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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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2
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Legeard I, Chevrollier MA, Bader G. Diagnosis of a plasmoblastic lymphoma of the mandible after renal transplantation: a case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2021. [DOI: 10.1051/mbcb/2021036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Post-transplant lymphoproliferations (PTL) are a severe complication of solid organ transplants. Their locations can be extra-nodal. Observation: The diagnosis and management of a non-Hodgkin's plasmablastic lymphoma of mandibular localization affecting a 66-year-old kidney transplanted patient are reported here. Comment: The main risk factors for non-Hodgkin lymphoma are immunosuppression and infection with Epstein-Barr virus. Clinical and radiographic examinations, which are not specific, must be supplemented by a histological examination. Treatment which is not consensual will most often consist of a reduction in immunosuppression coupled with chemotherapy. Conclusion: Despite a constant evolution in the incidence and clinical picture of post-transplant lymphomas, the role of the dentist remains essential in the early detection of lesions.
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Bhattacharyya S, Bains AP, Sykes DL, Iverson BR, Sibgatullah R, Kuklani RM. Lymphoid neoplasms of the oral cavity with plasmablastic morphology—a case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:651-659. [DOI: 10.1016/j.oooo.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/27/2019] [Accepted: 08/01/2019] [Indexed: 01/27/2023]
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4
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Dagher E, Soetart N, Chocteau F, Dequéant B, Piccirillo E, Ibisch C, Abadie J, Jaillardon L. Plasma cell leukemia with plasmablastic morphology in a dog. J Vet Diagn Invest 2019; 31:868-874. [PMID: 31609183 PMCID: PMC6900715 DOI: 10.1177/1040638719882045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A 5-y-old female Golden Retriever was presented with a 2-wk history of hyporexia, vomiting, diarrhea, lethargy, weight loss, polyuria, and polydipsia. Clinical examination and ultrasonography revealed multiple organ enlargement with gallbladder and kidney nodules suggestive of disseminated neoplasia. Hematologic and biochemical analyses revealed pancytopenia, hypercalcemia, and monoclonal IgA gammopathy suspicious for a plasma cell neoplasm. Bone marrow and blood smear examination revealed neoplastic atypical cells highly suggestive of lymphoid origin. Autopsy confirmed the presence of homogeneous white masses and multifocal pale infiltrates in the spleen, kidney, small intestine, gallbladder, and urinary tract. Histologic features were consistent with a multicentric atypical plasma cell tumor. Tumor cells were negative for CD204, IBA-1, E-cadherin, CD3, CD5, CD79a, CD20, and PAX5, and positive for MUM1, consistent with plasma cell origin. The presence of > 20% of circulating blastic plasma cells was consistent with primary plasma cell leukemia with plasmablastic morphology, a disease rarely described in veterinary medicine.
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Affiliation(s)
- Elie Dagher
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Nicolas Soetart
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Florian Chocteau
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Bérengère Dequéant
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Esther Piccirillo
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Catherine Ibisch
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Jérôme Abadie
- Department of Biology, Pathology and Food Sciences,
Laboniris (Dagher, Soetart, Chocteau, Dequéant, Abadie, Jaillardon), Nantes,
France
- Department of Clinical Sciences (Piccirillo,
Ibisch), Nantes, France
- École nationale vétérinaire, agroalimentaire et de
l’alimentation de Nantes-Atlantique (Oniris), Nantes, France
| | - Laëtitia Jaillardon
- Laëtitia Jaillardon,
Department of Biology, Pathology and Food Sciences, Oniris, Laboniris, 102 route
de Gachet, Nantes, Pays de la Loire, 44300, France.
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Ma H, Wei MH, Qin HM, Wang GY, Hu ZC. Long-Term Survival of Primary Intracranial Plasmablastic Lymphoma: Case Report and Review of the Literature. World Neurosurg 2016; 97:750.e5-750.e10. [PMID: 27794513 DOI: 10.1016/j.wneu.2016.10.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary intracranial plasmablastic lymphoma (PIPBL) is a rare malignant tumor. CASE DESCRIPTION We present a case of PIPBL in a 32-year-old man who complained of a progressive growing, painful mass on the right parieto-occipital part of head. Computed tomography and magnetic resonance imaging revealed a homogeneously enhanced mass with partial bone destruction. The patient underwent total resection and cranioplasty in one stage. Histopathologic examination showed large tumor cells with immunoblast-like nuclei. Immunohistochemical staining displayed CD38(+), CD138(+), Mum-1(+), CD20(-), and PAX-5(-). The patient received chemotherapy. The patient has survived more than 3.5 years after operation, with follow-up. We also review the clinical data, molecular pathologic traits, treatment, and prognosis of additional 6 cases with PIPBL in the literature. CONCLUSIONS This study provides important clinical information for the diagnosis and treatment of PIPBL.
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Affiliation(s)
- Hui Ma
- Department of Pharmacology, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, PR China
| | - Ming-Hai Wei
- Department of Neurosurgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, PR China
| | - Hua-Min Qin
- Department of Pathology, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, PR China
| | - Guan-Yu Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, PR China
| | - Zeng-Chun Hu
- Department of Neurosurgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, PR China.
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Mondello P, Pitini V, Barresi V, Brea EJ, Di Mirto C, Arrigo C, Cuzzocrea S, Mian M. Extranodal diffuse large B-cell lymphoma with monoclonal gammopathy: an aggressive and primary refractory disease responding to an immunomodulatory agent. Exp Hematol Oncol 2016; 5:1. [PMID: 26740908 PMCID: PMC4702294 DOI: 10.1186/s40164-015-0030-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/29/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although the clinical outcome of patients with diffuse large B cell lymphoma (DLBCL) has been improved by the addition of rituximab to standard chemotherapy, almost one-third fails or relapses after first line treatment. The presence of monoclonal gammopathy (MG) is a known adverse prognostic factor for DLBCL. Because this subset of patients does not benefit from R-CHOP, new therapeutic options are required. Herein, we report the first case of extranodal DBCL of the lung with a concomitant MG who achieved a long lasting complete remission with lenalidomide. CASE PRESENTATION The 73-year-old male patient presented with lateral cervical lymphadenopathy, B symptoms, lactate dehydrogenase and beta2-microglobulin elevation. Computed tomography (CT) showed mediastinal lymphadenopathy and bilateral lung involvement. Biopsy of both disease locations revealed the presence of DLBCL. Successive bone marrow trephine biopsy proved the presence of concordant DLBCL involvement. At the time of diagnosis, a MG was present as well. The patient did not respond to the standard treatments, and subsequently underwent lenalidomide 25 mg/m(2) days 1-21 q28 plus dexamethasone 40 mg days 1-4, 9-12 e 17-20. This therapeutic regimen was efficacious and safe as salvage therapy in extranodal DBCL with a MG. Furthermore, we observed a close association between DLBCL response to therapy and MG levels, suggesting that the amount of M-protein might be a surrogate marker of disease response. CONCLUSION Although DLBCL associated with MG does not respond properly to the standard treatments, it is highly sensitive to lenalidomide, which is why we endorse its role as treatment of choice in this subset of patients. In addition, MG levels appear to correlate with tumor burden, suggesting that it might be a useful marker of disease response. Prospective trials to validate these observations are warranted.
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Affiliation(s)
- Patrizia Mondello
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy ; Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy ; Lymphoma Department, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY USA
| | - Vincenzo Pitini
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Valeria Barresi
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Elliott Joseph Brea
- Molecular Pharmacology and Chemistry Program, Sloan-Kettering Institute, New York, NY USA ; Weill Cornell Medical College, New York, NY USA
| | - Cristian Di Mirto
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Carmela Arrigo
- Department of Internal Medicine, University of Messina, Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Michael Mian
- Department of Hematology and CBMT, Ospedale di Bolzano, Bolzano, Italy ; Universitätsklinik für Innere Medizin V, Hämatologie and Onkologie, Innsbruck, Austria
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7
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Plasmablastic lymphoma versus diffuse large B cell lymphoma with plasmablastic differentiation: proposal for a novel diagnostic scoring system. J Hematop 2015. [DOI: 10.1007/s12308-014-0227-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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8
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Jiang P, Liu M, Liu B, Liu B, Zhou Y, Dong L. Human immunodeficiency virus-negative plasmablastic lymphoma in the neck: a rare case report and literature review. Eur J Med Res 2014; 19:64. [PMID: 25416032 PMCID: PMC4243291 DOI: 10.1186/s40001-014-0064-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive neoplasm exclusively occurring in AIDS patients. Recently, increasing cases of human immunodeficiency virus (HIV)-negative PBL have been reported. No standard therapy protocol is currently available since there is a great difference between PBL with and without HIV infection. Here, we present a rather rare case of HIV-negative PBL in the neck that dramatically responded to radiotherapy alone. Our case highlights the possibility of PBL in the neck and helps to expand our understanding of this separate lymphoma. The related literature review summarized the clinicopathological features and treatment status of HIV-negative PBL.
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Affiliation(s)
| | | | | | | | | | - Lihua Dong
- Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China.
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9
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Interplay among viral antigens, cellular pathways and tumor microenvironment in the pathogenesis of EBV-driven lymphomas. Semin Cancer Biol 2013; 23:441-56. [DOI: 10.1016/j.semcancer.2013.07.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/22/2022]
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10
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Gloghini A, Dolcetti R, Carbone A. Lymphomas occurring specifically in HIV-infected patients: from pathogenesis to pathology. Semin Cancer Biol 2013; 23:457-67. [PMID: 23999127 DOI: 10.1016/j.semcancer.2013.08.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 12/22/2022]
Abstract
Lymphomas that develop in HIV positive patients are predominantly aggressive B-cell malignancies. The most common HIV-associated lymphomas are Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL). Lymphomas that occur specifically in HIV positive patients include primary effusion lymphoma (PEL) and its solid variants, plasmablastic lymphoma of the oral cavity type and lymphoma associated with Kaposi sarcoma herpesvirus (KSHV)-related multicentric Castleman disease. These lymphomas, together with BL and immunoblastic lymphoma subtypes with plasmacytoid differentiation, carry Epstein-Barr virus (EBV) infection and display a phenotype related to plasma cells. Globally, EBV is identified in the neoplastic cells of approximately 40% of HIV-associated lymphomas, but the detection of EBV varies considerably with the site of presentation and the histological subtype. EBV infection occurs in 80-100% of primary central nervous system lymphomas and PELs, 80% of DLBCLs with immunoblastic-plasmacytoid features, and 30-50% of BL-plasmacytoid. KSHV is specifically associated with PEL, which usually occurs in a setting of profound immunosuppression. Current knowledge about HIV-associated lymphomas can be summarized as follows: (1) lymphomas specifically occurring in patients with HIV infection are closely linked to other viral diseases; (2) most of these lymphomas exhibit plasmablastic differentiation.
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Affiliation(s)
- Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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11
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Pather S, MacKinnon D, Padayachee RS. Plasmablastic lymphoma in pediatric patients: clinicopathologic study of three cases. Ann Diagn Pathol 2012; 17:80-4. [PMID: 23036261 DOI: 10.1016/j.anndiagpath.2012.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/07/2012] [Accepted: 08/07/2012] [Indexed: 11/16/2022]
Abstract
Plasmablastic lymphoma (PBL) is an aggressive high grade non-Hodgkin lymphoma which occurs predominantly in adult patients who are concomitantly afflicted with HIV infection. In contrast to several reports and studies of PBL in adult patients, PBL has very rarely been reported in pediatric patients. This article hereby provides collaborative clinicopathologic information of de novo PBL diagnosed in 3 pediatric patients with concomitant HIV infection. Cognizance of this rare tumor in the pediatric population coupled with antiretroviral therapy and prompt initiation of multimodality treatment may, in the future, facilitate improved outcome in pediatric patients with PBL.
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Affiliation(s)
- Sugeshnee Pather
- Department of Anatomical Pathology, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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12
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Sagüés M, Navarro JT, Ribera JM, Millá F. Linfoma plasmablástico de localización testicular como primera manifestación de infección por el VIH. Med Clin (Barc) 2012; 139:89-90. [DOI: 10.1016/j.medcli.2011.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 11/29/2022]
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13
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Favorable outcome of plasmablastic lymphoma expressing both immunoglobulin light chains arising in an immunocompetent man. J Hematop 2012. [DOI: 10.1007/s12308-012-0150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Plasmablastic lymphoma of the retroperitoneum in an HIV- and HCV-positive patient: hard to diagnose and harder to treat. Med Oncol 2012; 29:3529-34. [DOI: 10.1007/s12032-012-0248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
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Plasmablastic lymphoma of the oral cavity, a B cell-derived lymphoma associated with HIV infection: a case series. Eur Arch Otorhinolaryngol 2012; 269:1713-9. [PMID: 22350427 DOI: 10.1007/s00405-012-1952-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Plasmablastic lymphoma (PBL) of the oral cavity is a rare form of non-Hodgkin lymphoma that is most frequently met in human immunodeficiency (HIV) positive patients. Only a few cases have been reported worldwide since 1997. This clinical entity may escape detection due to its unusual immunophenotype and rare occurrence. Our aim is to present two cases with this rare condition that were diagnosed and treated in our department. MATERIALS AND METHODS We describe two cases of PBLs in HIV-infected patients, who presented with an expanding painless oral lesion and summarize the literature in order to elucidate the nature of this malignancy. RESULTS The first patient received chemotherapy with additional radiotherapy that led to complete remission of the disease, while the second experienced a relapse 6 months after treatment with chemotherapy, that caused his death after refusal of further treatment. CONCLUSION Because of the consistent epidemiological association of PBL with immunosuppression, any patient diagnosed with PBL should be tested for HIV. The clinical picture of PBL, including its affinity with HIV-infection, male sex, and its predilection for the oral cavity, may contribute to the differential diagnosis. Any oral mass occurring in an immunosuppressed patient should be referred for biopsy, since the early diagnosis of these tumors leads to better prognosis of the patients.
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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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17
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Brahmania M, Sylwesterowic T, Leitch H. Plasmablastic lymphoma in the ano-rectal junction presenting in an immunocompetent man: a case report. J Med Case Rep 2011; 5:168. [PMID: 21539737 PMCID: PMC3107799 DOI: 10.1186/1752-1947-5-168] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/03/2011] [Indexed: 12/12/2022] Open
Abstract
Introduction Plasmablastic lymphoma is an aggressive non-Hodgkin lymphoma classically occurring in individuals infected with HIV. Plasmablastic lymphoma has a predilection for the oral cavity and jaw. However, recent case reports have shown lymphoma in the stomach, lung, nasal cavity, cervical lymph nodes and jejunum in HIV-negative individuals. We report what is, to the best of our knowledge, the first case of plasmablastic lymphoma occurring in the ano-rectal junction of an HIV-negative man. Case Presentation A previously healthy 59-year-old Caucasian man presented with painless rectal bleeding. Colonoscopy revealed a lesion in the ano-rectal junction, with pathological examination demonstrating atypical lymphoid cells consisting primarily of plasmablasts with rounded nuclei, coarse chromatin, small nucleoli and multiple mitotic figures. Immunohistochemical analysis showed the atypical cells were negative for CD45, CD20, CD79a and immunoglobulin light chains, but were strongly positive for CD138 and EBV-encoded RNA. The results were consistent with a diagnosis of plasmablastic lymphoma. Aggressive systemic chemotherapy and involved field radiation therapy resulted in complete clinical and pathological remission. Conclusion Increasing awareness of plasmablastic lymphoma in HIV-negative individuals and in this location is warranted.
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Affiliation(s)
- Mayur Brahmania
- Department of Medicine, Division of Gastroenterology & Hematology, St Paul's Hospital, Vancouver, BC, V5Z 1M9, Canada.
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18
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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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19
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Castellarin P, Pozzato G, Tirelli G, Di Lenarda R, Biasotto M. Oral lesions and lymphoproliferative disorders. JOURNAL OF ONCOLOGY 2010; 2010:202305. [PMID: 20871659 PMCID: PMC2939410 DOI: 10.1155/2010/202305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/13/2010] [Accepted: 07/26/2010] [Indexed: 11/17/2022]
Abstract
Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.
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Affiliation(s)
- P. Castellarin
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - G. Pozzato
- Department of Haematology, University of Trieste, 34142 Trieste, Italy
| | - G. Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Trieste, 34127 Trieste, Italy
| | - R. Di Lenarda
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - M. Biasotto
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
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20
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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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21
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Sarode SC, Sarode GS, Patil A. Plasmablastic lymphoma of the oral cavity: A review. Oral Oncol 2010; 46:146-53. [DOI: 10.1016/j.oraloncology.2009.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 12/20/2009] [Accepted: 12/21/2009] [Indexed: 12/26/2022]
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22
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Lester R, Li C, Phillips P, Shenkier TN, Gascoyne RD, Galbraith PF, Vickars LM, Leitch HA. Improved Outcome of Human Immunodeficiency Virus-Associated Plasmablastic Lymphoma of the Oral Cavity in the Era of Highly Active Antiretroviral Therapy: A Report of Two Cases. Leuk Lymphoma 2009; 45:1881-5. [PMID: 15223650 DOI: 10.1080/10428190410001697395] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Plasmablastic lymphoma (PBL) is a recently described type of non-Hodgkin's lymphoma (NHL) that occurs in up to 3% of patients with HIV infection. Although the clinical-pathological features of several patients with HIV-associated plasmablastic lymphoma are documented, detailed description of clinical outcome is limited to isolated case reports. Generally, the response to lymphoma therapy is poor and survival is short. Response to highly active anti-retroviral therapy (HAART), however, has also been described. In this report, we describe the clinical course of two patients diagnosed with HIV-associated PBL in the era of HAART. One patient had a complete response to HAART, with a response-duration of 14 months, followed by relapse in the gastrointestinal tract several months after an anti-retroviral holiday. He is currently in complete remission (CR) eight months from diagnosis of relapse after receiving a full course of combination chemotherapy with modified CHOP, and 25 months from initial diagnosis. A second patient responded to brief chemotherapy in conjunction with HAART and is in clinical CR ten months from diagnosis. These cases illustrate that immunologic and virologic control with HAART may be beneficial for treating PBL and may possibly maintain continued CR. We advocate a high index of suspicion for primary PBL or its recurrence in patients with HIV infection, a history of low CD4 counts or high viral load, and oral or gastrointestinal symptoms.
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Affiliation(s)
- Richard Lester
- Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Abstract
Plasmablastic lymphoma was originally described in 1997 by Delecluse et al. and is an aggressive variant of diffuse large B-cell non-Hodgkin lymphoma seen predominantly in a setting of acquired immunodeficiency syndrome and nearly always in extranodal sites. The authors have seen 10 cases in their department between 2001 and 2005. The patients' ages ranged from 24 to 39 years and there were 7 females and 3 males. In 7 cases where human immunodeficiency virus had been tested it was positive. Eight cases were extranodal and 2 cases involved lymph nodes. Five cases were followed up and 4 were confirmed dead within 5 months of diagnosis, verifying the aggressive nature of this condition. Histology showed large, polygonal tumor cells some of which had a slightly plasmacytic appearance. Six cases had a "starry sky" background. Immunohistochemical stains were negative in 1 case, while the other 9 cases were positive for CD138. Electron microscopy showed concentrically arranged rough endoplasmic reticulum in the cytoplasm in 9 cases. In 1 case the cells were too degenerate for evaluation. This study shows that the ultrastructural features are well developed and can help in distinguishing plasmablastic lymphoma from other light microscopically undifferentiated tumors.
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MESH Headings
- Adult
- Diagnosis, Differential
- Female
- HIV Infections/complications
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/ultrastructure
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/ultrastructure
- Male
- Microscopy, Electron, Transmission
- Multiple Myeloma/pathology
- Plasmacytoma/pathology
- Syndecan-1/metabolism
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Affiliation(s)
- J Goedhals
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Free State and National Health Laboratory Services, Bloemfontein, South Africa
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24
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Carbone A, Gloghini A, Rinaldo A, Devaney KO, Tubbs R, Ferlito A. True identity by immunohistochemistry and molecular morphology of undifferentiated malignancies of the head and neck. Head Neck 2009; 31:949-61. [DOI: 10.1002/hed.21080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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25
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Liu ML, Kallakury B, Kessler C, Hartmann DP, Azumi N, Ozdemirli M. Chronic idiopathic myelofibrosis terminating in extramedullary anaplastic plasmacytoma. Leuk Lymphoma 2009; 47:315-22. [PMID: 16321864 DOI: 10.1080/10428190500286358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic idiopathic myelofibrosis (CIMF) is a chronic myeloproliferative disorder (CMPD) with progressive fibrosis and extramedullary hematopoiesis. Similar to other CMPDs, the stem cell in CIMF has the potential to differentiate into myeloid or lymphoid lineages, and thus CIMF can culminate in acute leukemia of myeloid or, rarely, lymphoid lineage. We describe an unusual case of CIMF terminating in extramedullary anaplastic plasmacytoma. The patient was a 61-year-old male with an 11-year history of CIMF. His course was complicated by rapidly growing abdominal and inguinal lymphadenopathy. Lymph node biopsy revealed a diffuse undifferentiated infiltrate in the background of extramedullary hematopoiesis. Flow cytometric and immunohistochemical analysis demonstrated plasma cell-related antigens (CD138, CD38, cytoplasmic kappa light chain), epithelial membrane antigen and CD43 in the tumor cells. The myeloid, B-cell or T-cell markers were negative. A clonal immunoglobulin heavy chain gene rearrangement was identified by polymerase chain reaction. The plasma cell origin was further confirmed by electron microscopic examination, which revealed stacks of rough endoplasmic reticulum. Monoclonal gammopathy may occur in CIMF, and rare cases of simultaneous plasma cell myeloma and CIMF have been reported in the literature. However, to the best of our knowledge, this is the first report of CIMF terminating in extramedullary anaplastic plasmacytoma.
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Affiliation(s)
- Min-Ling Liu
- Department of Pathology, Georgetown University Hospital, 3900 Reservoir Road, NW, Washington, DC 20007, USA
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26
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Bose P, Thompson C, Gandhi D, Ghabach B, Ozer H. AIDS-related plasmablastic lymphoma with dramatic, early response to bortezomib. Eur J Haematol 2009; 82:490-2. [DOI: 10.1111/j.1600-0609.2009.01235.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Mendoza N, Diamantis M, Arora A, Bartlett B, Gewirtzman A, Tremaine AM, Tyring S. Mucocutaneous manifestations of Epstein-Barr virus infection. Am J Clin Dermatol 2009; 9:295-305. [PMID: 18717604 DOI: 10.2165/00128071-200809050-00003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This review focuses on Epstein-Barr virus (EBV) infection, diagnosis, and current treatment, with emphasis on EBV-associated mucocutaneous manifestations in primary infections, acute EBV-associated syndromes, chronic infections, lymphoproliferative disorders, and lymphomas. In primary infection, EBV infects B cells and can cause mucocutaneous manifestations in infectious mononucleosis or acute EBV-associated syndromes such as Gianotti-Crosti syndrome and hemophagocytic syndrome. EBV then persists in the majority of humans generally without causing disease. In some cases, however, latent EBV infection may result in diseases such as hydroa vacciniforme, hypersensitivity to mosquito bites, and lymphoproliferative disorders such as plasmablastic lymphoma, oral hairy leukoplakia, and post-transplant lymphoproliferative disorders, particularly in immunocompromised patients. Latent EBV infection has also been implicated in a variety of malignant conditions such as Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, and Kikuchi histocytic necrotizing lymphadenitis. Since the immune system is critical in preventing the progression of EBV disease, the immunologic status of the patient plays a crucial role in the subsequent development of pathologies.
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28
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Abstract
Among the most common HIV-associated lymphomas are Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) with immunoblastic-plasmacytoid differentiation (also involving the central nervous system). Lymphomas occurring specifically in HIV-positive patients include primary effusion lymphoma (PEL) and its solid variants, plasmablastic lymphoma of the oral cavity type and large B-cell lymphoma arising in Kaposi sarcoma herpesvirus (KSHV)-associated multicentric Castleman disease. These lymphomas together with BL and DLBCL with immunoblastic-plasmacytoid differentiation frequently carry EBV infection and display a phenotype related to plasma cells. EBV infection occurs at different rates in different lymphoma types, whereas KSHV is specifically associated with PEL, which usually occurs in the setting of profound immunosuppression. The current knowledge about HIV-associated lymphomas can be summarized in the following key points: (1) lymphomas specifically occurring in patients with HIV infection are closely linked to other viral diseases; (2) AIDS lymphomas fall in a spectrum of B-cell differentiation where those associated with EBV or KSHV commonly exhibit plasmablastic differentiation; and (3) prognosis for patients with lymphomas and concomitant HIV infection could be improved using better combined chemotherapy protocols incorporating anticancer treatments and antiretroviral drugs.
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29
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Carbone A, Gloghini A, Dotti G. EBV-associated lymphoproliferative disorders: classification and treatment. Oncologist 2008; 13:577-85. [PMID: 18515742 DOI: 10.1634/theoncologist.2008-0036] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since its discovery as the first human tumor virus, Epstein-Barr virus (EBV) has been implicated in the development of a wide range of B-cell lymphoproliferative disorders, including Burkitt's lymphoma, classic Hodgkin's lymphoma, and lymphomas arising in immunocompromised individuals (post-transplant and HIV-associated lymphoproliferative disorders). T-cell lymphoproliferative disorders that have been reported to be EBV associated include a subset of peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphoma, extranodal nasal type natural killer/T-cell lymphoma, and other rare histotypes. EBV encodes a series of products interacting with or exhibiting homology to a wide variety of antiapoptotic molecules, cytokines, and signal transducers, hence promoting EBV infection, immortalization, and transformation. However, the exact mechanism by which EBV promotes oncogenesis is an area of active debate. The focus of this review is on the pathology, diagnosis, classification, and pathogenesis of EBV-associated lymphomas. Recent advances in EBV cell-based immunotherapy, which is beginning to show promise in the treatment of EBV-related disorders, are discussed.
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MESH Headings
- Adult
- Disease Susceptibility
- Epstein-Barr Virus Infections/classification
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/virology
- Herpesvirus 4, Human/classification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/immunology
- Humans
- Immunocompromised Host/immunology
- Immunotherapy
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/virology
- Lymphoma, T-Cell/classification
- Lymphoma, T-Cell/immunology
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/virology
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Affiliation(s)
- Antonino Carbone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian 1, Milano I-20133, Italy.
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30
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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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31
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Chuah KL, Ng SB, Poon L, Yap WM. Plasmablastic lymphoma affecting the lung and bone marrow with CD10 expression and t(8;14)(q24;q32) translocation. Int J Surg Pathol 2008; 17:163-6. [PMID: 18508845 DOI: 10.1177/1066896908316785] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Plasmablastic lymphoma is a rare variant of a diffuse, large B-cell lymphoma, which typically presents in the oral cavity in immunocompromised patients. In HIV positive patients, this tumor has a tendency to manifest in extramedullary sites. In this report, we document a rare instance in which this neoplasm besides affecting the bone marrow also involved the lung. In addition, the lymphoma in our case disclosed CD10 positivity on immunohistochemistry and t(8;14)(q24;q34) translocation on cytogenetic analysis, mimicking a Burkitt/atypical Burkitt lymphoma. The problems in diagnosis are discussed.
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32
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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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33
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KSHV/HHV8 Doesn't Play a Significant Role in the Development of Plasmablastic Lymphoma of the Oral Cavity. Am J Surg Pathol 2008. [DOI: 10.1097/pas.0b013e3180dc92d5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Abstract
This review looks at the current state of knowledge on primary effusion lymphoma (PEL) and other Kaposi sarcoma herpesvirus (KSHV)/human herpesvirus 8 (HHV8)-associated lymphomas. In 1995, KSHV DNA sequences were identified within a distinct subgroup of acquired immunodeficiency syndrome-related non-Hodgkin lymphomas localized in body cavities and presenting as pleural, peritoneal and pericardial lymphomatous effusions. Subsequently, the spectrum of KSHV/HHV8-associated lymphomas has been expanded by the identification of cases of extracavitary solid lymphomas without serous effusions. Despite the diversification in the clinical presentation of KSHV/HHV8-associated lymphomas, the majority of the cases reported demonstrated similar morphology, immunophenotype and KSHV/HHV8 viral status. KSHV/HHV8 infection is also in multicentric Castleman disease-associated plasmablastic lymphoma. The exact oncogenic mechanisms of KSHV/HHV8 are not clearly defined. The prognosis for KSHV/HHV8-associated lymphomas is poor. Novel approaches for therapy, outside traditional chemotherapy with CHOP (cyclophosphamide, doxorubicin, prednisone, vincristine), have been suggested. These include the addition of antiviral therapy as well as inhibition of specific cellular targets.
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Affiliation(s)
- Antonino Carbone
- Department of Pathology, Istituto Nazionale Tumori, Milan, Italy.
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35
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Panos G, Karveli EA, Nikolatou O, Falagas ME. Prolonged survival of an HIV-infected patient with plasmablastic lymphoma of the oral cavity. Am J Hematol 2007; 82:761-5. [PMID: 17094093 DOI: 10.1002/ajh.20807] [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] [Indexed: 11/12/2022]
Abstract
Plasmablastic lymphoma is an aggressive subtype of diffuse large B-cell lymphoma that is mainly observed in patients with the human immunodeficiency virus (HIV) infection, and it tends to arise in the oral cavity. We present a case of an HIV-infected patient with plasmablastic lymphoma with prolonged survival. The 30-yr-old woman was found to have an oral lesion at the time of the diagnosis of HIV infection. Histological and immunochemical examination of biopsy of the oral lesion showed plasmablastic lymphoma (CD138+). She received two cycles of cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP) that started 10 weeks after the initiation of antiretroviral therapy. The continuing pancytopenia and an adenoviral febrile infection did not permit further antineoplastic treatment. A gradual decrease of the oral lesion was noted after the second cycle of chemotherapy that led to the disappearance of the lesion 7 months later. The patient remains in complete remission 61 months after the diagnosis of plasmablastic lymphoma.
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Affiliation(s)
- George Panos
- HIV Unit, 2nd Internal Medicine Clinic, 1st IKA Hospital, Athens, Greece
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36
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Chen YB, Yu H, Gillani A, Brown JR. AIDS-Associated Plasmablastic Lymphoma Presenting at the Insertion Site of a Peritoneal Dialysis Catheter. J Clin Oncol 2007; 25:3176-8. [PMID: 17634499 DOI: 10.1200/jco.2007.12.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/diagnosis
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Catheters, Indwelling/adverse effects
- Device Removal
- Follow-Up Studies
- Humans
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/therapy
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, Large-Cell, Immunoblastic/complications
- Lymphoma, Large-Cell, Immunoblastic/diagnosis
- Lymphoma, Large-Cell, Immunoblastic/drug therapy
- Male
- Peritoneal Dialysis/adverse effects
- Peritoneal Dialysis/methods
- Risk Assessment
- Treatment Outcome
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Affiliation(s)
- Yi-Bin Chen
- Dana Farber Cancer Institute, Boston, MA, USA
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37
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Kravetz JD, Rose MG, Payne-Blackman S, Federman DG. Plasmablastic lymphoma presenting as an arm mass in an individual negative for human immunodeficiency virus: a case report. ACTA ACUST UNITED AC 2006; 6:493-5. [PMID: 16796782 DOI: 10.3816/clm.2006.n.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Plasmablastic lymphoma is an aggressive diffuse large B-cell lymphoma classically arising in the oral cavities and jaws of individuals infected with the human immunodeficiency virus (HIV). More recently, cases of plasmablastic lymphoma have been identified in individuals negative for HIV. We report a case of plasmablastic lymphoma presenting as a rapidly expanding upper extremity mass in a 66-year-old individual negative for HIV. Aggressive multiple-agent chemotherapy resulted in a dramatic improvement of all symptoms. Increasing awareness of plasmablastic lymphoma in individuals who are HIV negative can allow for a better understanding of its clinical course and for specific chemotherapeutic regimens to be developed.
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Affiliation(s)
- Jeffrey D Kravetz
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
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38
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Gilaberte M, Gallardo F, Bellosillo B, Saballs P, Barranco C, Serrano S, Pujol RM. Recurrent and self-healing cutaneous monoclonal plasmablastic infiltrates in a patient with AIDS and Kaposi sarcoma. Br J Dermatol 2006; 153:828-32. [PMID: 16181470 DOI: 10.1111/j.1365-2133.2005.06803.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infection with human immunodeficiency virus (HIV) increases the risk of developing non-Hodgkin lymphoma. Plasmablastic lymphoma (PBL) is a rare variant of diffuse large cell lymphoma that often involves the oral cavity of HIV+ patients. It is characterized by immunoblastic morphology and plasma cell phenotype. Cutaneous involvement in PBL appears to be rare. We report a 44-year-old man with AIDS and Kaposi sarcoma (KS) previously treated with doxorubicin who, following treatment with highly active antiretroviral therapy, developed an erythematous infiltrated nodule on the right arm. Histology showed subcutaneous fat necrosis and clusters of atypical large plasma cells (plasmablastic cells). Immunohistochemistry revealed lambda light chain restriction. Epstein-Barr virus (EBV) mRNA was detected by in situ hybridization within the plasmablastic cells. Polymerase chain reaction amplification with specific primers for human herpesvirus 8 (HHV-8) performed on the skin biopsy specimen detected a specific band. A complete screening (bone marrow biopsy, computed tomographic scan, radiological survey) disclosed no abnormalities. The lesion resolved spontaneously after 3 months. Two years later an infiltrated plaque developed on the abdominal wall. The clinical and histopathological features of this new lesion were similar to those observed 2 years previously. No evidence of extracutaneous involvement was detected. The lesion again resolved spontaneously after 25 days. PBL may be seen in patients with transplants or receiving chemotherapy, but is usually observed in patients with advanced AIDS. The observation of recurrent self-healing EBV- and HHV-8-associated cutaneous monoclonal plasmablastic infiltrates, in a patient with AIDS and KS, expands the clinical spectrum of AIDS-associated plasmablastic lymphoproliferative disorders.
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Affiliation(s)
- M Gilaberte
- Department of Dermatology, Hospital del Mar, IMAS, Passeig Maritim 25-29, 08003 Barcelona, Spain
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39
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Radhakrishnan R, Suhas S, Kumar RV, Krishnanand G, Srinivasan R, Rao NN. Plasmablastic lymphoma of the oral cavity in an HIV-positive child. ACTA ACUST UNITED AC 2005; 100:725-31. [PMID: 16301154 DOI: 10.1016/j.tripleo.2005.03.028] [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: 01/20/2005] [Revised: 02/20/2005] [Accepted: 03/23/2005] [Indexed: 01/04/2023]
Abstract
A 7-year-old boy with a positive history of vertical HIV transmission presented with a painful swelling over the left upper jaw of 20 days' duration. A provisional diagnosis of non-Hodgkin's lymphoma or embryonal rhabdomyosarcoma was made. Fine-needle aspiration cytology findings were inconclusive, and incisional biopsy tissue on routine stains gave an impression of small round cell tumor with plasmacytoid features. A series of histochemical stains and immunohistochemical studies was carried out to differentiate and characterize this tumor. The salient immunostaining was negativity with all routine small round cell tumor markers and positivity with CD138 and lambda light chain restriction. The heterogeneous presentation of plasmablastic lymphoma as a variant of diffuse large B-cell lymphoma and its histogenesis is documented. Potential pitfalls and differential characterization of AIDS-plasmablastic lymphoma from other closely related tumors are addressed. The importance of excluding other common pediatric small round cell tumors by immunohistochemistry is highlighted. To the best of our knowledge, this is the first report of this entity in a vertically transmitted HIV-positive child.
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MESH Headings
- Child
- Diagnosis, Differential
- HIV Seropositivity/complications
- HIV Seropositivity/transmission
- Humans
- Immunoenzyme Techniques
- Immunoglobulin lambda-Chains/analysis
- Infectious Disease Transmission, Vertical
- Lymphoma, AIDS-Related/chemistry
- Lymphoma, AIDS-Related/etiology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Maxillary Neoplasms/chemistry
- Maxillary Neoplasms/etiology
- Maxillary Neoplasms/pathology
- Membrane Glycoproteins/analysis
- Proteoglycans/analysis
- Syndecan-1
- Syndecans
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Pantanowitz L, Wu Z, Dezube BJ, Pihan G. Extracavitary Primary Effusion Lymphoma of the Anorectum. ACTA ACUST UNITED AC 2005; 6:149-52. [PMID: 16231856 DOI: 10.3816/clm.2005.n.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report a case of an extracavitary primary effusion lymphoma occurring in the anorectum of a patient with advanced acquired immune deficiency syndrome. The morphology, null cell immunophenotype, and acquisition of plasma cell markers in this case are typical of the so-called solid variant of primary effusion lymphoma. Lymphoma cells in this case were shown to be co-infected with human herpesvirus-8 and Epstein-Barr virus. Following combination chemotherapy and highly active antiretroviral therapy, this patient has remained in clinical remission for > 3.5 years. The purpose of this report is to add another case to the emerging literature regarding the heterogeneous category of extraserous human herpesvirus-8-associated lymphomas.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Springfield, MA, USA
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Vega F, Chang CC, Medeiros LJ, Udden MM, Cho-Vega JH, Lau CC, Finch CJ, Vilchez RA, McGregor D, Jorgensen JL. Plasmablastic lymphomas and plasmablastic plasma cell myelomas have nearly identical immunophenotypic profiles. Mod Pathol 2005; 18:806-15. [PMID: 15578069 DOI: 10.1038/modpathol.3800355] [Citation(s) in RCA: 241] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Plasmablastic lymphoma is an aggressive neoplasm that shares many cytomorphologic and immunophenotypic features with plasmablastic plasma cell myeloma. However, plasmablastic lymphoma is listed in the World Health Organization (WHO) classification as a variant of diffuse large B-cell lymphoma. To characterize the relationship between plasmablastic lymphoma and plasmablastic plasma cell myeloma, we performed immunohistochemistry using a large panel of B-cell and plasma cell markers on nine cases of plasmablastic lymphoma and seven cases of plasmablastic plasma cell myeloma with and without HIV/AIDS. The expression profiles of the tumor suppressor genes p53, p16, and p27, and the presence of Epstein-Barr virus (EBV) and human herpes virus type 8 (HHV-8) were also analyzed. All cases of plasmablastic lymphoma and plasmablastic plasma cell myeloma were positive for MUM1/IRF4, CD138, and CD38, and negative for CD20, corresponding to a plasma cell immunophenotype. PAX-5 and BCL-6 were weakly positive in 2/9 and 1/5 plasmablastic lymphomas, and negative in all plasmablastic plasma cell myelomas. Three markers that are often aberrantly expressed in cases of plasma cell myelomas, CD56, CD4 and CD10, were positive in 5/9, 2/5, and 6/9 plasmablastic lymphomas, and in 3/7, 1/5, and 2/7 plasmablastic plasma cell myelomas. A high Ki-67 proliferation index, overexpression of p53, and loss of expression of p16 and p27 were present in both tumors. No evidence of HHV-8 infection was detected in either neoplasm. The only significant difference between plasmablastic lymphoma and plasma cell myeloma was the presence of EBV-encoded RNA, which was positive in all plasmablastic lymphoma cases tested and negative in all plasma cell myelomas. In conclusion, most cases of AIDS-related plasmablastic lymphoma have an immunophenotype and tumor suppressor gene expression profile virtually identical to plasmablastic plasma cell myeloma, and unlike diffuse large B-cell lymphoma. These results do not support the suggestion in the WHO classification that plasmablastic lymphoma is a variant of diffuse large B-cell lymphoma.
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Affiliation(s)
- Francisco Vega
- Department of Pathology, Baylor College of Medicine [corrected] Houston, TX [corrected] USA
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Teruya-Feldstein J, Chiao E, Filippa DA, Lin O, Comenzo R, Coleman M, Portlock C, Noy A. CD20-negative large-cell lymphoma with plasmablastic features: a clinically heterogenous spectrum in both HIV-positive and -negative patients. Ann Oncol 2005; 15:1673-9. [PMID: 15520070 DOI: 10.1093/annonc/mdh399] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) has been described as a rapidly progressive and almost invariably fatal CD20- VS38c+ diffuse large-cell lymphoma with plasmablastic features, almost exclusively involving the jaw and oral mucosa in HIV-positive patients. METHODS From 2001 to 2003 we evaluated 12 men with PBL, and report the pathology, clinical findings, treatment and outcome. Six of 12 were HIV-positive while among the others, one was post-renal transplant, one had ulcerative colitis and four had no known immunodeficiency. RESULTS Tumor growth pattern, in general, showed cohesiveness and a starry-sky pattern; the morphology varied from typical plasmablastic to centroblastic cells. Partial immunophenotypes were (+/total): CD138, 11 of 12 (91.7%); MIB1 10 of 11 (4+, range 75-95%); p63/VS38c, nine of 10 (90%); EBV, eight of 11 (73%); LCA(CD45), two of 12 (16.7%); HHV8/LANA, zero of 10; ALK, zero of seven; and CD20, zero of 12. Three had stage IE and nine stage IV disease. Nine of 12 had an intermediate/high International Prognostic Index or high-risk disease. Computed tomography and positron emission tomography scan in four of 12 revealed extensive bone metastases. Eight of 12 are alive after treatment, with a median follow-up of 11+ months (range 1-24). Of the HIV-positive patients, five of six are alive with a median follow-up of 17 months. CONCLUSIONS It appears that PBL are heterogenous in terms of clinical presentation and morphology. The outcome presented here is superior to that originally reported.
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Affiliation(s)
- J Teruya-Feldstein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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Lin O, Gerhard R, Zerbini MCN, Teruya-Feldstein J. Cytologic features of plasmablastic lymphoma. Cancer 2005; 105:139-44. [PMID: 15803491 DOI: 10.1002/cncr.21036] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Plasmablastic lymphomas (PBLs) were originally described exclusively in human immunodeficiency virus (HIV)-positive patients who presented with jaw or oral mucosa involvement. Recent studies have reported this neoplasm also in patients without HIV infection and involving sites other than head and neck. This lymphoma has a heterogeneous morphologic presentation but distinct phenotype. METHODS Cytologic features from four cases of histologically confirmed PBL were evaluated. The cytology specimens were evaluated for criteria as follow: cellularity, cell size and shape, pleomorphism, cytoplasmic characteristics, chromatin pattern, nucleolar features, and mitotic figures. RESULTS Specimens evaluated were two head and neck fine needle aspiration specimens, one anal smear, and one cerebrospinal fluid specimen. Atypical lymphocytes ranged from intermediate to large in size and demonstrated slight nuclear pleomorphism. The cytoplasm varied from scant to moderate in the alcohol-fixed slides. Nuclei were round with vesicular chromatin. Nucleoli varied from a prominent one to multiple small ones. Multinucleated cells and mitotic figures were easily identified in three of four cases. Tingible-body histiocytes were seen in one case. Ancillary studies in two cases demonstrated expression of CD138 with lack of CD20 expression. CONCLUSION PBL is a variant of large cell lymphoma with heterogeneous cytologic findings but distinct immunophenotype. Knowledge of the cytomorphologic spectrum of PBLs and detection of CD138 expression by flow cytometry can be helpful in achieving a correct diagnosis.
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Affiliation(s)
- Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
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Dales JP, Harket A, Bagnères D, Andrac-Meyer L, Xerri L, Frances Y, Taranger-Charpin C. Lymphome plasmoblastique du sujet infecté par le VIH : à propos d’un cas très inhabituel de localisation cutanée. Ann Pathol 2005; 25:45-9. [PMID: 15981931 DOI: 10.1016/s0242-6498(05)80098-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a plasmablastic lymphoma involving the skin in a 45 year-old HIV-positive patient. Plasmablastic lymphoma was first described in 1997 and is considered to be a diffuse large B-cell lymphoma with a unique immunophenotype and a predilection for the oral cavity. In this case, the tumor was revealed by multiple purple cutaneous nodules predominantly localized on the trunk and proximal parts of the limbs. A skin biopsy led to the diagnosis of plasmablastic lymphoma in view of the presence of a dense nodular infiltrate invading the dermis and subcutaneous fat composed of large cells that expressed neither the leucocyte common antigen nor the B- and T-cell antigens CD20 and CD3, but which showed a strong immunostaining with plasma cell marker VS38c. Most of the cells expressed Kappa light chain of immunoglobulins, they did not express Lambda light chain. In situ hybridization with EBER probe revealed detection of Epstein Barr virus in about 15 % of tumor cells. The clinical course was aggressive and rapidly fatal. Despite one cycle chemotherapy the patient died four months after presentation. HIV-associated plasmablastic lymphoma is a poor prognosis malignancy that may resist typing due to the lack of expression of commonly used lymphoid markers.
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Affiliation(s)
- Jean-Philippe Dales
- Service d'Anatomie et Cytologie Pathologiques, CHU Nord, Bd Pierre Dramard, 13916 Marseille 20.
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Schichman SA, McClure R, Schaefer RF, Mehta P. HIV and plasmablastic lymphoma manifesting in sinus, testicles, and bones: a further expansion of the disease spectrum. Am J Hematol 2004; 77:291-5. [PMID: 15495247 DOI: 10.1002/ajh.20190] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients with HIV infection are at increased risk for B-cell neoplasms and plasma cell dyscrasias. Both B cell and plasma cell tumors tend to be intermediate or high grade and are frequently associated with Epstein-Barr virus. Patients with HIV infection are also at higher risk of acquiring plasmablastic lymphoma. Until this time, only sinus, oral gastrointestinal, and lung manifestation have been noted. In this report we describe a 41-year-old male with HIV infection who developed multiple pleomorphic, extramedullary plasmablastic lymphomas associated with Epstein-Barr virus. We review the clinical and immunological features of his malignancy and thereby expand the spectrum of disease to include additional sites (bones, testicles) not previously reported.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Bone Neoplasms/immunology
- Bone Neoplasms/pathology
- Bone Neoplasms/virology
- Epstein-Barr Virus Infections/complications
- HIV Infections/complications
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Lymphoma, AIDS-Related/immunology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/virology
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Paranasal Sinus Neoplasms/immunology
- Paranasal Sinus Neoplasms/pathology
- Paranasal Sinus Neoplasms/ultrastructure
- Paranasal Sinus Neoplasms/virology
- Phenotype
- Testicular Neoplasms/immunology
- Testicular Neoplasms/pathology
- Testicular Neoplasms/virology
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Affiliation(s)
- Steven A Schichman
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Häusermann P, Khanna N, Buess M, Itin PH, Battegay M, Dirnhofer S, Buechner SA. Cutaneous plasmablastic lymphoma in an HIV-positive male: an unrecognized cutaneous manifestation. Dermatology 2004; 208:287-90. [PMID: 15118393 DOI: 10.1159/000077324] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Accepted: 01/04/2004] [Indexed: 11/19/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and relatively new entity originally described in HIV-infected individuals. This subset of Epstein-Barr-virus (EBV)-related non-Hodgkin lymphomas is now regarded as a distinct clinicopathological category of AIDS-associated lymphomas occurring preferentially in the oral cavity and showing a poor prognosis. We describe for the first time an EBV-associated PBL with an isolated cutaneous distribution on the lower extremities in an HIV-infected heterosexual male and point to the unique clinical, morphological and immunophenotypic characteristics of this lymphoma. The patient presented with fast growing solid and livid nodules on both legs. The large, blastic tumor cells showed the following immunophenotype: CD138+, CD45+, CD20-, CD10-, CD3-, CD30-, bcl-2-, bcl-6-, LMP-1- and EMA-. The proliferation fraction (Mib-1) was >90%. EBV association was demonstrated by in situ hybridization (EBV-encoded RNAs 1/2). Polymerase-chain-reaction-based DNA analysis demonstrated a clonal IgH rearrangement in the absence of a bcl-2/IgH translocation. PBL in HIV patients may occur not only in the oral cavity, but can probably involve any other organs including the skin.
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Affiliation(s)
- P Häusermann
- Department of Dermatology, University Hospital Basel, Basel, Switzerland.
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Abstract
PURPOSE OF REVIEW Infection with human immunodeficiency virus (HIV) is associated with an increased risk of non-Hodgkin lymphoma and Hodgkin disease. This review summarizes developments within the past 18 months. RECENT FINDINGS Investigators continue to demonstrate that many standard therapies similar to those used in the non-HIV- infected population may be used in the HAART era for patients infected with HIV. Biologic differences do exist, however, and not all treatments and outcomes are directly translatable. Some treatments, such as rituximab in combination with CHOP, may have unforeseen toxicity. Nonetheless, high-dose therapy does appear feasible and may offer curative therapy for those with refractory and relapsed disease. SUMMARY HIV-infected persons appear to benefit from most, but not all standard treatments for lymphoma.
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Affiliation(s)
- Ariela Noy
- Division of Hematology, Memorial Sloan-Kettering Cancer, Weill Medical College of Cornell University, New York, New York 10021, USA.
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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.
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Affiliation(s)
- Adina M Cioc
- Department of Pathology, Ohio State University Medical Center and College of Dentistry, Columbus, OH 43210, USA
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de Leval L, Harris NL. Variability in immunophenotype in diffuse large B-cell lymphoma and its clinical relevance. Histopathology 2003; 43:509-28. [PMID: 14636252 DOI: 10.1111/j.1365-2559.2003.01758.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL), the single largest category of lymphoma, is a clinically and biologically heterogeneous disease entity. Clinically, patients differ in their mode of presentation and respond variably to therapy. A combination of clinical parameters can be used to predict the patient's response to therapy and survival. The pathological variability of DLBCL is expressed in morphology, immunophenotype, cytogenetic and molecular genetic features. Numerous markers detectable by immunohistochemistry and linked to different aspects of tumour biology have been studied in DLBCL, including lineage-associated and immune markers, proliferation and apoptosis markers, cell adhesion molecules, and more recently stage-specific markers of B-cell differentiation. This review summarizes these studies in regard to their clinical significance and in the light of recent advances in our understanding of the molecular pathology and histogenesis of DLBCL.
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Affiliation(s)
- L de Leval
- Department of Pathology, C.H.U. of Liège, Belgium.
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