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Perricone AJ, Mohammad MK, Geller RL, Mosunjac MB. Cytodiagnostic Sensitivity of Fine Needle Aspiration Biopsy for Hodgkin's Lymphoma Is Decreased in Patients with Human Immunodeficiency Virus Infection. Acta Cytol 2019; 63:352-360. [PMID: 31234174 DOI: 10.1159/000501098] [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] [Received: 02/15/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to evaluate the sensitivity of fine needle aspiration (FNA) for the diagnosis of Hodgkin's lymphoma (HL) in HIV-infected patients. STUDY DESIGN An electronic search was conducted to retrospectively identify patients diagnosed with HL who underwent FNA followed by confirmatory biopsy. FNAs were categorized as negative, atypical/suspicious/positive, or nondiagnostic. Diagnostic sensitivity in HIV+ and HIV- patients was statistically compared via Fisher's exact test, with a p value <0.05 considered significant. RESULTS Thirty-six patients meeting inclusion criteria were identified (24 HIV- and 12 HIV+). Average age was 36.0 ± 11.5 and 36.5 ± 7.4 years (means ± SD) in HIV- and HIV+ patients, respectively. The male-to-female ratio was 1.4:1 in HIV- patients versus 3:1 in HIV+ patients. Among these 36 patients, a total of 42 FNAs were performed. Overall sensitivity of FNA was 66.7% (95% confidence interval: 52.4-80.9%). When stratified by HIV status, a statistically significant difference in FNA sensitivity was detected, as sen-sitivity was 84.6% (70.8-98.4%) in HIV- patients versus only 37.5% (13.8-61.2%) in HIV+ patients (p =0.003). CONCLUSION The diagnostic sensitivity of FNA biopsy was significantly attenuated in the HIV+ cohort. In HIV-infected patients presenting with lymphadenopathy, increased clinical suspicion of HL is critical to avoid misdiagnosis.
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Affiliation(s)
- Adam J Perricone
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mohammad K Mohammad
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Rachel L Geller
- Fulton County Medical Examiner's Office, Atlanta, Georgia, USA
| | - Marina B Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA,
- Department of Pathology and Laboratory Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA,
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Jain L, Mackenzie S, Bomanji JB, Shortman R, Noursadeghi M, Edwards SG, Miller RF. 18F-Fluorodeoxyglucose positron emission tomography-computed tomography imaging in HIV-infected patients with lymphadenopathy, with or without fever and/or splenomegaly. Int J STD AIDS 2017; 29:691-694. [PMID: 29198183 DOI: 10.1177/0956462417745960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We audited whether 18F-Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) imaging could discriminate between different diagnoses in HIV-infected patients presenting with lymphadenopathy, with or without fever and/or splenomegaly. Maximum standardised uptake (SUVmax) values were similar in lymphoma and mycobacterial and fungal infections and were lower but similar in those with human herpesvirus (HHV) 8-associated disease and HIV-associated reactive lymphadenopathy. Nodal 18FDG avidity, with SUVmax ≥10, excluded diagnoses of HHV 8-associated disease and miscellaneous conditions, and HIV-associated reactive lymphadenopathy was additionally excluded in those who had undetectable plasma HIV viral loads. This audit suggests 18FDG PET-CT imaging did not permit discrimination between specific diagnoses but has utility in identifying lymph nodes with increased avidity that could be targeted for biopsy and in ruling out significant pathology.
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Affiliation(s)
- L Jain
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Mackenzie
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK
| | - J B Bomanji
- 3 Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, London, UK
| | - R Shortman
- 3 Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Noursadeghi
- 2 T8, University College London Hospitals NHS Foundation Trust, London, UK.,4 Division of Infection and Immunity, University College London, London, UK
| | - S G Edwards
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK
| | - R F Miller
- 1 Central and North West London NHS Foundation Trust, London, UK.,2 T8, University College London Hospitals NHS Foundation Trust, London, UK.,5 Research Department of Infection and Population Health, Institute for Global Health, University College London, London, UK.,6 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Hey-Nguyen WJ, Xu Y, Pearson CF, Bailey M, Suzuki K, Tantau R, Obeid S, Milner B, Field A, Carr A, Bloch M, Cooper DA, Kelleher AD, Zaunders JJ, Koelsch KK. Quantification of Residual Germinal Center Activity and HIV-1 DNA and RNA Levels Using Fine Needle Biopsies of Lymph Nodes During Antiretroviral Therapy. AIDS Res Hum Retroviruses 2017; 33:648-657. [PMID: 28287825 DOI: 10.1089/aid.2016.0171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
HIV-1 reservoirs are most often studied in peripheral blood (PB), but not all lymphocytes recirculate, particularly T follicular helper (Tfh) CD4+ T cells, as well as germinal center (GC) B cells, in lymph nodes (LNs). Ultrasound-guided fine needle biopsies (FNBs) from inguinal LNs and PB samples were obtained from 10 healthy controls (HCs) and 21 HIV-1-infected subjects [11 antiretroviral therapy (ART) naive and 10 on ART]. Tfh cells and GC B cells were enumerated by flow cytometry. HIV-1 DNA and cell-associated (CA) RNA levels in LNs and PB were quantified by real-time polymerase chain reaction. FNBs were obtained without adverse events. Tfh cells and GC B cells were highly elevated in ART-naive subjects, with a median GC B cell count >300-fold higher than HCs, but also remained higher in 4 out of the 10 subjects on ART. GC B cell counts and Tfh cell counts were highly correlated with each other, and also with activated T cells in LNs but not in blood. Levels of HIV-1 DNA and CA RNA viral burden in highly purified CD4+ T cells from FNBs were significantly elevated compared with those in CD4+ T cells from PB in the ART-naive group, but only trended toward an increase in the ART patients. FNBs enabled minimally invasive access to, and parallel measurement of residual activated T and B cells and viral burden within LNs in HIV-1-infected patients. These FNBs revealed significant GC activity that was not apparent from corresponding PB samples.
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Affiliation(s)
| | - Yin Xu
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Kazuo Suzuki
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Applied Medical Research, St. Vincent's Hospital, Darlinghurst, Australia
| | - Robyn Tantau
- Department of Medical Imaging, St. Vincent's Hospital, Darlinghurst, Australia
| | - Solange Obeid
- Department of Medical Imaging, St. Vincent's Hospital, Darlinghurst, Australia
| | - Brad Milner
- Department of Medical Imaging, St. Vincent's Hospital, Darlinghurst, Australia
| | - Andrew Field
- Department of Anatomical Pathology, St. Vincent's Hospital, Darlinghurst, Australia
| | - Andrew Carr
- Centre for Applied Medical Research, St. Vincent's Hospital, Darlinghurst, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Darlinghurst, Australia
| | - David A. Cooper
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Applied Medical Research, St. Vincent's Hospital, Darlinghurst, Australia
| | - Anthony D. Kelleher
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Applied Medical Research, St. Vincent's Hospital, Darlinghurst, Australia
| | - John J. Zaunders
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Applied Medical Research, St. Vincent's Hospital, Darlinghurst, Australia
| | - Kersten K. Koelsch
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Applied Medical Research, St. Vincent's Hospital, Darlinghurst, Australia
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4
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[Pathological findings in patients with HIV infection and lymphadenopathies]. BIOMEDICA 2017; 37:79-85. [PMID: 28527251 DOI: 10.7705/biomedica.v37i1.3293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/31/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Lymphadenopathy is a frequent clinical finding in HIV-infected patients. The differential diagnosis includes infection, malignancy or reactive changes. Currently, there are no data on this topic in the region. OBJECTIVES To describe the etiology of lymph node pathology in HIV-infected patients from the Hospital La María in Medellín, Colombia. MATERIALS AND METHODS The medical records of HIV-infected patients with lymphadenopathy who underwent excisional lymph node biopsy between June 2009 and October 2011 were retrospectively evaluated. The data were registered according to immune status, antiretroviral therapy and final diagnosis. RESULTS The evaluation of 120 medical records revealed the following diagnosis distribution: 58% of the cases were attributable to infectious causes, 32.5% were attributable to reactive changes, 6.6% were attributable to neoplastic disease, and 2.5% were normal. The most frequent diagnosis was tuberculosis, which was found in 48.3% of the patients. The lymph node biopsy was useful for identifying additional opportunistic infections in different organs in 14.1% of the patients. CONCLUSION A lymph node biopsy in HIV-infected patients is a useful aid in the diagnosis of serious neoplastic and infectious diseases and should be routinely performed in such patients with lymphadenopathy.
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Field AS, Geddie WR. Role of fine needle aspiration biopsy cytology in the diagnosis of infections. Diagn Cytopathol 2016; 44:1024-1038. [PMID: 27555237 DOI: 10.1002/dc.23568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022]
Abstract
The role of fine needle aspiration biopsy (FNAB) cytology in diagnosing infections has expanded due to the increase in the number of immune compromised patients and the increasing role of FNAB in the developing world where infection is a major cause of illness. FNAB has become the first procedural test in cases where the clinical and imaging findings suggest an infectious lesion or where there is a differential diagnosis of infection or metastatic or primary tumor. This applies to FNAB of palpable or image directed or deep seated lesions accessed by EUS and EBUS. This article details a recommended approach and technique for FNAB of infectious lesions, and discusses the role of rapid on site evaluation and the application of ancillary testing including the rapidly expanding array of molecular tests based on FNAB material. The utility of recognizing suppurative and granulomatous infectious patterns in FNAB direct smears, and the specific cytomorphological features on routine Papanicolaou and Giemsa stains and on special stains of FNAB smears is described for a large number of bacterial, fungal, viral, parasitic, and protozoan infections. The role of cytopathologists is to now train cytopathologists in sufficient numbers to provide FNAB services, teach trainee cytopathologists and cytotechnologists, and to encourage our clinical colleagues to use FNAB in the diagnosis of infections and other lesions to the benefit of patients and the medical system. Diagn. Cytopathol. 2016;44:1024-1038. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew S Field
- Department of Anatomical Pathology, St. Vincent's Hospital and Notre Dame University Medical School, Sydney, Australia
| | - William R Geddie
- Department of Anatomical Pathology, University Health Network, Toronto, Canada
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Hadadi A, Jafari S, Jebeli ZH, Hamidian R. Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients. Asian Pac J Trop Biomed 2014; 4:S171-6. [PMID: 25183076 DOI: 10.12980/apjtb.4.2014c1253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients. METHODS This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy. RESULTS Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count <200 cell/µL) vs. HIV(+) patients (CD4 count >200 cell/µL). CONCLUSIONS Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis.
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Affiliation(s)
- Azar Hadadi
- Iranian Research Center for HIV/AIDS Institute of High Risk Behavior Reduction, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Internal Medicine Department & Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sirous Jafari
- Infectious Diseases Department and Iranian Research Center for HIV/AIDS, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Hamidian
- Research Development Center, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran
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Alçada J, Taylor MN, Shaw PJ, Janes SM, Navani N, Miller RF. High prevalence of malignancy in HIV-positive patients with mediastinal lymphadenopathy: a study in the era of antiretroviral therapy. Respirology 2014; 19:339-45. [PMID: 24471994 PMCID: PMC4016741 DOI: 10.1111/resp.12241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/09/2013] [Accepted: 11/24/2013] [Indexed: 12/15/2022]
Abstract
Background and objective Mediastinal lymphadenopathy (MLN) in human immunodeficiency virus (HIV) infection has a wide spectrum of aetiologies with different prognoses and treatments. The decision to pursue a histopathological diagnosis represents a clinical challenge as patients present with non-specific symptoms. This study aimed to determine the aetiology and predictive factors of MLN in a cohort of HIV-infected patients in the combination antiretroviral therapy (cART) era. Methods Single-centre retrospective cohort study of 217 consecutive HIV-infected patients who underwent computed tomography (CT) of the chest between January 2004 and December 2009. Fifty-two patients were identified to have MLN (>10 mm in short axis). CT images were re-reviewed by an independent radiologist blinded to the clinical information. Final diagnoses of MLN were obtained from clinical records. Multivariate analysis was performed to identify predictors of aetiology of MLN. Results Seventeen patients (33%) had a diagnosis of malignancy. Consolidation on CT was associated with a reduced likelihood of malignancy odds ratio (OR) 0.03 (95% confidence interval 0.002–0.422), and larger lymph nodes were associated with an increase in the odds of malignancy (OR 2.89; 95% confidence interval 1.24–6.71). CD4 count was found not to be a predictor of aetiology of MLN. Conclusions In the era of combination cART, opportunistic infections and malignancy remain to be the frequent causes of MLN in HIV-positive patients, but the prevalence of non-HIV related malignancy has increased compared with previous studies. Although certain findings are predictors of non-malignant disease, pathological diagnosis of MLN in HIV-positive patients should be pursued whenever possible.
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Affiliation(s)
- Joana Alçada
- Department of Thoracic Medicine, University College London Hospitals, London, UK
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8
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Xu Y, Fernandez C, Alcantara S, Bailey M, De Rose R, Kelleher AD, Zaunders J, Kent SJ. Serial study of lymph node cell subsets using fine needle aspiration in pigtail macaques. J Immunol Methods 2013; 394:73-83. [PMID: 23702165 DOI: 10.1016/j.jim.2013.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 11/28/2022]
Abstract
Lymphoid tissues are of intense interest for studies of the pathogenesis of human immunodeficiency virus (HIV) in humans and simian immunodeficiency virus (SIV) in macaques but are relatively difficult to sample non-invasively. Fine needle aspiration (FNA) cytology, conventionally a diagnostic procedure for lymphadenopathy, can be used for longitudinal study of tissue cell subsets during HIV/SIV infection. In this study, we serially sampled lymph node (LN) FNA from pigtail macaques and studied cell subsets in the aspect of absolute count, frequency, and functionality by flow cytometry. The median recovered lymphocyte count from FNA samples was 2.01×10(5) (3.0×10(3) to 2.25×10(6), n=38) and median CD4+ T cell subset recovered was 5.94×10(4) (277 to 6.17×10(5), n=38). Although we observed a relatively large variation in the frequencies of cell subsets of FNA samples taken from different time points, the cell subset composition of FNA samples, in particular T cell and CD4+ T cell frequencies, was broadly comparable to whole excised LNs (n=6) and distinct from peripheral blood. A subset of CD4+ T cells that is located almost exclusively in secondary lymphoid tissues, T follicular helper (TFH) cells, was readily identifiable in LN FNAs and the TFH cell frequencies were strongly correlated with B cell frequencies. In vitro functionality of FNA lymphocytes was demonstrated using polyclonal SEB stimulation, resulting in a median 6% of responding CD4+ T cells, comparable to circulating CD4+ T lymphocytes. We conclude that serial sampling of macaque LNs using FNA is a potentially useful method to study the immunopathogenesis of SIV infection and may be extended to HIV infection.
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Affiliation(s)
- Yin Xu
- The Kirby Institute, The University of New South Wales, Sydney, New South Wales 2052, Australia.
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Khillan R, Sidhu G, Axiotis C, Braverman AS. Fine needle aspiration (FNA) cytology for diagnosis of cervical lymphadenopathy. Int J Hematol 2012; 95:282-4. [PMID: 22351165 DOI: 10.1007/s12185-012-1024-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/30/2022]
Abstract
Patients with cervical adenopathy suspicious for malignancy are often referred to the Otolaryngology Service for tissue diagnosis. Confirmation of nodal involvement by upper aero-digestive tract tumors (UADT) is best obtained by fine needle aspiration (FNA). Reported studies of FNA for lymphoma diagnosis have yielded conflicting results. Retrospective review of charts and pathology of 161 patients diagnosed with lymphomas yielded 53 patients with cervical adenopathy without apparent UADT. FNA's were performed on 28, and were repeated nine times, for a total of 37. Eleven had Hodgkin's disease and 17 other types of lymphomas. Seven of 37 specimens contained only blood; 15 contained lymphoid cells, nine of which were designated "reactive." Lymphoid cells designated as "atypical" or "suspicious for lymphoma" were found in 13 of the 37 aspirates. Two were diagnostic of lymphoma. Lymphoma was confirmed by histopathologic specimens in all patients, obtained 0-941 days (median 15, mean 73 days) after initial FNA. In lymphoma patients with cervical lymphadenopathy, FNA does not usually suffice for, and often leads to significant delays in diagnosis.
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Affiliation(s)
- Ratesh Khillan
- Division of Hematology/Oncology, Department of Medicine, Downstate Medical College of the State University of NY and Kings County Hospital Medical Center, DMC-SUNY, 450 Clarkson Ave, Box 55, Brooklyn, NY 11203, USA
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Sayer R, Paul J, Tuke PW, Hargreaves S, Noursadeghi M, Tedder RS, Grant P, Edwards SG, Miller RF. Can plasma HHV8 viral load be used to differentiate multicentric Castleman disease from Kaposi sarcoma? Int J STD AIDS 2011; 22:585-9. [DOI: 10.1258/ijsa.2011.010464] [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
We measured plasma human herpesvirus 8 (HHV8) DNA load in consecutive patients presenting with HIV-associated multicentric Castleman disease (MCD) and in contemporaneous patients who had Kaposi sarcoma (KS), lymphoma or other diagnoses. All 11 patients with MCD had detectable plasma HHV8 DNA compared with 18 (72%) of 25 patients with KS, none with lymphoma and one of 38 patients with other diagnoses. Detectable plasma HHV8 DNA levels were higher among MCD patients, median (interquartile range [IQR]) = 43,500 (5200–150,000) copies/mL, when compared with those with KS, median (IQR) = 320 (167–822) copies/mL and those with lymphoma and other diagnoses (one-way analysis of variance; P = 0.0303). Using receiver operating characteristic analysis, a cut-off of >1000 copies HHV8 DNA/mL of plasma helped to discriminate between MCD and other diagnoses, with a specificity of 94.7% and a negative predictive value of 97.3%. The level of HHV8 viraemia, while not diagnostic, may aid discrimination between patients with MCD and those with KS and other systemic illnesses.
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Affiliation(s)
- R Sayer
- Mortimer Market Centre, Camden Provider Services
- T8, University College London Hospitals NHS Trust
| | - J Paul
- Department of Virology, University College London Hospitals
| | - P W Tuke
- Blood Borne Viruses Unit, Virus Reference Department, Centre for Infections, Health Protection Agency
| | - S Hargreaves
- Mortimer Market Centre, Camden Provider Services
| | - M Noursadeghi
- T8, University College London Hospitals NHS Trust
- Division of Infection and Immunity
| | - R S Tedder
- Blood Borne Viruses Unit, Virus Reference Department, Centre for Infections, Health Protection Agency
| | - P Grant
- Department of Virology, University College London Hospitals
| | - S G Edwards
- Mortimer Market Centre, Camden Provider Services
- T8, University College London Hospitals NHS Trust
| | - R F Miller
- Mortimer Market Centre, Camden Provider Services
- T8, University College London Hospitals NHS Trust
- Research Department of Infection and Population Health, Division of Population Health, University CollegeLondon
- Department of Clinical Research, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Immune reconstitution syndrome presenting as probable AIDS-related lymphoma: a case report. AIDS Res Ther 2011; 8:34. [PMID: 21955517 PMCID: PMC3192656 DOI: 10.1186/1742-6405-8-34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 09/28/2011] [Indexed: 01/16/2023] Open
Abstract
We report an unusual case of HIV-related immune reconstitution inflammatory syndrome, presenting as suspected AIDS-related lymphoma. Symptoms, initial investigations including fine-needle biopsy and 18F-FDG PET/CT scan were highly compatible with high grade AIDS-related lymphoma, however subsequently IRIS was diagnosed. We discuss pitfalls in the interpretation of diagnostic results in ARL versus IRIS.
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Abstract
A subset of HIV-infected patients who receive antiretroviral therapy (ART) develop immune restoration syndrome. A case of immune restoration Klebsiella lymphadenitis is described. Fine needle aspiration cytology remains a useful investigative tool in the post-ART era, particularly in the diagnosis of persistent generalized lymphadenopathy, infection and malignancy of the lymph nodes.
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Affiliation(s)
- A Gohar
- Gohar's Skin and Sexual Health Clinic, Greater Cairo, Egypt.
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Lang TU, Khalbuss WE, Monaco SE, Michelow P, Pantanowitz L. Review of HIV-Related Cytopathology. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:256083. [PMID: 21559199 PMCID: PMC3090088 DOI: 10.4061/2011/256083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/15/2011] [Indexed: 11/28/2022]
Abstract
Exfoliative and aspiration cytologies play a major role in the management of patients with human immunodeficiency virus infection. Common cytology samples include cervicovaginal and anal Papanicolaou tests, fine needle aspirations, respiratory specimens, body fluids, Tzanck preparations, and touch preparations from brain specimens. While the cytopathologists need to be aware of specific infections and neoplasms likely to be encountered in this setting, they should be aware of the current shift in the pattern of human immunodeficiency virus-related diseases, as human immunodeficiency virus patients are living longer with highly active antiretroviral therapy and suffering fewer opportunistic infections with better antimicrobial prophylaxis. There is a rise in nonhuman immunodeficiency virus-defining cancers (e.g., anal cancer, Hodgkin's lymphoma) and entities (e.g., gynecomastia) from drug-related side effects. Given that fine needle aspiration is a valuable, noninvasive, and cost-effective tool, it is frequently employed in the evaluation and diagnosis of human immunodeficiency virus-related diseases. Anal Papanicolaou tests are also increasing as a result of enhanced screening of human immunodeficiency virus-positive patients for cancer. This paper covers the broad spectrum of disease entities likely to be encountered with human immunodeficiency virus-related cytopathology.
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Affiliation(s)
- Tee U. Lang
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
| | - Walid E. Khalbuss
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
| | - Sara E. Monaco
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
| | - Pam Michelow
- Cytology Unit, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg 2192, South Africa
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center Cancer Pavilion, 5150 Centre Avenue, Suite 201, Pittsburgh, PA 15232, USA
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Sarma PK, Chowhan AK, Agrawal V, Agarwal V. Fine needle aspiration cytology in HIV-related lymphadenopathy: experience at a single centre in north India. Cytopathology 2010; 21:234-9. [PMID: 19843144 DOI: 10.1111/j.1365-2303.2009.00712.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Fine needle aspiration (FNA) is emerging as a rapid and minimally invasive tool in evaluating lymphadenopathy associated with human immunodeficiency virus (HIV). We evaluated the role of FNA in differentiating various causes of lymphadenopathy in patients with HIV and correlated the cytological diagnosis with CD4 counts. METHODS Seventy-nine HIV-positive patients (median age 35 years, 68 male) underwent ultrasound-guided (n = 16) and unguided (n = 63) FNA from 1999 to 2006. Smears were stained with May-Grünwald-Giemsa, haematoxylin & eosin and Papanicolaou stains. Ziehl-Neelsen (ZN) staining for acid-fast bacilli (AFB) was performed in all cases. Staining for fungus was performed whenever required. RESULTS The aspirates were adequate in 75 cases (95%). Non-specific reactive hyperplasia was the most common FNA diagnosis (39, 52%) followed by granulomatous necrotizing lymphadenitis (15, 20%), necrotizing lymphadenitis (13, 17.3%) and granulomatous lymphadenitis (4, 5.2%). Fungal infection and non-Hodgkin lymphoma (NHL) were seen in two patients each. ZN staining was positive for AFB in 25 (33.3%) cases. One of these was morphologically interpreted as reactive hyperplasia, 12 as necrotizing lymphadenitis and 12 as granulomatous necrotizing lymphadenitis. Both patients with NHL had CD4 counts below 100/dl. Necrotizing lymphadenitis and granulomatous lymphadenitis were significantly associated with CD4 counts below and above 200/dl, respectively (P = 0.0002). CONCLUSIONS FNA is an important tool for assessing the cause of lymphadenopathy in HIV patients. Necrotizing inflammation is more often seen in patients with low CD4 counts. AFB are commonly found in necrotic aspirates with or without granulomas. However, a stain for AFB should be performed in all aspirates from HIV-related lymphadenopathy including reactive hyperplasia.
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Affiliation(s)
- P K Sarma
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
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Young M, Miller R. Immunosuppression. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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