised Host
- Immunohistochemistry
- In Situ Hybridization
- Lymphoma, B-Cell/virology
- Lymphoma, Follicular/virology
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, Non-Hodgkin/virology
- Lymphoma, T-Cell/virology
- Lymphoma, T-Cell, Peripheral/virology
- Male
- Middle Aged
- Mouth Neoplasms/virology
- RNA, Viral/genetics
- Replication Protein A
- Statistics as Topic
- Trans-Activators/analysis
- Viral Matrix Proteins/analysis
- Viral Proteins/analysis
- Virus Latency
- Virus Replication
Collapse
Affiliation(s)
- I T Leong
- Department of Oral Pathology, University of Toronto, Ontario, Canada.
| | | | | |
Collapse
|
24
|
Affiliation(s)
- D M Knowles
- Department of Pathology, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA.
| | | |
Collapse
|
25
|
Cohen K, Scadden DT. Non-Hodgkin's lymphoma: pathogenesis, clinical presentation, and treatment. Cancer Treat Res 2001; 104:201-30. [PMID: 11191128 DOI: 10.1007/978-1-4615-1601-9_7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Antiviral Agents/therapeutic use
- Bleomycin/therapeutic use
- California
- Clinical Trials as Topic
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Dexamethasone/therapeutic use
- Doxorubicin/therapeutic use
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/isolation & purification
- Homosexuality, Male
- Humans
- Infusions, Intravenous
- Lymphoma, B-Cell/pathology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, T-Cell/pathology
- Male
- Prognosis
- Registries
- Vincristine/therapeutic use
Collapse
Affiliation(s)
- K Cohen
- Massachusetts General Hospital, Dana-Farber/Harvard Cancer Center, Partners AIDS Research Center, Harvard Medical School, USA
| | | |
Collapse
|
26
|
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/genetics
- B-Lymphocytes/immunology
- Burkitt Lymphoma/etiology
- Burkitt Lymphoma/pathology
- Central Nervous System Neoplasms/etiology
- Central Nervous System Neoplasms/pathology
- DNA, Viral/analysis
- Genes, Tumor Suppressor
- HIV Infections/complications
- HIV Infections/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunohistochemistry
- Immunophenotyping
- In Situ Hybridization
- Interleukin-6/analysis
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/pathology
- Peritoneal Neoplasms/etiology
- Peritoneal Neoplasms/pathology
- Pleural Neoplasms/etiology
- Pleural Neoplasms/pathology
- Proto-Oncogenes
Collapse
Affiliation(s)
- D M Knowles
- Weill Medical College of Cornell University, USA
| |
Collapse
|
27
|
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antiretroviral Therapy, Highly Active
- Antiviral Agents/therapeutic use
- Burkitt Lymphoma/epidemiology
- Burkitt Lymphoma/virology
- Epstein-Barr Virus Infections/complications
- Genes, myc
- Genes, p53
- Herpesviridae Infections/complications
- Herpesvirus 8, Human
- Humans
- Immunocompromised Host
- Immunotherapy
- Incidence
- Lymphoma, AIDS-Related/epidemiology
- Lymphoma, AIDS-Related/virology
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/virology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, Non-Hodgkin/epidemiology
- Lymphoma, Non-Hodgkin/virology
- Male
- Prognosis
- Risk Factors
- Translocation, Genetic
Collapse
Affiliation(s)
- M Bower
- Department of Oncology, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
| |
Collapse
|
28
|
Fife K, Bower M. Current Management of AIDS Related Non Hodgkin's Lymphoma. Pathol Oncol Res 2001; 2:272-275. [PMID: 11173615 DOI: 10.1007/bf02904823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Non Hodgkin's lymphoma is the AIDS defining illness in 3-3.5% of patients and is increasing in incidence as the survival of HIV infected people improves. The incidence of these intermediate/high grade B cell malignancies is sixty times higher than in the general population. The most important prognostic factors are a CD4 positive lymphocyte count of <100 cells/mm3, a prior AIDS defining diagnosis, an ECOG performance status >2 and primary cerebral origin. Patients with any of these factors are most likely to benefit from palliative rather than radical treatment. Good prognosis patients have a 30-40% chance of cure from their lymphoma with carefully administered intensive chemotherapy.
Collapse
Affiliation(s)
- Kathryn Fife
- Charing Cross Hospital, Medical Oncology Unit, London, England
| | | |
Collapse
|
29
|
Kempf W, Margolin DH, Dezube BJ, Kadin ME, Letvin NL, Koralnik IJ. Clinicopathological characterization of an HIV-2-infected individual with two clonally unrelated primary lymphomas. Am J Hematol 2000; 65:302-6. [PMID: 11074559 DOI: 10.1002/1096-8652(200012)65:4<302::aid-ajh9>3.0.co;2-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Human immunodeficiency virus 2 (HIV-2) is endemic in West Africa and is a causative agent of the acquired immunodeficiency syndrome. Only a small number of HIV-2-infected patients have been described in detail. Non-Hodgkin's lymphoma (NHL) is the second most common neoplasm occurring in HIV-1-infected patients, but its incidence seems to be lower in HIV-2-infected individuals. We report an HIV-2-infected patient from Cape Verde (West Africa) with separate and distinct systemic and primary central nervous system large B-cell lymphomas and review the findings of cases of HIV-2-associated lymphomas reported in the literature. Different clonal rearrangements of the immunoglobulin heavy chain gene could be detected in the two lymphomas of our patient by polymerase chain reaction and sequence analysis. These data indicate the presence of two clonally unrelated large B-cell lymphomas in the same patient, which is an unusual finding. Neither Epstein-Barr virus nor human herpesvirus 8 could be detected in the tumor tissues or the cerebrospinal fluid. HIV-2 infection should be considered in patients with NHL, especially in those from West Africa.
Collapse
Affiliation(s)
- W Kempf
- Department of Medicine, Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
| | | | | | | | | | | |
Collapse
|
30
|
Mhawech P, Krishnan B, Shahab I. Primary pulmonary mucosa-associated lymphoid tissue lymphoma with associated fungal ball in a patient with human immunodeficiency virus infection. Arch Pathol Lab Med 2000; 124:1506-9. [PMID: 11035584 DOI: 10.5858/2000-124-1506-ppmalt] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We describe a case of primary mucosa-associated lymphoid tissue lymphoma of the lung in a 44-year-old man with human immunodeficiency virus. Low-grade pulmonary lymphomas in human immunodeficiency virus-positive patients are rare and are described most commonly in pediatric patients. The gross, histologic, and molecular features of this unusual case are described.
Collapse
MESH Headings
- Adult
- Aspergillosis/microbiology
- Aspergillosis/pathology
- Aspergillosis/surgery
- Aspergillus/isolation & purification
- DNA Primers/analysis
- DNA, Neoplasm/analysis
- Follow-Up Studies
- HIV Seropositivity
- Humans
- Immunoenzyme Techniques
- Lung/microbiology
- Lung/pathology
- Lung/surgery
- Lung Neoplasms/microbiology
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymph Nodes/microbiology
- Lymph Nodes/pathology
- Lymphoma, AIDS-Related/microbiology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/surgery
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Male
- Polymerase Chain Reaction
Collapse
Affiliation(s)
- P Mhawech
- Department of Pathology, Baylor College of Medicine and Veterans Affairs Medical Center, Houston, TX 77030, USA
| | | | | |
Collapse
|
31
|
Pickhardt PJ, Siegel MJ, Hayashi RJ, Kelly M. Posttransplantation lymphoproliferative disorder in children: clinical, histopathologic, and imaging features. Radiology 2000; 217:16-25. [PMID: 11012419 DOI: 10.1148/radiology.217.1.r00oc3816] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Posttransplantation lymphoproliferative disorder (PTLD) is a condition in patients who receive transplants in which chronic immunosuppression leads to an unregulated expansion of lymphoid cells; the condition ranges from hyperplasia to malignant lymphoid proliferation. Risk factors affecting the incidence of PTLD include allograft type, Epstein-Barr virus infection, and immunosuppression. In this article, we review the clinical, histopathologic, and imaging features of PTLD in children. Because PTLD can affect nearly any organ system, a wide variety of clinical manifestations is possible. The heterogeneous nature of the disease is also reflected on imaging studies. The goals of imaging in patients with PTLD are to detect disease, guide biopsy, and direct appropriate follow-up imaging rather than to establish a specific diagnosis. Because the clinical and imaging manifestations of PTLD are nonspecific and are not reliably predictive of histopathologic subtype, tissue biopsy is necessary for final diagnosis.
Collapse
Affiliation(s)
- P J Pickhardt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA
| | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE To review the current literature on HIV associated non-Hodgkin's lymphoma. METHODS A comprehensive Medline/Pubmed search of articles pertaining to HIV associated non-Hodgkin's lymphoma as well as personal experience from the treatment of over 200 patients at the Chelsea and Westminster Hospital, one of the largest centres for the management of HIV disease in Europe. CONCLUSION High grade B cell non-Hogdkin's lymphoma is the second commonest tumour affecting people with HIV. The incidence of this tumour is not declining following the introduction of highly active antiretroviral therapy. Chemotherapy has been employed with modest success in this group of patients; however, the prognosis remains worse than for immunocompetent patients. Advances in molecular genetics and virology have led to a greater understanding of the biology of these tumours. However, these advances have yet to be translated into improvements in the clinical management of patients with AIDS associated non-Hodgkin's lymphoma.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Antiviral Agents/therapeutic use
- CD4 Lymphocyte Count
- Female
- Humans
- Lymphoma, AIDS-Related/classification
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/etiology
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/etiology
- Lymphoma, Non-Hodgkin/classification
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/etiology
- Male
- Prognosis
- Remission Induction
Collapse
Affiliation(s)
- T Powles
- Department Oncology, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | | | | |
Collapse
|
33
|
Valencia ME, Martinez P, Moreno V, Laguna F, Lahoz JG. AIDS-related body cavity-based lymphomas, herpesvirus-8 and HIV infection: a study of seven cases. AIDS 1999; 13:2603-5. [PMID: 10630536 DOI: 10.1097/00002030-199912240-00021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Mätz-Rensing K, Pingel S, Hannig H, Bodemer W, Hunsmann G, Kuhn EM, Tiemann M, Kaup FJ. Morphologic and immunophenotypic characteristics of malignant lymphomas in SIV-infected rhesus macaques. J Med Primatol 1999; 28:318-28. [PMID: 10733204 DOI: 10.1111/j.1600-0684.1999.tb00280.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Eight cases of extranodal non-Hodgkin's lymphoma in simian immunodeficiency virus (SIV)-infected rhesus macaques, aged 4-9 years, were phenotypically and immunologically characterized, using the updated Kiel classification, in order to determine both the differences and the similarities between these types of lymphoma in immunodeficient rhesus macaques (Macaca mulatta) and man. The high-grade malignant tumors were of B-cell origin, with a predilection for extranodal growth in viscera and periorbital tissues. Immunophenotypical characterization showed that the monkey lymphomas were similar in many aspects to human immunodeficiency virus-associated lymphomas. The number of Ki67 positive cells varied from case to case and ranged from 50 to 90%. A serological screening for the simian equivalent of the Epstein-Barr virus (sEBV) by immunofluorescence assay revealed a prevalence of 92% of the sEBV antibodies in our cohort. The presence of Ebstein-Barr virus nuclear antigen (EBNA-2) could be demonstrated by immunohistochemistry in four out of eight cases. In situ hybridization revealed the presence of small EBV-encoded RNAs (EBER-1, EBER-2) in six of the eight cases. Further studies should define the precise role of herpesvirus infection for lymphomagenesis in SIV-induced immunodeficiency.
Collapse
|
35
|
Porter SR, Diz Dios P, Kumar N, Stock C, Barrett AW, Scully C. Oral plasmablastic lymphoma in previously undiagnosed HIV disease. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:730-4. [PMID: 10397667 DOI: 10.1016/s1079-2104(99)70170-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-Hodgkin's lymphoma is the second most common HIV-associated malignancy. This report details a case of the recently described entity plasmablastic lymphoma of the mouth in a patient who was later found to have severe HIV disease. The tumor manifested as a large ulcerated mass of the left maxillary alveolus, causing bony destruction and tooth mobility. Histologic examination of lesional tissue revealed a lymphoid tumor with a high proliferation rate containing lymphoplasmacytoid cells that were reactive to the plasma cell marker VS38c but not to CD20 or CD79a; these are features of the recently reported non-Hodgkin's lymphoma termed plasmablastic lymphoma. This is only the second report of an unusual tumor that has a predilection for the orofacial tissues.
Collapse
Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, United Kingdom
| | | | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- M D Volm
- Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA
| | | |
Collapse
|
37
|
Jordan RC, Chong L, Dipierdomenico S, Satira F, Main JH. Oral lymphoma in human immunodeficiency virus infection: a report of six cases and review of the literature. Otolaryngol Head Neck Surg 1998; 119:672-7. [PMID: 9852547 DOI: 10.1016/s0194-5998(98)70033-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R C Jordan
- Department of Dentistry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
38
|
Lazzi S, Ferrari F, Nyongo A, Palummo N, de Milito A, Zazzi M, Leoncini L, Luzi P, Tosi P. HIV-associated malignant lymphomas in Kenya (Equatorial Africa). Hum Pathol 1998; 29:1285-9. [PMID: 9824108 DOI: 10.1016/s0046-8177(98)90258-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clinical and pathological features of acquired immune deficiency syndrome (AIDS)-related lymphomas, including their relationship with other viruses, such as Epstein-Barr virus (EBV) and human herpes virus-8 (HHV8), have been the subject of several studies from North America and Europe. No consistent data have been reported in Africa, where AIDS runs an epidemiological and clinical course different from that observed in Western countries. We retrospectively evaluated the presence of human immunodeficiency virus (HIV), HHV8, and EBV in 146 cases of malignant lymphomas collected in Kenya (Equatorial Africa), with the use of polymerase chain reaction (PCR) and in situ hybridization (ISH). The PCR technique confirmed HIV infection in 16 HIV-seropositive subjects (11%) and showed the presence of HIV sequences in five additional cases (3%) in which the occurrence of lymphoma was the only clinical manifestation. Our findings suggest that AIDS-related lymphomas are not pathogenetically homogenous, and different mechanisms may contribute to lymphomagenesis in these severely immunocompromised patients. In our series, no association of Hodgkin's disease (HD) with HIV infection could be shown. Among non-HIV-related lymphomas, EBV was present in 94% of Burkitt lymphoma (BL) occurring in patients younger than 15 years of age, in 87% of HD independently of age, sex, and histological types, in 60% of anaplastic large cell lymphoma (ALCL), and to a lesser extent (13%) in large B-cell lymphoma (LBCL) cases. Only one tumor, a case of HD, showed HHV8 by PCR.
Collapse
Affiliation(s)
- S Lazzi
- Institute of Pathologic Anatomy and Histology, University of Siena, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Ray P, Antoine M, Mary-Krause M, Lebrette MG, Wislez M, Duvivier C, Meyohas MC, Girard PM, Mayaud C, Cadranel J. AIDS-related primary pulmonary lymphoma. Am J Respir Crit Care Med 1998; 158:1221-9. [PMID: 9769285 DOI: 10.1164/ajrccm.158.4.9801057] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe 12 cases of AIDS-related primary pulmonary lymphoma occurring between 1986 and 1996 in a large French cohort of HIV-infected patients. Diagnostic criteria were: (1) histologically proven lymphomatous pulmonary involvement; (2) absence of mediastinal and/or hilar adenopathy on chest radiography; (3) absence of extrathoracic lymphoma extension. All patients were severely immunodeficient at the time of diagnosis. All but one patient presented with B and/or nonspecific respiratory symptoms. Chest radiography showed one or more marginated nodule(s) or large mass. CT scan showed a cavitary lesion in five patients. No lymph node enlargement or specific pleural effusion was detected. Transthoracic needle biopsies were performed in 10 patients and avoided open-lung biopsy for the diagnosis of lymphoma in five patients. All but one of the primary pulmonary lymphoma were high-grade B-cell non-Hodgkin's lymphomas. Using antilatent membrane protein-1 antibodies and an Epstein-Barr-Virus-encoded RNA transcript-specific probe, latent EBV infection of tumor cells was demonstrated in every case. All but one of the patients received chemotherapy. The median survival time was 4 mo, and no patient was still alive at the cut-off date for this analysis. Progessive pulmonary lymphoma was the main cause of death, but infections were also frequent.
Collapse
MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- Adult
- Antigens, Viral/analysis
- Antineoplastic Agents/therapeutic use
- Biopsy, Needle
- Cohort Studies
- Epstein-Barr Virus Infections/diagnosis
- Female
- Follow-Up Studies
- France
- HIV Infections
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/immunology
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/diagnostic imaging
- Lymphoma, AIDS-Related/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Pleural Effusion/diagnosis
- RNA, Viral/analysis
- Radiography, Thoracic
- Survival Rate
- Tomography, X-Ray Computed
- Viral Matrix Proteins/analysis
Collapse
Affiliation(s)
- P Ray
- Services de Pneumologie et de Réanimation Respiratoire et Service d'Anatomie-Pathologique, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Del Forno A, Del Borgo C, Turriziani A, Ottaviani F, Antinori A, Fantoni M. Non-Hodgkin's lymphoma of the maxillary sinus in a patient with acquired immunodeficiency syndrome. J Laryngol Otol 1998; 112:982-5. [PMID: 10211229 DOI: 10.1017/s0022215100142264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) is one of the most common malignancies in patients infected with human immunodeficiency virus (HIV): it occurs 25-60 times more frequently in HIV-infected patients than in the general population. This neoplasm in acquired immunodeficiency syndrome (AIDS) patients is a highly aggressive tumour with a poor prognosis and tends to develop in extranodal sites, such as the central nervous system, digestive tract and bone marrow. NHL involving the paranasal sinuses is rare in HIV-infected patients, and is likely to be confused clinically and radiographically with sinusitis; moreover, its optimal treatment is currently uncertain. We present a case of NHL involving the left maxillary sinus in a patient with AIDS. The patient was treated with systemic chemotherapy (low dose-CHOP), but the malignancy did not respond. Subsequently, he was treated with local maxillary sinus irradiation which resulted in partial regression of the neoplasm and in decrease of local symptoms.
Collapse
Affiliation(s)
- A Del Forno
- Department of Infectious Diseases, Catholic University, Rome, Italy
| | | | | | | | | | | |
Collapse
|
41
|
Costello R, Heuberger L, Petit N, Olive D, Gastaut JA. [Hodgkin's disease in patients infected with the human immunodeficiency virus]. Rev Med Interne 1998; 19:558-64. [PMID: 9775071 DOI: 10.1016/s0248-8663(99)80023-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Hodgkin's disease in patients infected by the human immunodeficiency virus (HIV) is still not part of the definition of acquired immune deficiency syndrome. Nonetheless, this entity has a particular presentation when compared to the disease occurring in immune-competent patients. CURRENT KNOWLEDGE AND KEY POINTS Increased frequency (> 75%) of advanced anatomical stages and extranodular localizations (Ann Arbor system stages III and IV) has been outlined in HIV-infected patients. Mediastinal involvement is more unusual in immunocompromised than in immune-competent patients. The presence of B symptoms (fever, weight loss, nocturnal sweats) is very frequent. Finally, the predominance of mixed cellularity (type 3) characterizes Hodgkin's disease in immunocompromised patients. Due to either the immunodeficiency, antiretroviral treatments, poor hematological tolerance in response to chemotherapy, or to advanced anatomical stages, disease management may be hampered. Current therapeutical approaches often obtain complete remission; however, some deaths are still related to the disease progression to acquired immune deficiency syndrome. FUTURE PROSPECTS AND PROJECTS From these observations, Hodgkin's disease management in HIV-infected patients relies on therapeutical approaches similar to those used for non infected patients, with some specific recommendations. Chemotherapy should be conducted in the shortest time in order to minimize chemotherapy-induced immunosuppression. Simultaneous use of antiretroviral treatment and reinforced opportunistic infection prophylaxis are of pivotal importance. Finally, the use of hematopoietic growth factors appears to be safe regarding viral replication, but still requires further evaluation.
Collapse
Affiliation(s)
- R Costello
- Département d'hématologie, université de la Méditerranée, institut Paoli-Calmettes, Marseille, France
| | | | | | | | | |
Collapse
|
42
|
Regezi JA, McMillan A, Dekker N, Daniels TE, Silverman S, Schoelch M, Ziober BL. Apoptosis-associated proteins in oral lymphomas from HIV-positive patients. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:196-202. [PMID: 9720096 DOI: 10.1016/s1079-2104(98)90125-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Extranodal oral lymphomas, seen with increasing frequency in HIV infection, may have dysfunctional apoptotic mechanisms that favor tumor progression. The purpose of this study was to evaluate extranodal lymphomas from HIV-positive patients for expression of apoptosis-associated proteins. Correlations were made with 10 histologically comparable extranodal lymphomas from HIV-negative patients and 6 hyperplastic lymph nodes from otherwise healthy young adults. Formalin-fixed tissue sections were immunohistochemically stained for apoptosis-associated proteins (Bcl-2, Bcl-x, Bax, Bak, p53, MDM2, BHRF). In situ hybridization was also done on deparaffinized sections for Epstein-Barr virus EBER mRNA. Eighteen consecutive oral lymphomas were studied in HIV/AIDS-positive patients. Four of 5 intermediate-grade lymphomas expressed Bcl-2 to a greater degree than did high-grade lymphomas (4 of 13). Most lymphomas were positive for Bcl-x and Bax, and few expressed Bak. The staining patterns for these proteins were similar to those seen in HIV-negative patients. Staining patterns were relatively consistent in the hyperplastic lymph nodes, whereas such patterns were irregular in lymphomas. Positive p53 staining was seen in 11 of 18 HIV-positive cases; 9 of these were also MDM2-positive. Double stains suggested that both p53 and MDM2 proteins were expressed in the same cells in these nine cases. Epstein-Barr virus-EBER mRNA was detected in 14 of 18 cases and in 3 of 10 cases from HIV-negative patients. BHRF staining was evident in only a few cells of three HIV-positive lymphomas. The irregular expression of Bcl-2, Bcl-x, Bax, and Bak in oral lymphomas indicates dysfunctional apoptotic mechanisms in these tumors. Bcl-2 staining differs with tumor grade. Positive staining for p53 and MDM2 proteins is a notable feature of lymphomas in HIV-positive patients and may relate to binding of MDM2 to wild-type p53. Epstein-Barr virus is more commonly associated with oral lymphomas in HIV-positive patients, although the Epstein-Barr virus-produced protein BHRF, which has Bcl-2-like activity, is minimally expressed.
Collapse
|
43
|
Abstract
In the US over one million persons are currently infected with the HIV, over half a million have had AIDS, and over 300,000 have died from AIDS. Worldwide, it is estimated that more than 17 million people are currently infected with HIV, and over 1,200,000 cases of AIDS have been reported to the World Health Organization. By some estimates, up to 40% of patients with AIDS will ultimately develop some form of cancer. Non-Hodgkin's lymphoma, Kaposi's sarcoma and invasive cervical cancer have a higher incidence in persons with HIV infection and all three are AIDS-defining illnesses. In addition, several reports suggest that a number of other malignancies may occur at an increased incidence in persons with HIV infection, including squamous-cell carcinoma of the head, neck and anus, plasmacytoma, melanoma, small-cell lung cancer, basal-cell cancer, and germ-cell tumours. Clinicians should become familiar with HIV-related malignancies as their incidence is expected to further increase as more effective therapies for HIV and associated opportunistic infections allow patients to live longer in an advanced state of immunodeficiency. In the current article, we will review the clinical and therapeutic aspects of the most common AIDS-related malignancies including non-Hodgkin's and Hodgkin's lymphomas, Kaposi's sarcoma and anogenital epithelial neoplasias.
Collapse
Affiliation(s)
- C Smith
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Ioachim HL, Antonescu C, Giancotti F, Dorsett B. EBV-associated primary lymphomas in salivary glands of HIV-infected patients. Pathol Res Pract 1998; 194:87-95. [PMID: 9584321 DOI: 10.1016/s0344-0338(98)80075-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The lymph nodes within and around salivary glands are commonly involved in inflammatory processes, but rarely the site of primary lymphomas. We observed six cases of primary salivary gland lymphoma in HIV-infected patients and studied them in parallel with three cases of primary salivary gland lymphoma unrelated to HIV and three cases of HIV-related salivary gland lymphadenopathies in order to characterize this new entity. We found that all salivary gland lymphomas in HIV-infected patients were of high histologic grade while salivary gland lymphomas unrelated to HIV were predominantly of low grade MALT type. All lymphomas in both categories expressed the B-cell phenotype. Just as HIV-unrelated lymphomas frequently arise on the background of chronic inflammatory lymphoid processes, lesions characteristic of HIV-lymphadenopathy were still present in some lymphomas of HIV-infected patients. EBV RNA transcripts (EBER) were demonstrated in three, and latent membrane protein (LMP) in two of the six HIV-related and in none of the three HIV-unrelated lymphomas. The three EBER-positive lymphomas were of the histologic types known to express the virus in most cases. The presence of HIV in the form of the core protein p24 and envelope glycoprotein gp41 on the dendritic reticular cells of germinal centers was ascertained in the cases of HIV-related lymphadenopathies but also in the coexistent lymphadenopathies of lymphomas. The practical importance of diagnosing the salivary lymphadenopathies and lymphomas associated with the HIV-infection resides in avoiding their misdiagnosis and surgical removal as tumors of salivary glands.
Collapse
Affiliation(s)
- H L Ioachim
- Department of Pathology, Lenox Hill Hospital, New York, N.Y. 10021, USA
| | | | | | | |
Collapse
|
45
|
Chiang FL, Walot I, Sinow RM, Mehringer CM. Diagnostic imaging of the brain in acquired immunodeficiency syndrome (AIDS). Semin Ultrasound CT MR 1998; 19:133-53. [PMID: 9567319 DOI: 10.1016/s0887-2171(98)90056-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The central nervous system is commonly involved in acquired immunodeficiency syndrome (AIDS), resulting in a variety of lesions and diseases. They can be divided into the primary effects of human immunodeficiency virus (HIV), opportunistic infections, tumors, and vascular disease. This article is a review of the major imaging findings observed in each disease, with clinical and pathological correlations relevant to the goal of differential diagnosis.
Collapse
Affiliation(s)
- F L Chiang
- Department of Radiology, Harbor-UCLA Medical Center, Torrance 90509, USA
| | | | | | | |
Collapse
|
46
|
|
47
|
Abstract
One in six patients with acquired immunodeficiency syndrome (AIDS) both in the USA and Europe develop malignancies, in particular Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). After an initial rapid increase, the proportion of AIDS patients with KS steadily declined in the USA and in Europe, while the proportion of AIDS-NHL has been stable during the last decade in the USA and Europe. Human immunodeficiency virus (HIV) infected patients are living longer due to advances in antiretroviral therapy and treatment of prophylaxis against opportunistic infections, yet because of their immunodeficiency they are at high risk for cancers, especially NHL. The natural history of cancers in patients with HIV infection differs from that of the general population. Unusual aspects of tumor localization, growth behavior and therapeutical response distinguish tumors in patients with HIV infection from those without. The pathologic and virological aspects of HIV-related tumors are peculiar and a pathological classification of HIV-associated systemic lymphomas based on the morphological features of the two main types, ie, blastic and anaplastic cell lymphomas, has been formulated. The treatment of HIV-related neoplasms is controversial as it is not clear whether conventional therapy, particularly chemotherapy, is able to modify the natural history of these malignancies in the HIV setting. Moreover the treatment of HIV-related tumors presents several problems due to the aggressive behaviors of tumors and because of immunosuppressive chemotherapy employed in patients with immunodeficiency. This paper reviews the most relevant data on the epidemiology, pathology and treatment of malignant tumors in patients with HIV infection.
Collapse
Affiliation(s)
- G Nasti
- Division of Medical Oncology and AIDS, National Cancer Center, Aviano, Italy
| | | | | | | |
Collapse
|
48
|
|
49
|
Ioachim HL, Antonescu C, Giancotti F, Dorsett B, Weinstein MA. EBV-associated anorectal lymphomas in patients with acquired immune deficiency syndrome. Am J Surg Pathol 1997; 21:997-1006. [PMID: 9298875 DOI: 10.1097/00000478-199709000-00003] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary lymphomas of the gastrointestinal tract represent 9% of all non-Hodgkin lymphomas, and of these only 3% arise in the rectum or anus. In contrast to their rare occurrence in the general population, the incidence of anorectal lymphomas in patients with acquired immune deficiency syndrome (AIDS), particularly homosexual patients, may be as high as 26% as reported in our own series of AIDS-associated lymphomas. To determine the characteristics of this entity, we studied 15 cases of primary anorectal lymphoma in AIDS patients and compared them with four cases of anorectal lymphoma unrelated to AIDS. The cases in our study were also compared with the reports of rectal lymphoma in the medical literature over the past 30 years. In the present series, the AIDS patients were all male with a median age of 34 years, human immunodeficiency virus (HIV)-positive, with homosexuality as the main risk factor. The four non-AIDS patients included a woman and had a median age of 66.5 years. Histologically, the anorectal lymphomas in AIDS patients were all high grade, predominantly immunoblastic, and polymorphous. In the non-AIDS patients, only two of four lymphomas were high grade, including one Burkitt type. All tumors were of B-cell phenotype. In the AIDS-associated anorectal lymphomas, the presence of Epstein-Barr virus (EBV) in a latent form was demonstrated by an abundance of Epstein-Barr-encoded RNA (EBER) in 14 of 15 cases and latent membrane protein (LMP) in four cases. All anorectal lymphomas unrelated to AIDS were negative for EBV. The unusual anorectal location of AIDS-associated lymphomas is explainable by the high incidence of preceding traumatic lesions and chronic infections in the area. As a result, EBV-carrying B cells may be attracted to the field providing the cell population that, under the conditions of immune deficiency, is able to give rise to high-grade lymphomas.
Collapse
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/epidemiology
- Acquired Immunodeficiency Syndrome/pathology
- Adult
- Aged
- Aged, 80 and over
- Antigens, Viral/analysis
- Anus Neoplasms/complications
- Anus Neoplasms/epidemiology
- Anus Neoplasms/pathology
- B-Lymphocytes/chemistry
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Burkitt Lymphoma/complications
- Burkitt Lymphoma/epidemiology
- Burkitt Lymphoma/pathology
- Female
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/immunology
- Homosexuality, Male
- Humans
- Immunophenotyping
- Incidence
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Phenotype
- RNA, Viral/analysis
- RNA, Viral/genetics
- Rectal Neoplasms/complications
- Rectal Neoplasms/epidemiology
- Rectal Neoplasms/pathology
- Risk Factors
Collapse
Affiliation(s)
- H L Ioachim
- Department of Pathology, Lenox Hill Hospital and New York University, New York 10021-1883, USA
| | | | | | | | | |
Collapse
|
50
|
Cool CD, Bitter MA. The malignant lymphomas of Kenya: morphology, immunophenotype, and frequency of Epstein-Barr virus in 73 cases. Hum Pathol 1997; 28:1026-33. [PMID: 9308726 DOI: 10.1016/s0046-8177(97)90055-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent information is limited regarding pathological features of the malignant lymphomas of Africa, other than Burkitt's lymphoma. In this study, we apply modern techniques and nomenclature to classify 73 lymphomas from a central histopathology laboratory serving 40 mission hospitals in Kenya. We were particularly interested in the frequency of recently recognized lymphomas and the incidence of Epstein-Barr virus in various lymphoma subtypes. Malignant lymphomas accounted for 12% of all surgical pathology specimens processed in the laboratory over the 21-month period included in the study. Patient age ranged from 4 to 97 years (median, 35 years). The male-to-female ratio was 2.5:1. Sixty lymphomas (82%) were non-Hodgkin's, and 13 (18%) were Hodgkin's disease. Of the non-Hodgkin's lymphomas (NHLs), 52 (87%) were B-lineage, including 21 (35% of NHLs) Burkitt's lymphomas (only one from the jaw), 11 (18%) diffuse large B cell lymphomas; nine (15%) small lymphocytic lymphomas, six (10%) Burkitt's-like lymphomas, two (3%) follicular lymphomas (two of two expressed bcl-2 protein; one of two showed bcl-2 major breakpoint region rearrangement), two (3%) mantle cell lymphomas, and one extranodal marginal zone lymphoma. Of the eight T cell lymphomas, six were precursor T-cell type, and the remaining two were peripheral T cell lymphomas, unspecified. The median age of the 13 patients (18% of lymphomas) with Hodgkin's disease was 23 years (range, 9 to 97 years). Six were nodular sclerosis, four were mixed cellularity, one case each was lymphocyte depletion, lymphocyte predominance, and unclassified Hodgkin's disease. Hodgkin's cells in 6 of the 12 nonlymphocyte predominance cases were positive for CD20, and in three of the six for CD45 as well. Epstein-Barr virus was identified using in situ hybridization for EBER 1 in the malignant cells of 22 of 39 informative lymphomas, including each of 17 Burkitt's lymphomas, and three of seven diffuse large B cell lymphomas. Of note, none of five Burkitt's-like lymphomas expressed EBER 1. One of two informative cases of peripheral T cell lymphoma, and four of nine cases of Hodgkin's disease were EBER 1 positive. In summary, T cell lymphomas and recently recognized B-lineage non-Hodgkin's lymphoma subtypes do not appear to be particularly common in East Africa.
Collapse
Affiliation(s)
- C D Cool
- Department of Pathology, University of Colorado Health Sciences Center, Denver 80262, USA
| | | |
Collapse
|