Oral plasmablastic lymphoma in a case with HIV infection

Abstract

Plasmablastic lymphoma (PBL) is a rarely seen malignant lesion and it is most commonly detected in HIV (Human-immunodeficiency virus)-infected subjects predominantly in the oral cavity. It was first described in 1997. It has been recognized as a distinct entity, as a subtype of diffuse large B-cell lymphoma. Recently, PBL presentation has been reported frequently outside the oral cavity. Gastrointestinal tract and skin were the most commonly involved extra-oral organ systems. Plasmablastic lymphoma usually displays a characteristic immunophenotype that includes negativity for typical B-cell markers (eg, CD20), and positivity for plasma cell markers such as CD38, CD138and VS38c. In this report, we described a case of PBL in a 44-year-old HIV infected male patient who presented with an expanding 30×30 mm oral lesion, pulmonary tuberculosis and an 18×30 mm cerebral left thalamic lesion. Histopathological evaluation of the lesion in oral cavity was consistent with PBL. The neoplastic cells were CD20 negative. Evaluation of the hematoxylin and eosin stained slides revealed diffuse plasmacytoid infiltrate and showed large atypical cells with large cytoplasm, round nuclei and occasionally located nucleoli. Bone marrow biopsy revealed involvement of non-Hodgkin lymphoma (NHL). The patient received HAART (highly active antiretroviral therapy) consisting of stavudine + lamivudine + lopinavir/ritonavir for the treatment of HIV infection; iso-niasid + ethambutol + rifampin/streptomycin and morphosinamide for the treatment of pulmonary tuberculosis; and chemotherapy [cyclophosphamide + doxorubicin + oncovin + prednisone (CHOP)] and radiotherapy for the treatment of PBL. Despite treatment, the patient died after 7.5 months of follow-up. This case, the first case in Turkey, was presented to draw attention to screening of HIV-infected patients for rarely seen malignancies because early diagnosis and appropriate treatment could prolong their survival. © 2012 by Türkiye Klinikleri.