Lymphoproliferative Lesions in the Setting of HIV Infection: A Five-Year Retrospective Case Series and Review

Etienne Mahe,Catherine Ross,Monalisa Sur

doi:10.4061/2011/618760

Abstract

A wide variety of noninfectious lesions have been identified in association with HIV infection. Many hematolymphoid lesions are possible in this patient group, both reactive and neoplastic. Epidemiologic data suggests that lymphoid malignancies are among the most common neoplasms in patients with HIV. We present a selective case series assembled over a 5-year period from the relatively low HIV-prevalence Hamilton Regional Laboratory Medicine Program (HRLMP), a tertiary care referral centre in Southern Ontario. This series serves to demonstrate the wide variety of lymphoid lesions that may be encountered in patients with HIV. In addition to outlining the pathologic work-up necessary in these cases, we discuss characteristics that distinguish the HIV-associated lesions from the pathobiologically similar non-HIV-associated lymphoid lesions.

Highlights

The HIV/AIDS epidemic bears the dubious distinction of one of the world’s most devastating yet medically challenging disease entities
Most of the mechanisms leading to death from HIV infection are related to immunodeficiency, neoplasia has long been recognized as a major contributor to morbidity and mortality of the HIV/AIDS population [3]
HIV/AIDS creates a milieu of combined immunosuppression and antigenic stimulation in lymph nodes

Summary

Introduction

The HIV/AIDS epidemic bears the dubious distinction of one of the world’s most devastating yet medically challenging disease entities. A number of the common HIV-related B-cell lymphomas are AIDS-defining illnesses [7]. Epidemiologic studies have observed lower incidences of HIV-related lymphomas in patients receiving HAART relative to those that do not [9, 10]. The combined immunosuppression and immunologic stimulation present in HIV infection may synergize with other infectious agents known to be oncogenic, such as EBV, to produce lymphoproliferative disease. This is consistent with the observation of EBV positivity in greater proportions in HIV-associated hematolymphoid lesions than in those in the non-HIV population. The following explores the relevant clinical and pathological features of these lesions, highlighting the distinguishing features they may have relative to their non-HIV associated kindred lesions, and some of the difficulties and pitfalls in diagnosis

HIV-Associated Lymphadenitis

HIV-Associated Plasmablastic Lymphoma

Findings

Discussion