[1425] Clonal Analysis of Multiple Lymphoproliferative Lesions (LPDs) in HIV Positive Patients

Jacqueline Lekostaj, Juehua Gao, David Dittman, Amy Chadburn. Northwestern University Feinberg School of Medicine, Chicago, IL

Background: Malignant lymphoma is generally thought to be a monoclonal process involving one or more sites in a patient (pt). In the setting of immunosuppression and Epstein Barr virus (EBV) infection clonally distinct LPDs may arise in a single individual; furthermore morphology does not always correlate with clonality. HIV+ pts are immunosuppressed and often infected with EBV. However, whether multiple LPDs, reactive and/or neoplastic, occurring in an individual HIV+ pt are of identical or disparate clonal content, or are clonally consistent with morphology has not been fully investigated.
Design: DNA from touch preparations or FFPE tissue of 2-4 LPDs from 10 HIV+ pts (M:9/F:1; age 28-53 yrs) was amplified using primer sets for heavy (H), kappa (K) and lambda (L) immunoglobulin loci. Samples were assessed for quality using a control gene primer set. PCR products were analyzed by capillary electrophoresis. Monoclonal was defined as a peak >3 times the height of the third highest peak in the appropriate region. EBV was detected by in situ hybridization with an EBER probe. Tests performed were dependent on available material.
Results:

Morphology, Clonality, EBV Status in HIV-LPDs*
 Pt. 1@Pt. 2^Pt. 3**Pt. 4Pt. 5Pt. 6Pt. 7
Lesion 1Poly-LPDPoly-LPDRxtRxtRxtDLBCLPEL
ClonalityMonoPolyPolyPolyPolyMonoMono
Lesion 2 - TimeDLBCL-14moDLBCL-18moDLBCL-1wkDLBCL-2 wkBL-1wkRxt-2moRxt-2wk
ClonalityMonoMonoMonoMonoOligoPolyPoly
Clonal relatednessYesNoYes**NoNoNoNo
EBV (#1; #2)Pos;PosPos;PosNA;NAPos;PosNANA;RarePos;NA
BL=Burkitt Lymphoma; DLBCL=Diffuse large B cell lymphoma; Poly-LPD=polymorphic LPD; Rxt=Reactive; PEL=Primary effusion lymphoma; NA=not available

*Similar morphology and clonal content was seen in 2-4 tissue biopsies from 3 additional patients (2 with lymphoma; 1 Rxt) over a period of 6-81 mo. @Clonal content was identical but the morphology evolved. ^Small clone in the 2nd biopsy; **The DLBCL K clone was present at a low level in the Rxt Poly proliferation. The remaining Rxt cases were polyclonal and the neoplastic cases were monoclonal. Large numbers of EBV were seen only in neoplastic cases except in Pt 5's Rxt lesion.
Conclusions: In the setting of HIV infection clonal content is usually consistent with morphology and constant over time. Although malignant LPDs may be EBV associated, therefore driven by an infectious agent, redevelopment or new site of lymphoma is usually of the same clone. Thus, the presence of recurrent disease is not a new separate clonal process and may require different chemotherapy for possible remission.
Category: Hematopathology

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 217, Monday Morning

 

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