Malignancies in the acquired immunodeficiency syndrome

Diagnostic imaging in pediatric AIDS

The manifestations of acquired immune deficiency syndrome (AIDS) in children are mainly secondary to opportunistic infection, lymphoproliferative diseases, and AIDS-related neoplasms. This article reviews the pathologic findings of various disorders afflicting children with AIDS and emphasizes the imaging of these disorders. Although many of the radiologic findings are not specific for a particular infection or neoplasm, the differential diagnostic possibilities for an abnormality can be narrowed down significantly with proper clinical correlation and knowledge of the imaging findings and pathologies specific to children with AIDS.

Lower extremity lymphedema caused by acquired immune deficiency syndrome-related Kaposi's sarcoma: case report and review of the literature

A case of severe lymphedema of the lower extremity caused by obstruction by human immunodeficiency virus-associated Kaposi's sarcoma is presented. A review of the signs and symptoms of obstructive lymphedema and Kaposi's sarcoma is provided. Early recognition of this clinical entity may allow use of simple preventative measures and help to avoid this life- and limb-threatening situation.

Pediatric HIV infection: an imaging update

Infection with the human immunodeficiency virus (HIV) can produce a broad range of illness, including opportunistic infections, lymphoproliferative diseases, and benign and malignant neoplasms. Each conditions has its own spectrum of imaging findings. This paper will highlight those findings in children suffering from HIV infection/AIDS. We will stress the findings in the more frequently involved organ systems and those that are unique to children.

Malignant lymphomas in HIV-seropositive patients. Frequency, features, and prognosis. Report on 31 cases

In a random HIV-seropositive population, malignant lymphomas were diagnosed in 31 patients, of whom 24 (77%) had non-Hodgkin lymphoma (NHL) and 7 (23%) Hodgkin lymphoma (HL). The prevalence of NHL among AIDS patients was 8% (23/279 cases), with a prevalence of 17% among autopsied patients (16/96 cases). No patient with HL had AIDS at the time of diagnosis. In 7 of 23 AIDS patients with NHL (30%) the diagnosis was made only post mortem; among these were all 5 patients with primary CNS NHL. Median survival from the time of diagnosis was 1 month for patients with NHL and 3 months for those with HL. In individual patients, survival for several years may be possible with chemotherapy. Certain patients with NHL appear to benefit from intensive chemotherapy with a combination of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOPB protocol). Appropriate, therapeutic strategies taking into account the patients' individual conditions, including the overall prognosis, urgently requires development. Metastatic CNS involvement, which was the primary cause of death in 5 of 11 patients with NHL (45%) receiving chemotherapy, represents a serious limitation to successful treatment.

Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival

To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill.

Aggressive non-Hodgkin's lymphomas in AIDS: the University of Colorado experience

The authors performed this retrospective study to further investigate the relationship between non-Hodgkin's lymphoma (NHL) and the Acquired Immunodeficiency Syndrome (AIDS). From January 1984 through December 1987 all cases of AIDS and NHL diagnosed at the University of Colorado affiliated hospitals were identified and submitted to chart review. Twenty-five patients fulfilled criteria for the diagnosis of AIDS and 24 had biopsy-proven NHL, an additional patient met criteria for the diagnosis of primary central nervous system lymphoma and was included in the analysis. All patients had known risk factors for the development of AIDS. Of the biopsy proven tumors, 23 were categorized as high grade. Most patients (68%) presented with stage IV disease and 92% with extra nodal involvement. Median survival was 5 months and the cause of death was most often progressive lymphoma and/or opportunistic infections. These data are similar to previously published series. Clinical trials to evaluate effective treatment are warranted.

Primary central nervous system lymphomas: natural history and response to radiation therapy in 55 patients with acquired immunodeficiency syndrome

The incidence of primary central nervous system (CNS) lymphoma has increased rapidly in patients with acquired immunodeficiency syndrome (AIDS) and is predicted to exceed 1800 cases annually by 1991. To characterize the natural history and response to radiation therapy (RT) of these lesions, the authors have reviewed the clinical histories of 55 AIDS patients with biopsy-proven primary CNS lymphomas. The tumors responded both clinically and radiologically to whole-brain RT consisting of 4000 rad in 267-rad fractions over 3 weeks or an equivalent neuroret dose. The mean duration of survival from the appearance of symptoms consistent with the mass lesion was significantly greater in patients who received RT than in those who did not (42 vs. 134 days, p less than 0.5; median 27 vs. 119 days). Autopsy findings showed that patients who did not receive RT died from tumor progression, whereas those who completed RT died of opportunistic infections. Patients with AIDS who are suspected of having primary CNS lymphoma should therefore immediately undergo biopsy and, if the diagnosis is confirmed, whole-brain RT. With early diagnosis and treatment, these tumors respond to, and patients benefit from, RT. Survival of such patients may in future be prolonged by more effective treatments for systemic opportunistic infections.

Testicular seminoma associated with the acquired immunodeficiency syndrome and acquired immunodeficiency syndrome related complex: 2 case reports

Two homosexual men positive for human immunodeficiency virus with evidence of acquired cellular immunodeficiency were diagnosed recently to have seminoma of the testis. One man has the acquired immunodeficiency syndrome with lymphopenia, a low CD4:CD8 ratio, condylomata accuminata, pneumocystis carinii and cerebral toxoplasmosis, and 1 has an acquired immunodeficiency syndrome related complex with generalized lymphadenopathy showing follicular hyperplasia on biopsy, recurrent Herpes simplex infections and lymphopenia but a supranormal CD4:CD8 ratio. Neither patient has a known risk factor for testicular seminoma. Our report provides supportive evidence for the presence of an increased risk of seminoma of the testis in patients with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome related complex.

Basal cell carcinoma in a patient with acquired immunodeficiency syndrome: treatment with Mohs micrographic surgery fixed-tissue technique

A case illustrating Mohs micrographic surgery fixed-tissue technique in the treatment of a large basal cell carcinoma of the left nasal alar groove in a patient with acquired immunodeficiency syndrome is described. Fixation of the tissue before excision and appropriate infectious disease precautions minimize exposure to the human immunodeficiency virus by the surgical and laboratory personnel, while Mohs micrographic mapping assures complete removal of a potentially life-threatening cancer in an immunocompromised patient.