Histopathologic spectrum of AIDS-associated lesions in Maharaj Nakorn Chiang Mai Hospital

Abstract

The histopathological alterations in various organs and the presence of AIDS-associated lesions were studied in 86 biopsy and 29 necropsy specimens of AIDS patients. The most common cancer seen in this study were malignant lymphomas (4% of cases) with development of extensive extranodal lymphomatous involvement from the outset. Although a preponderance of high grade B-cell pathologic subtypes is found in AIDS-associated lymphoma, we also report the first case of T-lymphoblastic lymphoma with a picture of acute lymphoblastic leukemia (T-ALL). Tuberculosis (34% of cases) was the most common opportunistic infection presented in tissue sections, and the majority of tissue biopsies revealed poorly organized granulomas and extensive necrosis with numerous bacilli. Penicilliosis (20% of cases) appeared to be the most common cutaneous lesion with multiple organ involvement. The involved organs showed a partially anergic tissue reaction characterized by poorly formed granulomas with diffuse infiltrate of fungi-laden macrophages and lymphoid cell depletion. This organism has to be distinguished from Histoplasma capsulatum and other yeast-form fungi. Co-existing cytomegalovirus and P. carinii infections were the predominant findings in lung necropsy specimens from pediatric patients who died from AIDS. A major pathologic feature in this group was diffuse alveolar damage stage II to III with heavy loads of organism and extensive lymphoplasmacytic infiltration.