Early stage primary gastric diffuse large B-cell lymphoma in a young HIV-positive patient

Abstract

HIV infection is known to be associated with the development of a wide range of neoplasia. About 25 to 40% of HIV-positive patients will present some kind of malignancy in the course of the disease; among them 10% are non-Hodgkin lymphomas (NHL) and 20% of these are represented by the diffuse large B-cell lymphoma. HIV-positive patients have a relative risk of 110 times higher to develop neoplasia, than the non-infected population. The gastrointestinal (GI) tract is the most frequent extranodal site of involvement. However, the primary GI lymphoma is rare. The authors present a case of a 31-year-old male patient with a 16-year history of HIV infection, who deliberately withdrew the Highly Active Antiretroviral Therapy (HAART) regimen and was hospitalized because of a respiratory infection. Because of a long-term complaint of dyspepsia, an upper gastrointestinal endoscopy was performed disclosing a large elevated and ulcerated gastric lesion, which biopsy revealed a diffuse large B-cell lymphoma. Clinical, imaging and laboratory tests showed an early stage diagnosis: Lugano stage I. Although not frequent, the authors alert to considering this neoplasia in all HIV-positive patients with dyspeptic symptoms.

Keywords: Acquired Immunodeficiency Syndrome; Lymphoma, AIDS-Related; Lymphoma, Large B-Cell, Diffuse; Stomach Neoplasms.

Figure 1. Endoscopic view of the gastric antrum, showing in its posterior wall a well-delimitated ulcerated lesion, with elevated borders, granular and clean wound bed.

Figure 2. A - Photomicrography of gastric biopsy showing large lymphoid cells exhibiting prominent nucleoli and basophilic cytoplasm in a diffuse growing pattern. (H&E, 400x); B - Immunohistochemistry showing diffuse staining for CD20 (400x); C - Focal immunostaining for CD30 (1000x); D - High proliferation index (80-90%) as accessed by Ki67 (400x).