Synchronous Anal Squamous Cell Carcinoma and Diffuse Large B Cell Lymphoma of Stomach: the First Report of an Odd Couple

Abstract

The unique case study presented here explores an exceptionally rare occurrence in an HIV-positive female-synchronous diagnoses of anal squamous cell carcinoma and diffuse large B cell lymphoma (DLBCL) of the stomach. With limited existing literature on such clinical scenarios, this case serves as an unprecedented insight into the complexities of managing such synchronous malignancies in HIV-positive patients. The article also examines the heightened risk of specific cancer types in individuals living with HIV compared to those without the virus, focusing on AIDS-defining cancers such as Kaposi sarcoma, various lymphomas (including Burkitt lymphoma, immunoblastic lymphoma, and primary central nervous system lymphoma), and invasive cervical cancer. Additionally, it highlights an increased incidence and severity of other cancers amongst HIV-positive individuals, including Hodgkin lymphoma, anal cancer, testicular cancer, melanoma, various skin and superficial eye cancers, and leiomyosarcoma. The article discusses the challenges in the treatment plan, the impact of HIV status on the patient's condition, and the evolving landscape of cancer risk in people living with HIV. Despite significant progress in HIV care, cancer remains a paramount health concern for this population, necessitating tailored approaches and further research to ensure improved outcomes for individuals facing this dual challenge. The case highlights the need for greater inclusivity of PLWH in cancer clinical trials and reinforces the importance of equitable cancer care for this unique patient demographic.

Keywords: Anal cancer; HIV; Lymphoma; Synchronous.

Fig. 1

Contrast-enhanced MRI of the pelvis showed a concentric wall thickening involving the anorectum with infiltration of the posterior wall of the vagina and extending in the vaginal canal. There is infiltration of the right-sided levator ani muscle

Fig. 2

PET-CT scan showed the anal polypoidal lesion and also additionally revealed increased FDG uptake in the stomach

Fig. 3

HPE from anal canal growth showing squamous cell carcinoma

Fig. 4

HPE from the stomach lesion showed poorly differentiated malignant neoplasm

Fig. 5

Immunohistochemistry (IHC) of the stomach lesion showed nuclear positivity for CD45 (A), CD20 (B), BCL6 (C), MUM1 (D), C-Myc (E), and Ki 67 (F)