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. 2013:2013:862585.
doi: 10.1155/2013/862585. Epub 2013 Nov 26.

A Case of Cutaneous Plasmablastic Lymphoma in HIV/AIDS with Disseminated Cryptococcus

Jun Gong  1 , Serhan Alkan  2 , Sidharth Anand  1
Affiliations

A Case of Cutaneous Plasmablastic Lymphoma in HIV/AIDS with Disseminated Cryptococcus

Jun Gong et al. Case Rep Oncol Med. 2013.

Abstract

We present a case of a patient with HIV/AIDS who presented with a tender left lower extremity cutaneous mass over a site of previous cryptococcal infection and was found to have plasmablastic lymphoma (PBL). The incidence of PBL is estimated to account for less than 5% of all cases of non-Hodgkin lymphoma (NHL) in HIV-positive individuals. In fact, there were only two reports of extraoral PBL at the time of a 2003 review. PBL in HIV-positive individuals is an aggressive malignancy that tends to occur in middle-aged males with low CD4 counts, high viral loads, and chronic HIV infection. The definitive diagnosis can be made with biopsy which typically shows malignant lymphoid cells that stain positive for plasma cell markers and negative for B-cell markers. The most common treatment is chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens, but the overall survival rate is poor despite its relative responsiveness to chemotherapy. This case highlights the challenges that remain in improving clinical outcomes, the importance of antiretroviral therapy and HIV disease control, and a potential association between a chronic inflammatory state caused by disseminated Cryptococcus and tumorigenesis in individuals with PBL.

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Figures

Figure 1
Figure 1
Physical exam of the right thigh revealed two fluctuant, well-circumscribed, circular lesions approximately 3 cm in diameter that were tender to palpation and non-mobile (a). Examination of the left lower extremity showed a fleshy-appearing, pinkish, ovular exophytic mass approximately 5 cm in diameter that was tender to palpation (b) and (c).
Figure 2
Figure 2
Cutaneous biopsy revealed a diffuse sheet of subepidermal large lymphoma cells with high mitotic rate and occasional tingible body macrophages (a) and (b). Immunohistochemical staining showed expression of CD138 (c) and EBV in situ hybridization (EBER transcript) revealed many of the lymphoma cells infected by EBV (d).
Figure 3
Figure 3
Staging CT scan showed a pulmonary nodule identified in the left lower lobe which is 1.8 × 1.8 cm in diameter.
Figure 4
Figure 4
Staging CT scan showed a left perirectal soft tissue mass which is 2.0 × 2.2 cm in diameter.
See this image and copyright information in PMC

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