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Wiemer L, Quan JR, Omman R. An Atypical Presentation of an Uncommon Malignancy: Plasmablastic Lymphoma Presenting As Recurrent Scrotal Abscesses. Cureus 2023; 15:e38879. [PMID: 37303424 PMCID: PMC10257366 DOI: 10.7759/cureus.38879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and extremely diagnostically challenging entity. We report a unique case of PBL in an adult male with a history of recurrent scrotal abscesses who presented with progressively worsening scrotal pain, swelling, and drainage. Pelvic CT demonstrated a large scrotal abscess with external draining tracts with foci of air. Surgical debridement revealed necrotic tissue throughout the abscess cavity, abscess wall, and scrotal skin. Immunohistochemical analysis of the scrotal skin specimen uncovered diffuse proliferation of plasmacytoid cells with immunoblastic features that stained positive for CD138, CD38, IRF4/MUM1, CD45, lambda restriction, and Epstein-Barr encoded RNA in situ hybridization (EBER-ISH) with high Ki-67 proliferation index greater than 90%. Taken together, these findings confirmed a diagnosis of PBL. Treatment with six cycles of infusional etoposide, prednisolone, vincristine, cyclophosphamide, and hydroxydaunorubicin (EPOCH-like regimen) was administered with subsequent positron emission tomography (PET)/CT confirmation of complete response. There was no clinical evidence of lymphoma recurrence at the time of follow-up six months later. Our case exemplifies the growing diversity of ways in which PBL may manifest and underscores the importance of a clinician's familiarity with this entity and its well-defined risk factor of immunosuppression.
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Affiliation(s)
- Layton Wiemer
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - J R Quan
- Oncology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
- Oncology, University of Florida Health, Jacksonville, USA
| | - Reeba Omman
- Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Florindez JA, Alderuccio JP, Reis IM, Lossos IS. Survival analysis in treated plasmablastic lymphoma patients: a population-based study. Am J Hematol 2020; 95:1344-1351. [PMID: 32777103 DOI: 10.1002/ajh.25955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/19/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
Herein we analyzed survival outcomes in chemotherapy-treated patients with plasmablastic lymphoma (PBL) diagnosed between 2010 to 2016 (n = 248). Data was acquired from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (April 2019 release based on November 2018 submission). The majority of patients were male (81.9%) and younger than 60 years (71.0%). Oral and gastrointestinal (GI) sites were the most frequent primary extranodal locations (23% and 19.4%, respectively). Oral primary location was inversely associated with presence of B symptoms and advanced Ann-Arbor stage. The 3-year and 5-year overall survival (OS) rates of treated PBL patients were 54% (95% CI: 46.5%-60.8%) and 52.8% (95% CI: 45.2%-59.8%). Three-year conditional survival for 2-year and 3-year survivors were 90.3% and 97.8%, overlapping the survival of a general population matched by age, sex and calendar year. In a multivariable analysis, oral primary location was associated with not only better OS (HR 0.43; 95% CI: 0.21-0.88, P = .021) but also better lymphoma-specific survival (LSS) (SHR 0.36; 95% CI: 0.15-0.86, P = .022); age ≥60 years was associated with shorter LSS (SHR 1.73; 95% CI: 1.02-2.96, P = .043). Seven registries granted access to HIV status (n = 93) where HIV infection was detected in 52.7% of cases. The HIV status did not affect survival outcomes in unadjusted and adjusted analyses. We identified clinical characteristics associated with survival and showed that treated PBL patients may achieve long-term survival.
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Affiliation(s)
- Jorge A. Florindez
- Division of Hospital Medicine, Miller School of Medicine University of Miami Miami Florida
| | - Juan P. Alderuccio
- Divison of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
| | - Isildinha M. Reis
- Department of Public Health Science, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
| | - Izidore S. Lossos
- Divison of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
- Department of Molecular and Cellular Pharmacology University of Miami Miami Florida
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Rosado F, Guo L, Fuda F. Hematolymphoid neoplasms with a plasma cell phenotype. Semin Diagn Pathol 2020; 37:268-272. [PMID: 32564903 DOI: 10.1053/j.semdp.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Ling Guo
- Ohio State University Wexner Medical Center
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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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ALK-positive Large B-cell Lymphoma: A Clinicopathologic Study of 26 Cases With Review of Additional 108 Cases in the Literature. Am J Surg Pathol 2017; 41:25-38. [PMID: 27740969 DOI: 10.1097/pas.0000000000000753] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anaplastic lymphoma kinase-positive large B-cell lymphoma (ALK LBCL) is a rare, aggressive subtype of diffuse large B-cell lymphoma with characteristic ALK rearrangements. Diagnosis of ALK LBCL can be challenging because of its rarity, unique morphologic characteristics, and unusual immunophenotypic features, which significantly overlap with other hematologic and nonhematologic neoplasms. The purpose of this study is to further explore the clinicopathologic features of ALK LBCL to ensure the awareness and accurate diagnosis of this entity. We retrospectively reviewed the data from 26 cases in our institutions and additional 108 cases from the literature. ALK LBCL typically occurred in the lymph nodes of young and middle-aged, immunocompetent patients. The medium age was 35 years with a male to female ratio of 3.5:1. Vast majority of cases showed immunoblastic and/or plasmablastic morphology. All cases expressed ALK protein with a cytoplasmic granular pattern in most of them. Common B-cell markers (CD20, CD79a, and PAX5) were typically negative, but the tumor cells mostly expressed 2 B-cell transcriptional factors, BOB1 and OCT2. The 5-year overall survival (OS) was 34%, and the median survival was 1.83 years. In patients with stage III/IV disease, the 5-year OS was only 8%. Moreover, patients below 35 years of age had a significantly better OS than those aged 35 years or above.
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Richter Syndrome With Plasmablastic Lymphoma at Primary Diagnosis: A Case Report With a Review of the Literature. Appl Immunohistochem Mol Morphol 2017; 25:e40-e45. [PMID: 27801729 DOI: 10.1097/pai.0000000000000441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cajozzo M, Palumbo VD, Buscemi S, Damiano G, Florena AM, Cabibi D, Raffaele F, Anzalone AA, Fatica F, Cocchiara G, Dioguardi S, Bruno A, Caronia FP, Lo Monte AI. Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report. J Med Case Rep 2017; 11:75. [PMID: 28320457 PMCID: PMC5360031 DOI: 10.1186/s13256-016-1183-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/20/2016] [Indexed: 12/03/2022] Open
Abstract
Background Plasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects. Case presentation We describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allowed diagnosis of plasmoblastic lymphoma and establishment of an immediate chemotherapeutic regimen, with rapid remission of compression symptoms. Conclusions Plasmoblastic lymphoma is a very uncommon, difficult to diagnose, and aggressive disease. The presented case represents the first rare mediastinal plasmoblastic lymphoma in a human immunodeficiency virus-/human herpesvirus-8-negative patient. Pathologists should be aware that this tumor does appear in sites other than the oral cavity. Fine-needle aspiration biopsy is a low-cost, repeatable, easy-to-perform technique, with a high diagnostic accuracy and with very low complication and mortality rates. Fine-needle aspiration biopsy could represent the right alternative to surgery in those patients affected by plasmoblastic lymphoma, being rapid and minimally invasive. It allowed establishment of prompt medical treatment with subsequent considerable reduction of the neoplastic tissue and resolution of the mediastinal syndrome.
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Affiliation(s)
- Massimo Cajozzo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Vincenzo Davide Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy. .,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Damiano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Ada Maria Florena
- Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Daniela Cabibi
- Department of Science for Health Promotion and for Mother and Child "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Raffaele
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Antonino Alessio Anzalone
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Federica Fatica
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Gerlando Cocchiara
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Salvatore Dioguardi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Antonio Bruno
- Department of Diagnostic Medicine and Prevention, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
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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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Mani SSR, Kodiatte T, Jagannati M. A rare presentation of plasmablastic lymphoma as cutaneous nodules in an immunocompromised patient. Int J STD AIDS 2016; 28:623-625. [PMID: 27738277 DOI: 10.1177/0956462416675037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Plasmablastic lymphoma is a rare entity accounting for around 2.7% of all AIDS-related lymphomas. The oral cavity and gastrointestinal tract are the most common sites involved. We report a case of a 34-year-old HIV-positive woman with a rare presentation of cutaneous nodules all over the body. Due to overwhelming tumour burden, she developed tumour lysis syndrome during her hospital stay and succumbed to the illness.
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Affiliation(s)
| | - Thomas Kodiatte
- 2 Department of General Pathology, Christian Medical College, Vellore, India
| | - Manjeera Jagannati
- 1 Department of General Medicine, Christian Medical College, Vellore, India
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Kaleem T, Crozier JA, Menke DM, Sher T. Post-Transplant Lymphoproliferative Disorder Presenting as CD20-Negative Plasmablastic Lymphoma in the Lung. Rare Tumors 2016; 8:6220. [PMID: 27746876 PMCID: PMC5064292 DOI: 10.4081/rt.2016.6220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 12/22/2022] Open
Abstract
Post-transplant lymphoproliferative disorders (PTLD) are a serious complication of transplantation with a high mortality. Most PTLD present within the first year of transplantation and are associated with Epstein-Barr virus (EBV) infection. Plasmablastic lymphoma (PBL) is a rare but aggressive disease originally described in patients with HIV, presenting most commonly in the jaw and oral mucosa. To our knowledge, this is the first case of PBL presenting as PTLD of the lung in a HIV and EBV negative patient. Given the increasing number of transplants performed, we would like to share this uncommon presentation of PTLD as PBL.
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Affiliation(s)
- Tasneem Kaleem
- Department of Internal Medicine, Mayo Clinic, Jacksonville , FL, USA
| | - Jennifer A Crozier
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville , FL, USA
| | - David M Menke
- Department of Pathology, Mayo Clinic, Jacksonville , FL, USA
| | - Taimur Sher
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville , FL, USA
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Plasmablastic Lymphoma: A Review of Current Knowledge and Future Directions. Adv Hematol 2015; 2015:315289. [PMID: 26357515 PMCID: PMC4555447 DOI: 10.1155/2015/315289] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive subtype of non-Hodgkin's lymphoma (NHL), which frequently arises in the oral cavity of human immunodeficiency virus (HIV) infected patients. PBL shows diffuse proliferation of large neoplastic cells resembling B-immunoblasts/plasmablasts, or with plasmacytic features and an immunophenotype of plasma cells. PBL remains a diagnostic challenge due to its peculiar morphology and an immunohistochemical profile similar to plasma cell myeloma (PCM). PBL is also a therapeutic challenge with a clinical course characterized by a high rate of relapse and death. There is no standard chemotherapy protocol for treatment of PBL. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens have been the backbone while more intensive regimens such as cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, high-dose cytarabine (CODOX-M/IVAC), or dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH) are possible options. Recently, a few studies have reported the potential value of the proteasome inhibitor bortezomib and thalidomide in PBL patients. The introduction of genes encoding artificial receptors called chimeric antigen receptors (CARs) and CAR-modified T cells targeted to the B cell-specific CD19 antigen have demonstrated promising results in multiple early clinical trials. The aim of this paper is to review the recent advances in epidemiology; pathophysiology; clinical, pathologic, and molecular characteristics; therapy; and outcome in patients with PBL.
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Plasmablastic Lymphoma of Small Intestine: A Rare Case Report with Review of Literature. Indian J Hematol Blood Transfus 2015; 32:130-4. [PMID: 27408374 DOI: 10.1007/s12288-015-0549-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare aggressive neoplasm characterized by diffuse proliferation of large neoplastic cells with plasma cell immunophenotype. Cell of origin of PBL is believed to be a postgerminal center B-lymphocyte or plasmablast. The malignant cells in PBL usually do not express CD20 (B cell marker) but do express markers of plasmacytic differentiation, such as CD38, CD138, or MUM1/IRF4, akin to plasma cell myeloma (PCM). PBL though originally described in the oral cavity, has now been found to occur in extraoral locations as well. Small intestine as a site of PBL has been described very rarely. PBL remains a diagnostic challenge given its overlapping morphologic and immunophenotypic features with other high grade lymphomas and PCM. We report a rare case of PBL of small intestine in a 48 years old HIV infected male patient. To the best of our knowledge this represents sixth case in the literature described in this location. An unusual rare pattern of CD138 positivity by IHC is also reported along with extensive review of literature of PBL in extraoral locations.
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Isfahani F, Amar S, Dave H, Gridley D. Plasmoblastic lymphoma as cause of perianal fistula: a case report and literature review. J Int Assoc Provid AIDS Care 2014; 14:17-20. [PMID: 25320144 DOI: 10.1177/2325957414553838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 33-year-old HIV-infected man who presented with a recurrent, nonhealing perianal fistula. After multiple benign biopsies, the diagnosis of plasmablastic lymphoma (PBL) eventually was made. The patient underwent chemotherapy and radiation with a complete response. Perianal fistulas are frequent in HIV-positive patients, but PBL as a cause is extremely rare. This often delays the diagnosis and treatment of this highly aggressive disease. We review the literature and discuss the pitfalls in the diagnosis and management of the disease.
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Affiliation(s)
- Firoozeh Isfahani
- Department of Medicine, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Surabhi Amar
- Department of Medicine, Maricopa Integrated Health System, Phoenix, AZ, USA Division of Hematology-Oncology, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Harikrishna Dave
- Department of Pathology, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Daniel Gridley
- Department of Radiology, Maricopa Integrated Health System, Phoenix, AZ, USA
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William J, Variakojis D, Yeldandi A, Raparia K. Lymphoproliferative neoplasms of the lung: a review. Arch Pathol Lab Med 2013; 137:382-91. [PMID: 23451749 DOI: 10.5858/arpa.2012-0202-ra] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Diagnosis and classification of lymphomas are based on the morphologic, immunologic, and genetic features that the lesional cells share with their normal B and T lymphocyte counterparts. Primary pulmonary lymphomas account for 0.3% of primary lung neoplasms and less than 0.5% of all lymphomas. OBJECTIVE To describe and summarize the clinical and histopathologic features of the primary pulmonary lymphoma and secondary involvement of the lung by lymphoma. DATA SOURCES Peer-reviewed published literature and personal experience. CONCLUSIONS Diagnosis of clonal lymphoid proliferations in the lung has evolved owing to the greater utility of molecular and flow cytometric analysis of tissue. Further studies are needed to best define the clinical and prognostic features, as well as search for targeted therapy for these patients with rare neoplasms.
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Affiliation(s)
- Josette William
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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Pai K, Rao L. The cytological diagnosis of extra-oral plasmablastic lymphoma: a rare entity. J Clin Diagn Res 2013; 7:721-2. [PMID: 23730657 DOI: 10.7860/jcdr/2013/5759.2892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/20/2013] [Indexed: 11/24/2022]
Abstract
Non-Hodgkin's Lymphomas (NHLs) which are associated with the Acquired Immunodeficiency Syndrome (AIDS) are heterogeneous. Plasmablastic Lymphoma (PBL) was first recognized as an aggressive, invariably fatal subtype of Non-Hodgkin's Lymphoma which occurred mostly in patients with AIDS, with distinct histomorphologic and immunophenotypic findings, which affected the jaw and the oral mucosa exclusively. Subsequently, there have been case reports which have described extra-oral plasmablastic lymphomas in the lung, jejunum, caecum, nasal mucosa, etc. We are reporting a case of this rare subtype of diffuse large B-cell lymphoma which presented as a soft tissue mass, which we believe is the first case to be diagnosed by FNAC.
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Affiliation(s)
- Kanthilatha Pai
- Professor, Department of Pathology, KMC International Centre , Manipal, India
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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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Abstract
Plasmablastic lymphoma (PBL) is a unique type of diffuse proliferation of large neoplastic lymphoid cells most of which resemble B immunoblasts, but all tumor cells show the immunophenotype of plasma cells. It has a strong predilection for jaw and oral cavity in HIV-positive patients. Incidences of extraoral location of this tumor is increasingly being recognized especially in HIV-negative patients for example, stomach, jejunum, omentum, anorectum, lungs, testes, soft tissues, lymph nodes, bone marrow, skin, and central nervous system. We present a case of PBL found in cecum in an HIV-negative patient. It was accompanied by lung and lymph node involvement and presented as abdominal mass. This is only the second reported case of PBL originating in cecum.
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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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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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21
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Mihaljevic BS, Todorovic MR, Andjelic BM, Antic DA, Perunicic Jovanovic MD. Unusual presentation of gastric plasmablastic lymphoma in HIV-negative patient. Med Oncol 2011; 29:1186-9. [PMID: 21476144 DOI: 10.1007/s12032-011-9930-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 03/24/2011] [Indexed: 12/25/2022]
Abstract
Plasmablastic lymphoma (PBL) has initially been described as a rapidly progressive and almost invariably fatal diffuse large-cell lymphoma with plasmablastic features, exclusively involving the jaw and oral mucosa in HIV-positive patients. Although its clinical features may help in differential diagnosis, an extra-oral localization in a patient without HIV makes it more difficult to suspect clinically. We describe a very rare case of gastric PBL primarily involving stomach in a middle age man without an HIV infection. A biopsy was performed and its findings revealed a diffuse, monomorphous proliferation of the tumor cells with features of immunoblasts, MUM-1, EMA, and lambda light chains positive. Serology was negative for the human immunodeficiency virus (HIV), HBsAg, and hepatitis C virus infection. The patient started treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy, but unfortunately died before the second cycle was given. To our knowledge, this is the second case of gastric PBL presented in HIV-negative patients. The findings in this case suggest that PBL should be included in the differential diagnosis of gastrointestinal tumors.
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Affiliation(s)
- Biljana S Mihaljevic
- Clinic for Hematology, Clinical Center of Serbia, 2 Koste Todorovic str, 11000 Belgrade, Serbia
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22
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Mathews MS, Bota DA, Kim RC, Hasso AN, Linskey ME. Primary leptomeningeal plasmablastic lymphoma. J Neurooncol 2011; 104:835-8. [PMID: 21359853 PMCID: PMC3171045 DOI: 10.1007/s11060-011-0547-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 02/18/2011] [Indexed: 11/17/2022]
Abstract
Lymphomas that develop in human immunodeficiency virus (HIV) infected patients are predominantly aggressive B-cells lymphomas. The most common HIV-associated lymphomas include Burkitt lymphoma, diffuse large B-cell lymphoma (that often involves the CNS), primary effusion lymphoma, and plasmablastic lymphoma (PBL). Of these, PBL is relatively uncommon and displays a distinct affinity for presentation in the oral cavity. In this manuscript we report a previously undescribed primary leptomeningeal form of PBL in a patient with acquired immunodeficiency syndrome. A 40-year-old HIV positive man presented with acute onset confusion, emesis, and altered mental status. Lumbar puncture showed numerous nucleated cells with atypical plasmocyte predominance. CSF flowcytometry showed kappa restriction with CD8 and CD38 positivity and negative lymphocyte markers, while the MRI showed diffuse leptomeningeal enhancement. As the extensive systemic work-up failed to reveal any disease outside the brain, an en bloc diagnostic brain and meningeal biopsy was performed. The biopsy specimen showed sheets of plasmacytoid cells with one or more large nuclei, prominent nuclear chromatin, scattered mitoses, and abundant cytoplasm, highly suggestive of plasmablastic lymphoma. HIV-associated malignancies have protean and often confusing presentations, which pose diagnostic difficulties posed to the practicing neurological-surgeons. Even in cases where an infectious cause is suspected for the meningeal enhancement, neoplastic involvement should be considered, and cytology and flow-cytometry should be routinely ordered on the CSF samples.
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Affiliation(s)
- Marlon S Mathews
- Department of Neurological Surgery, University of California, Irvine, USA
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23
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Abstract
This article reviews the spectrum of Epstein-Barr virus and Kaposi sarcoma herpesvirus (KSHV/HHV-8)-associated B-cell lymphoid proliferations, their pathologic features and clinical presentation, diagnostic criteria, and pathogenetic aspects. Emphasis is on the differential diagnosis issues and difficulties that the pathologist may face for the correct identification and interpretation of these lesions.
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Affiliation(s)
- Laurence de Leval
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, 25 rue du Bugnon, 1011 Lausanne, Switzerland.
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Guan B, Zhang X, Hu W, Rao Q, Wang Y, Zhu Y, Wang H, Ma H, Zhou H, Zhou X. Plasmablastic lymphoma of the oral cavity in an HIV-negative patient. Ann Diagn Pathol 2010; 15:436-40. [PMID: 20952277 DOI: 10.1016/j.anndiagpath.2010.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 05/10/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare, highly aggressive lymphoma typified by immunoblast-like cells with abundant basophilic cytoplasm and paranuclear hof. It shows absent expression of CD45 and CD20. In contrast, it displays a constant reaction with CD138 and VS38c. It may be easily misinterpreted as some other lymphoma. An exhaustive integration of clinical, morphologic, phenotypic, and molecular features is important to exclude misdiagnosis and inappropriate treatment. We report a case of HIV-negative PBL arising on the left areas of posterior teeth mucosa of a 58-year-old man. Immunohistochemically, the tumor cell was immunoreactive for CD138, VS38c, VEGF, and vimentin; Ki-67 showed a high proliferation rate. Epstein-Barr virus (in situ hybridization) was nonreactive, and IgH gene rearrangement was identified by polymerase chain reaction amplification products. A diagnosis of PBL was rendered.
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Affiliation(s)
- Bing Guan
- Department of Pathology, School of Medicine Nanjing University/Nanjing Jinling Hospital, Nanjing 210002, PR China
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26
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Cha JM, Lee JI, Joo KR, Jung SW, Shin HP, Lee JJ, Kim GY. A case report with plasmablastic lymphoma of the jejunum. J Korean Med Sci 2010; 25:496-500. [PMID: 20191056 PMCID: PMC2826724 DOI: 10.3346/jkms.2010.25.3.496] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 11/12/2008] [Indexed: 12/14/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a recently identified entity that is considered to be a type of diffuse large B-cell lymphoma with a unique immunophenotype and a predilection for the oral cavity of patients with the human immunodeficiency virus (HIV). Although its clinical features may help in the differential diagnosis, an extraoral location in a patient without HIV makes it more difficult to suspect clinically. This case report is the first to describe a patient with PBL originating from the jejunum in a 60-yr-old, HIV-seronegative man. Computed tomography of the face, chest and abdomen showed about a 9.4 x 9.0 cm mass of the proximal jejunum, multiple masses in the musculoskeletal soft tissue, and multiple lymphadenopathies. The histological examinations demonstrated a large cell lymphoma with plasmablastic differentiation. The neoplastic cells were diffusely positive for MUM1, epithelial membrane antigen and lambda light chains, and focally positive for CD79a; but negative for CD3, CD20, CD30, CD34, CD45RO, CD56, CD99, and CD117. The proliferation index by Ki-67 immunohistochemistry was approximately 70%. These findings were compatible with the diagnosis of PBL. The findings in this case suggest that PBL should be included in the differential diagnosis of a small bowel mass even in a HIV-negative patient.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Korea.
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27
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Takahashi Y, Saiga I, Fukushima JI, Seki N, Sugimoto N, Hori A, Eguchi K, Fukusato T. Plasmablastic lymphoma of the retroperitoneum in an HIV-negative patient. Pathol Int 2010; 59:868-73. [PMID: 20021612 DOI: 10.1111/j.1440-1827.2009.02457.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Herein is reported a case of plasmablastic lymphoma (PBL) of the retroperitoneum in an HIV-negative patient. This is the first reported case of PBL at this location and of PBL from Japan in the English-language literature. A 76-year-old Japanese man was admitted to hospital with a chief complaint of right inguinal lymph node swelling. Lymph node biopsy indicated large tumor cells with both diffuse and cohesive growth patterns, and conspicuous tumor cell proliferation in lymph node sinuses. The initial pathological diagnosis was metastatic carcinoma. The patient died approximately 1 month after admission, and autopsy showed that the main lesion was a very large retroperitoneal mass. On histology diffusely proliferated plasmablast-like or immunoblast-like tumor cells were identified, which were positive on immunohistochemistry for CD138 and negative for B-cell and epithelial markers. Approximately 90% of the tumor cells were positive for Ki-67. Tumor cells were diffusely positive for EBV-encoded small RNA on in situ hybridization. The autopsy findings suggested a diagnosis of PBL. Accordingly, PBL should be considered as a differential diagnosis when lymph node biopsy findings resemble those of the present patient.
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Affiliation(s)
- Yoshihisa Takahashi
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.
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28
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Suzuki Y, Yoshida T, Nakamura N, Kamata H, Kotani S, Ohsaka M, Kajita S, Miyazaki K, Ohtani S, Nakayama M, Horie R, Hayakawa K, Niitsu N, Higashihara M. CD3- and CD4-positive plasmablastic lymphoma: a literature review of Japanese plasmablastic lymphoma cases. Intern Med 2010; 49:1801-5. [PMID: 20720363 DOI: 10.2169/internalmedicine.49.3164] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a very rare and recently-described subtype of diffuse large B-cell lymphoma. A maxillary tumor in an 84-year-old HIV-negative Japanese-man was referred. The biopsied specimen showed a diffuse proliferation of mature plasma cells, expressing CD3 (+), CD4 (+), CD20 (-), CD138 (+) and EBER (+) by immunohistochemistry. He was diagnosed as a plasmablastic lymphoma; radiation therapy (RT) was started, but the response to the RT was only a partial response. To our knowledge, this is the first report of a patient with PBL expressing CD3 and CD4.
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Affiliation(s)
- Yuhko Suzuki
- Department of Hematology, Kitasato University School of Medicine, Sagamihara, Japan.
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29
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Bibas M, Antinori A. EBV and HIV-Related Lymphoma. Mediterr J Hematol Infect Dis 2009; 1:e2009032. [PMID: 21416008 PMCID: PMC3033170 DOI: 10.4084/mjhid.2009.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 12/27/2009] [Indexed: 11/18/2022] Open
Abstract
HIV-associated lymphoproliferative disorders represent a heterogeneous group of diseases, arising in the presence of HIV-associated immunodeficiency. The overall prevalence of HIV-associated lymphoma is significantly higher compared to that of the general population and it continues to be relevant even after the wide availability of highly active antiretroviral therapy (HAART) (1). Moreover, they still represent one of the most frequent cause of death in HIV-infected patients. Epstein-Barr virus (EBV), a γ-Herpesviruses, is involved in human lymphomagenesis, particularly in HIV immunocompromised patients. It has been largely implicated in the development of B-cell lymphoproliferative disorders as Burkitt lymphoma (BL), Hodgkin disease (HD), systemic non Hodgkin lymphoma (NHL), primary central nervous system lymphoma (PCNSL), nasopharyngeal carcinoma (NC). Virus-associated lymphomas are becoming of significant concern for the mortality of long-lived HIV immunocompromised patients, and therefore, research of advanced strategies for AIDS-related lymphomas is an important field in cancer chemotherapy. Detailed understanding of the EBV lifecycle and related cancers at the molecular level is required for novel strategies of molecular-targeted cancer chemotherapy The linkage of HIV-related lymphoma with EBV infection of the tumor clone has several pathogenetic, prognostic and possibly therapeutic implications which are reviewed herein.
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Affiliation(s)
- Michele Bibas
- Clinical Department, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, Rome, Italy
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30
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Morley AMS, Verity DH, Meligonis G, Rose GE. Orbital Plasmablastic Lymphoma—Comparison of a Newly Reported Entity with Diffuse Large B-cell Lymphoma of the Orbit. Orbit 2009; 28:425-9. [PMID: 19929677 DOI: 10.3109/01676830903177427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
MESH Headings
- Adult
- Antigens, CD/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Biomarkers, Tumor/analysis
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/therapeutic use
- Fatal Outcome
- HIV Infections/complications
- HIV Infections/drug therapy
- Humans
- Immunophenotyping
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Orbital Neoplasms/drug therapy
- Orbital Neoplasms/pathology
- Plasma Cells/pathology
- Prednisone/therapeutic use
- Tomography, X-Ray Computed
- Vincristine/therapeutic use
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31
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Lim JH, Lee MH, Lee MJ, Kim CS, Lee JS, Choi SJ, Yi HG. Plasmablastic lymphoma in the anal canal. Cancer Res Treat 2009; 41:182-5. [PMID: 19809569 DOI: 10.4143/crt.2009.41.3.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 05/08/2009] [Indexed: 12/12/2022] Open
Abstract
Plasmablastic lymphoma (PBL) of the oral cavity is an acquired immunodeficiency syndrome-related lymphoma. The immunophenotype of this disease is associated with poor expression of B-cell markers but a positive reactivity for plasma cell markers. PBL is highly aggressive and responds poorly to treatment. Although originally described in the oral cavity, this disease can occur in other body niches. Here, we describe a very rare case of PBL in the anal canal of a 40-year-old woman with human immunodeficiency virus infection. The malignant cells were positive for Epstein-Barr virus and human herpes virus 8.
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Affiliation(s)
- Joo Han Lim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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32
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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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33
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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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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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35
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Lim JH, Joo WC, Choi SJ, Kim JS, Yi HG, Lee MH, Lee JS, Kim CS. Plasmablastic Lymphoma in a Human Immunodeficiency Virus-negative Patient: A Case Report and Review of the Literature. THE KOREAN JOURNAL OF HEMATOLOGY 2009. [DOI: 10.5045/kjh.2009.44.2.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joo Han Lim
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Woo Chul Joo
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Suk Jin Choi
- Department of Pathology, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Jin Soo Kim
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Hyeon Gyu Yi
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Moon Hee Lee
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Chul Soo Kim
- Department of Internal Medicine, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
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36
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Abstract
Plasmablastic lymphoma (PBL) has been recently characterised as an aggressive subtype of non-Hodgkin's lymphoma, most frequently arising in the oral cavity of HIV-infected patients. To date, approximately 60 cases fulfilling the clinico-pathological characteristics of PBL have been reported. PBLs are composed of large cells with eccentrically located nuclei and deeply basophilic cytoplasm with a paranuclear hof. The tumour cells are invariably immunoreactive for the plasma cell marker CD138, and show monoclonal rearrangement of the immunoglobulin heavy chain gene (IgH) and/or clonal restriction of the Ig light chain (IgL) gene expression in most of the cases. Similar to other types of AIDS-related lymphomas, there is evidence that Epstein-Barr virus and Kaposi-sarcoma associated Human Herpes Virus 8 may play a relevant role in the pathogenesis of PBL. PBL patients have been treated heterogeneously, with a combination of chemotherapy, radiotherapy and/or surgery, and their prognosis is usually poor, with a death rate of approximately 60% at 1 year.
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Affiliation(s)
- P Rafaniello Raviele
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Milan, Italy
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37
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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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38
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Plasmablastic lymphoma: Cytologic findings in 5 cases with unusual presentation. Cancer 2008; 114:333-41. [DOI: 10.1002/cncr.23794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mani D, Jr DGG, Aboulafia DM. AIDS-associated plasmablastic lymphoma presenting as a poorly differentiated esophageal tumor: A diagnostic dilemma. World J Gastroenterol 2008; 14:4395-9. [PMID: 18666332 PMCID: PMC2731195 DOI: 10.3748/wjg.14.4395] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare form of diffuse large B-cell lymphoma characterized by weak/absent expression of conventional B-cell markers and strong expression of plasma cell markers. It is strongly associated with human immunodeficiency virus (HIV) and Epstein Barr virus infection, and shows an unusual tropism to the oral cavity. Herein we describe a patient with AIDS who presented with weight loss and dysphagia owing to a large gastroesophageal mass. His radiographic and endoscopic findings and long history of cigarette consumption suggested carcinoma. Biopsy demonstrated a poorly differentiated tumor stained negatively to routine lymphoid markers including CD20. However, gene rearrangement studies confirmed a B-cell process and a more detailed immunohistochemical analysis revealed the cells stained positively for CD138 (plasma cell antigen). These findings were diagnostic of PBL. Our report reviews the wide differential diagnosis of PBL and underscores the importance of a broad array of viral and molecular studies needed to establish this diagnosis.
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Vieira FO, El Gandour O, Buadi FK, Williams GB, Shires CB, Zafar N. Plasmablastic lymphoma in a previously undiagnosed AIDS patient: a case report. Head Neck Pathol 2008; 2:92-6. [PMID: 20614329 PMCID: PMC2807551 DOI: 10.1007/s12105-008-0058-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 04/23/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is an unusual non-Hodgkin lymphoma (NHL) most commonly found in the head and neck region. The majority of cases are seen in adult HIV-positive patients, although PBL has been reported in HIV-negative patients. The diagnosis of PBL serves as an AIDS-defining illness. METHODS We report a case of PBL localized to the oral cavity in a previously undiagnosed AIDS patient. The lesion manifested as solitary, ulcerated, and markedly tender. PBL was confirmed by immunohistochemical profile and subsequent tests confirmed AIDS diagnosis. The patient was prescribed highly active antiretroviral therapy (HAART) and concomitant local low dose radiation therapy prior to initiation of chemotherapy. RESULTS Complete local clinical response was observed after 4 weeks of treatment with HAART and radiation therapy. The response sustained in this patient in the subsequent 11 months following diagnosis. CONCLUSIONS The diagnosis of PBL has a unique immunophenotypic profile and should raise suspicion for AIDS in these patients. HAART added to treatment has shown improved survival.
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Affiliation(s)
- Francisco O. Vieira
- Department of Otolaryngology—Head and Neck Surgery, University of Tennessee at Memphis, Health Science Center, 920 Madison St., S. 409, Memphis, TN 38103 USA ,The Med Regional Medical Center, Memphis, TN 38103 USA
| | - Omar El Gandour
- Department of Radiation Oncology, University of Tennessee Cancer Institute, Memphis, TN 38103 USA
| | | | - Glenn B. Williams
- Department of Otolaryngology—Head and Neck Surgery, University of Tennessee at Memphis, Health Science Center, 920 Madison St., S. 409, Memphis, TN 38103 USA
| | - Courtney B. Shires
- Department of Otolaryngology—Head and Neck Surgery, University of Tennessee at Memphis, Health Science Center, 920 Madison St., S. 409, Memphis, TN 38103 USA
| | - Nadeem Zafar
- The Med Regional Medical Center, Memphis, TN 38103 USA ,Department of Pathology, University of Tennessee Health Science Center, Memphis, TN 38163 USA
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Riedel DJ, Gonzalez-Cuyar LF, Zhao XF, Redfield RR, Gilliam BL. Plasmablastic lymphoma of the oral cavity: a rapidly progressive lymphoma associated with HIV infection. THE LANCET. INFECTIOUS DISEASES 2008; 8:261-7. [PMID: 18353267 DOI: 10.1016/s1473-3099(08)70067-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Plasmablastic lymphoma of the oral cavity is a form of non-Hodgkin lymphoma (NHL) and was first described in 1997. We describe a case of plasmablastic lymphoma in an HIV-infected patient who presented with an expanding oral lesion and symptoms of a toothache. We review all cases of plasmablastic lymphoma that have been reported in the literature. Plasmablastic lymphoma is strongly associated with immunodeficiency, and most particularly, with HIV infection. The pathophysiological origin of plasmablastic lymphoma has not been fully characterised, but the presence of Epstein-Barr virus (EBV) has often been documented in biopsy specimens, supporting a role for EBV in the pathogenesis of this lymphoma. The differential diagnosis for an expanding oral lesion includes both infectious and malignant processes. Biopsy is essential for making a correct and prompt diagnosis. Treatment usually involves chemotherapy, but antiretroviral therapy may also have an important role. Infectious disease clinicians should be aware of this newly described and increasingly encountered lymphoma, since it is prominently associated with immunosuppression and may be mistaken for other entities.
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Affiliation(s)
- David J Riedel
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Lee SC, Kim HJ, Bae SB, Kim CK, Lee NS, Lee KT, Park SK, Hong DS, Park HS, Jin SY, Won JH. Plasmablastic Lymphoma Mistaken for Perianal Abscess in Patient with AIDS. THE KOREAN JOURNAL OF HEMATOLOGY 2008. [DOI: 10.5045/kjh.2008.43.3.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sang-Cheol Lee
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Hyun-Jung Kim
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sang-Byung Bae
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Chan-Kyu Kim
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Nam-Su Lee
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Kyu-Taek Lee
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Sung-Kyu Park
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Dae-Sik Hong
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Hee-Sook Park
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Jong-Ho Won
- Division of Hematology & Oncology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
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43
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Abstract
Plasmablastic lymphoma (PBL) is a rare entity most commonly identified in the oral cavity of immunodeficient patients. The immunophenotype of this condition shows a poor expression for B-cell markers but, in contrast, a strong reactivity for well-differentiated plasma cells markers, such as CD138, CD38, and epithelial membrane antigens. PBL survival is limited due to its highly aggressive local and metastatic behavior and poor response to treatment. Although it can involve different organs, there have been only a few cases involving the ocular adnexa. We describe a case of atypical rapidly progressive pre-septal brawny induration affecting the right orbit in a patient with HIV-related lymphoma.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active/methods
- Biopsy, Needle
- Disease Progression
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Large-Cell, Immunoblastic/diagnosis
- Lymphoma, Large-Cell, Immunoblastic/drug therapy
- Lymphoma, Large-Cell, Immunoblastic/pathology
- Magnetic Resonance Imaging
- Orbital Neoplasms/diagnosis
- Orbital Neoplasms/drug therapy
- Orbital Neoplasms/pathology
- Risk Assessment
- Tomography, X-Ray Computed
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Affiliation(s)
- Alejandra A Valenzuela
- Department of Ophthalmology, Eyelid, Lacrimal, and Orbital Clinic, Royal Brisbane and Women's Hospital and the University of Queensland Medical School, Brisbane, Australia
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Abstract
The incidence of lymphoma in patients with HIV infection greatly exceeds that of the general population. The increased risk for lymphoma appears related to multiple factors, including the transforming properties of the retrovirus itself, the immunosuppression and cytokine dysregulation that results from the disease, and, most importantly, opportunistic infections with other lymphotrophic herpes viruses such as Epstein-Barr virus and human herpesvirus 8. Histologically lymphomas fall into three groups: (1) those also occurring in immunocompetent patients; (2) those occurring more specifically in HIV-positive patients; and (3) those also occurring in patients with other forms of immunosuppression. Aggressive lymphomas account for the vast majority cases. They frequently present with advanced stage, bulky disease with high tumour burden and, typically, involve extranodal sites. Clinical outcome appears to be worse than in similar aggressive lymphomas in the general population. However, following the introduction of highly active antiretroviral therapy, the risk for developing lymphoma in the context of HIV infection has decreased and the clinical outcome has improved.
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Affiliation(s)
- K L Grogg
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Borenstein J, Pezzella F, Gatter KC. Plasmablastic lymphomas may occur as post-transplant lymphoproliferative disorders. Histopathology 2007; 51:774-7. [PMID: 17944927 DOI: 10.1111/j.1365-2559.2007.02870.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To describe four cases of plasmablastic lymphoma arising in the unusual setting of a post-transplantation lymphoproliferative disorder (PTLD). METHODS AND RESULTS Four cases were encountered over 2 years in human immunodeficiency virus (HIV)-negative patients following renal, heart or bone marrow transplantation. The cases were routinely processed and immunohistochemistry was performed. The cases showed blastic non-Hodgkin's lymphoma morphology and plasma cell-like immunophenotypic features: minimal or absent expression of leucocyte common antigen and CD20, variable CD79a and VS38 positivity. Monoclonal light chain restriction was also detected. CONCLUSIONS The emphasis of this paper is to document further the occurrence of plasmablastic lymphomas in HIV- individuals and to expand the spectrum of PTLD.
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Affiliation(s)
- J Borenstein
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Masgala A, Christopoulos C, Giannakou N, Boukis H, Papadaki T, Anevlavis E. Plasmablastic lymphoma of visceral cranium, cervix and thorax in an HIV-negative woman. Ann Hematol 2007; 86:615-8. [PMID: 17361427 DOI: 10.1007/s00277-007-0280-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 02/26/2007] [Indexed: 02/03/2023]
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47
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Redmond M, Quinn J, Murphy P, Patchett S, Leader M. Plasmablastic lymphoma presenting as a paravertebral mass in a patient with Crohn's disease after immunosuppressive therapy. J Clin Pathol 2007; 60:80-1. [PMID: 17213349 PMCID: PMC1860602 DOI: 10.1136/jcp.2006.037556] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The case of a 32-year-old man with a paravertebral mass and skin nodules, occurring against a background of immunosuppressive therapy for Crohn's disease, is presented. The tumours showed morphological and immunophenotypical features of plasmablastic lymphoma. To our knowledge, this is the first reported case of plasmablastic lymphoma presenting in this location, and also after immunosuppression with infliximab treatment for Crohn's disease.
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Affiliation(s)
- M Redmond
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland.
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Tavora F, Gonzalez-Cuyar LF, Sun CCJ, Burke A, Zhao XF. Extra-oral plasmablastic lymphoma: report of a case and review of literature. Hum Pathol 2006; 37:1233-6. [PMID: 16938530 DOI: 10.1016/j.humpath.2006.04.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/05/2006] [Accepted: 04/12/2006] [Indexed: 12/15/2022]
Abstract
Plasmablastic lymphoma (PBL) of the oral cavity is classified as one subtype of diffuse large B-cell lymphoma that is most commonly seen in patients with human immunodeficiency virus infection. We report a rare case of PBL in the anal canal of a 33-year-old man with human immunodeficiency virus infection. The lymphoma cells were positive for CD138 and weakly positive for CD79a. In addition, these cells were also positive for CD10. The neoplastic cells were positive for Epstein-Barr virus and negative for human herpes virus 8. Review of the English medical literature revealed many more cases of extra-oral PBL. We propose that the term plasmablastic lymphoma of the oral cavity in World Health Organization classification be revised to simply plasmablastic lymphoma, which would include both oral and extra-oral PBLs, and the term to define the primary site of the lymphoma (ie, oral cavity) be dropped from the terminology used in World Health Organization classification.
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MESH Headings
- Adult
- Anus Neoplasms/classification
- Anus Neoplasms/metabolism
- Anus Neoplasms/pathology
- CD79 Antigens/metabolism
- Epstein-Barr Virus Infections/complications
- HIV Infections/complications
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/isolation & purification
- Humans
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Membrane Glycoproteins/metabolism
- Neprilysin/metabolism
- Proteoglycans/metabolism
- Syndecan-1
- Syndecans
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Affiliation(s)
- Fabio Tavora
- Department of Pathology, University of Maryland School of Medicine, Baltimore, 21201, USA
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49
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Abstract
Plasmablastic lymphoma (PBL) is an uncommon, recently described B-cell-derived lymphoma that displays distinctive affinity for extranodal presentation in the oral cavity. Plasmablastic lymphoma is strongly associated with human immunodeficiency virus (HIV) infection, but has been reported in HIV-negative individuals. Plasmablastic lymphoma may be poorly recognized by pathologists, which is partly attributable to its relatively rare occurrence and unusual immunophenotype. Five cases of oral cavity lymphomas conforming to the current World Health Organization morphological criteria for PBL were retrieved from the consultation files at the Armed Forces Institute of Pathology. An immunohistochemical panel consisting of CD3, CD20, CD30, CD38, CD45RB, CD79a, CD138, Bcl-2, Bcl-6, Alk-1, Ki-67, EBV-LMP-1, and HHV8 was performed. All 5 cases were immunoreactive for CD38 and/or CD138, confirming plasma cell differentiation of the tumor cells. CD20 was immunoreactive in 1 case, and CD79a was positive in 2 cases. HHV8 and EBV-LMP-1 were nonreactive in all cases. Follow-up revealed only 1 patient alive with no evidence of disease. Our cases show that PBL is an aggressive type of B-cell lymphoma predominantly found in the oral cavity. Plasmablastic lymphoma is often associated with HIV infection.
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Affiliation(s)
- Gretchen S Folk
- Department of Oral and Maxillofacial Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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50
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Dong HY, Scadden DT, de Leval L, Tang Z, Isaacson PG, Harris NL. Plasmablastic lymphoma in HIV-positive patients: an aggressive Epstein-Barr virus-associated extramedullary plasmacytic neoplasm. Am J Surg Pathol 2006; 29:1633-41. [PMID: 16327436 DOI: 10.1097/01.pas.0000173023.02724.1f] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIDS-associated aggressive B-cell lymphomas often have plasmacytoid features. Plasma cell neoplasms in HIV patients were commonly described to have atypical morphology and an aggressive clinical course in the literature. We reviewed 14 cases of neoplasms with marked plasmacytic differentiation in HIV-positive patients to determine their clinicopathologic features. Of these, 13 of 14 had homogeneous morphology and were generally CD45(+), CD20-, PAX-5-, and CD138(+). All were positive for Epstein-Barr virus-encoded RNA (EBER) but lacked EBV late membrane proteins (LMP). Human herpes virus 8 (HHV8) DNA was detected in 6 of 10 cases by nested PCR, but HHV8 latent nuclear antigen (LNA) was absent. The 13 patients ranged in age from 28 to 44 years (median, 41 years) (11 male patients; 2 female patients). All patients had extramedullary and 11 of 13 had extranodal tumor at the initial presentation; 2 had distant marrow involvement. The most commonly involved location was the oral cavity (6 of 13 cases), followed by bone and soft tissue (4 of 13), and the gastrointestinal tract (3 of 13). All 11 patients with follow-up died within 34 months (median, 7 months). The 14th patient who had a nodal disease with more undifferentiated morphology and expression of the HHV8 LNA protein was alive without disease at last follow-up (>72 months), probably representing a novel HHV8(+) lymphoma. We conclude that most plasmacytic tumors in HIV-positive individuals are extramedullary, clinically aggressive EBV(+) tumors identical to plasmablastic lymphoma that does not have the clinical features of plasma cell myeloma.
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Affiliation(s)
- Henry Y Dong
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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