Abstract
BackgroundHIV infection is reported to be associated with some malignant lymphomas (ML) so called AIDS-related lymphomas (ARL), with an aggressive behavior and poor prognosis. The ML frequency, pathogenicity, clinical patterns and possible association with AIDS in Tanzania, are not well documented impeding the development of preventive and therapeutic strategies.MethodsSections of 176 archival formalin-fixed paraffin-embedded biopsies of ML patients at Muhimbili National Hospital (MNH)/Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania from 1996–2001 were stained for hematoxylin and eosin and selected (70) cases for expression of pan-leucocytic (CD45), B-cell (CD20), T-cell (CD3), Hodgkin/RS cell (CD30), histiocyte (CD68) and proliferation (Ki-67) antigen markers. Corresponding clinical records were also evaluated. Available sera from 38 ML patients were screened (ELISA) for HIV antibodies.ResultsThe proportion of ML out of all diagnosed tumors at MNH during the 6 year period was 4.2% (176/4200) comprising 77.84% non-Hodgkin (NHL) including 19.32% Burkitt's (BL) and 22.16% Hodgkin's disease (HD). The ML tumors frequency increased from 0.42% (1997) to 0.70% (2001) and 23.7% of tested sera from these patients were HIV positive. The mean age for all ML was 30, age-range 3–91 and peak age was 1–20 years. The male:female ratio was 1.8:1. Supra-diaphragmatic presentation was commonest and histological sub-types were mostly aggressive B-cell lymphomas however, no clear cases of primary effusion lymphoma (PEL) and primary central nervous system lymphoma (PCNSL) were diagnosed.ConclusionMalignant lymphomas apparently, increased significantly among diagnosed tumors at MNH between 1996 and 2001, predominantly among the young, HIV infected and AIDS patients. The frequent aggressive clinical and histological presentation as well as the dominant B-immunophenotype and the HIV serology indicate a pathogenic association with AIDS. Therefore, routine HIV screening of all malignant lymphoma patients at MNH is necessary to enable comprehensive ARL diagnosis and formulation of preventive and therapeutic protocols.
Highlights
HIV infection is reported to be associated with some malignant lymphomas (ML) so called acquired immune deficiency syndrome (AIDS)-related lymphomas (ARL), with an aggressive behavior and poor prognosis
25–40% of HIV-1 seropositive patients eventually develop a malignancy predominantly Kaposi's sarcoma (KS) and malignant lymphoma (ML) mostly sub-classified as non-Hodgkin (NHL) [including Burkitt's lymphoma (BL)] and Hodgkin's lymphoma (HL) known as Hodgkin's disease (HD) which were shown to increase with the HIV epidemic in the USA. [1,2] In Tanzania a higher proportion of Non-Hodgkin's lymphoma (NHL) has been reported [3] during the AIDS epidemic as shown by a frequency of 9.1% in males in Dar es Salaam (1990–91) compared to the 6.3% during 1980–81 pre-AIDS period
[3] Rare ML subtypes namely primary effusion lymphoma (PEL) or body cavity-based lymphoma (BCBL) as well as primary central nervous system lymphoma (PCNSL) are more often associated with AIDS. [5,6] ML occurring in HIV infected persons are called AIDS-related lymphomas (ARL) and have distinct clinical and pathogenetic characteristics including, extra-nodal presentation, systemic dissemination, B-cell phenotype, presence of Epstein-Barr virus (EBV) markers in tumor cells and recurrent genetic lesions. [6,7,8] About 70–90% of ARL are predominantly high-grade diffuse large cell (DLBCL) having poor prognosis
Summary
HIV infection is reported to be associated with some malignant lymphomas (ML) so called AIDS-related lymphomas (ARL), with an aggressive behavior and poor prognosis. [1,2] In Tanzania a higher proportion of NHL has been reported [3] during the AIDS epidemic as shown by a frequency of 9.1% in males in Dar es Salaam (1990–91) compared to the 6.3% during 1980–81 pre-AIDS period. [5,6] ML occurring in HIV infected persons are called AIDS-related lymphomas (ARL) and have distinct clinical and pathogenetic characteristics including, extra-nodal presentation, systemic dissemination, B-cell phenotype, presence of Epstein-Barr virus (EBV) markers in tumor cells and recurrent genetic lesions. The association of NHL, HD and BL with HIV and AIDS generally in Africa including Tanzania is poorly documented and needs further clarification. [20,21]
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