1/5. Regression of a plasmablastic lymphoma in a patient with hiv on highly active antiretroviral therapy.We describe an hiv-infected 44-year-old man who presented 1 month after discontinuation of HAART therapy with a large mass extending from the mediastinum, enclosing the heart and extending through the diaphragm to the epigastric region. Biopsies subsequently revealed a highly aggressive non-Hodgkin's lymphoma (NHL) producing sheets of cells with an organoid distribution. The cells had abundant basophilic cytoplasm and a plasmacytic appearance. Although immunohistochemistry failed to show either B- or T-cell markers, antigens consistent with plasma cells were found. An immunoglobulin heavy chain clonal rearrangement was identified by PCR analysis. These studies were supportive of a diagnosis of a plasmablastic lymphoma. While awaiting the results of these tests, the patient was reinitiated on his HAART regimen. He was found on follow-up a month later to have complete resolution of his bulky mediastinal mass. He remained free of disease for 3 months with subsequent rectal and abdominal recurrence. Treatment with CHOP chemotherapy with filgrastim support was begun which resulted in another remission. Plasmablastic lymphoma is now reported in some studies to account for 2.6% of all hiv-related NHL. Originally described in 1997 in a series of 16 patients, this entity is highly associated with hiv infection in its later stages. Often, patients present with oral or jaw lesions with a rapidly progressive course. The tumors have the morphologic appearance of a plasmacytoid tumor with high proliferative index. Markers are positive mainly for LCA, CD79a, VS38C, and CD138. Co-infection with HHV-8 and EBV has not been consistently reported. Therapy with standard regimens has variable response. One case has been reported with a 3.5 year disease free survival. The regression of disease after resumption of HAART therapy alone in this patient suggests that HAART has an important role in the treatment of lymphoma in the hiv infected patient.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
2/5. Plasmablastic lymphoma in hiv patients: an expanding spectrum.AIM: To describe an unusual human immunodeficiency virus (hiv)-associated lymphoma in uncommon sites. Plasmablastic lymphoma is a distinctive hiv-associated tumour that was first described in the jaws and oral cavity. Only two cases (stomach and lung) have been documented in extra-oral sites. MATERIALS AND methods: Four cases were encountered in hiv patients: three in the anorectal region and one which was nasal and paranasal. The cases were routinely processed and immunohistochemistry was performed on formalin-fixed paraffin-embedded tissue. RESULTS: The cases showed the typical morphological appearances of a high-grade, blastic non-Hodgkin's lymphoma (brisk mitotic activity and tingible body macrophages). In addition, some cells had a plasmacytoid appearance and paranuclear clearing. Immunophenotypically, the tumour cells were negative for LCA, CD20 and CD45RA. However, a small proportion of cells (5%) were immunoreactive for CD79a and the majority were positive with VS38c, indicative of plasma cell differentiation. Kappa light chain and IgG heavy chain restriction was also detected. CONCLUSIONS: Plasmablastic lymphoma may occur in extra-oral sites and has a characteristic immunophenotype including focal expression of CD31 by the neoplastic cells. awareness of the absence of expression of conventional B-cell markers and its presence in unusual sites should facilitate the diagnosis of plasmablastic lymphoma in hiv patients.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
3/5. Plasmablastic lymphoma of the oral cavity in an hiv-positive child.A 7-year-old boy with a positive history of vertical hiv transmission presented with a painful swelling over the left upper jaw of 20 days' duration. A provisional diagnosis of non-Hodgkin's lymphoma or embryonal rhabdomyosarcoma was made. Fine-needle aspiration cytology findings were inconclusive, and incisional biopsy tissue on routine stains gave an impression of small round cell tumor with plasmacytoid features. A series of histochemical stains and immunohistochemical studies was carried out to differentiate and characterize this tumor. The salient immunostaining was negativity with all routine small round cell tumor markers and positivity with CD138 and lambda light chain restriction. The heterogeneous presentation of plasmablastic lymphoma as a variant of diffuse large B-cell lymphoma and its histogenesis is documented. Potential pitfalls and differential characterization of AIDS-plasmablastic lymphoma from other closely related tumors are addressed. The importance of excluding other common pediatric small round cell tumors by immunohistochemistry is highlighted. To the best of our knowledge, this is the first report of this entity in a vertically transmitted hiv-positive child.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
4/5. Favorable response of pediatric AIDS-related Burkitt's lymphoma treated by aggressive chemotherapy.We describe 4 male children infected by the human immunodeficiency virus (hiv) who developed Burkitt's lymphoma during their disease. The clinical picture was characterized by an insidious appearance of symptoms. All the children suffered for several months from abdominal discomfort and a gradual elevation of their blood lactic dehydrogenase (LDH) level prior to diagnosis. bone marrow involvement was found in 2 of the patients and jaw involvement in the other 2. After confirming the diagnosis of Burkitt's lymphoma, they were treated according to conventional protocols, with no need to reduce the dose intensity. They all went into complete remission and did not suffer from major opportunistic infections during chemotherapy. None of them relapsed. Two patients died from opportunistic infections 1 and 3 years after diagnosis. The other 2 are alive, 7 years and 6 months after diagnosis. The various characteristics of this unique pediatric group are described and the comparison of the clinical picture in adults is made, together with a review of the relevant literature.- - - - - - - - - - ranking = 1keywords = jaw (Clic here for more details about this article) |
5/5. Burkitt's lymphoma with mandible, intra-abdominal and renal involvement--initial presentation of hiv infection in a 4-year-old child.Burkitt's lymphoma of the jaw was first described as a jaw tumor occurring endemically in African children. We report a case of Burkitt's lymphoma in a child presenting with a painful jaw mass which proved to be Burkitt's lymphoma; renal involvement was also noted. The child was found to be hiv positive. Burkitt's may be the initial manifestation of hiv infection in the pediatric population.- - - - - - - - - - ranking = 3keywords = jaw (Clic here for more details about this article) |