Extra-Oral Plasmablastic Lymphomas as a Predominant Involvement Pattern in AIDS Patients of an Inner City Hospital
Iva Trgovcic, Christina Duckworth, Minh Nguyen, Clifford Gunthel, Marina Mosunjac. Emory University, Atlanta, GA
Background: Plasmablastic lymphoma (PBL) is defined as a rare aggressive lymphoma characterized by a diffuse proliferation of large neoplastic B-cells with predominance of immunoblastic/plasmablastic morphologic features and a plasma cell –like immunophenotype.Originally, PBL was outlined as an aggressive, B-cell lymphoma, primarily occurring in the oral cavity and most frequently arising in association with human immunodeficiency virus (HIV) infection.
Design: From 2004 to 2012, 14 cases of patients diagnosed with PBL were identified. Electronic medical records were used for extraction of demographic data, HIV status, HIV-associated risk factors, laboratory data, PET imaging scan results, pathology reports and flow cytometry reports. Pathology slides with immunohistochemistry stains were reviewed.
Results: Of the 14 patients with PBL, there were 13 men and one woman with an age range of 26-63 years. 13 patients were HIV + (92.9%), and one patient was HIV -. Less than one fourth (21.4%) of patients (3) presented with oral lesions and the remaining 71.5% presented with extra oral disease including anus, colon, rectum (5), stomach (2), liver (1), penis (1), inguinal node (1) and lungs (1). Most of the HIV + patients were on HAART therapy (84.6 %) treatment and one patient was reported as non-compliant. In the large majority of cases, PET scan demonstrated disease involving other organs, with only one patient free of widespread lymphoma. The bone marrow was infiltrated in 6 cases (42.8%). The most common HIVassociated risk factor was men having sex with men (MSM) (42.8%). The single HIV negative patient presented with disease in the oral cavity/gingival, and was the only patient noted to be in remission from the disease.
Conclusions: Contrary to other studies, our series demonstrates that the majority of PBL in HIV positive patients occurred primarily in extra oral and extra nodal sites. The most common extra oral sites were the ano/rectal area followed by the stomach, with single occurrences of cases in the lungs, liver and penis. Most of the HIV positive patients were on HAART therapy, with disease involving other organs and bone marrow.Diagnosis of PBL is challenging, particularly when it arises in unusual extra oral locations and present as an undifferentiated neoplasm. In those cases an appropriate immunohistochemical pattern including plasma cell markers and B-cell markers should help in diagnosis of such tumors.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 254, Wednesday Morning