Cavity Of HIV-positive Patients Research Articles

Clinical characteristics and prognostic factors of plasmablastic lymphoma patients: analysis of 135 patients from the LYSA group

Plasmablastic lymphoma (PBL), initially described in 1997 in the oral cavity of HIV positive patients, is now recognized as a distinct aggressive and rare entity of diffuse large B-cells lymphoma by the World Health Organization (WHO) classification. Since the original description, others cases have been reported. However, these are largely derived from case reports or small series limiting any definitive conclusions on clinical characteristics and outcome. The clinical, biological, pathological features and outcome of a cohort including 135 patients with PBL, from LYSA centers in France and Belgium, were reported and analyzed. The median age was 58 years, with a male predominance. The cohort was divided into 56 HIV-positive patients, 17 post-transplant patients and 62 HIV-negative/non-transplanted patients. Within HIV-negative/non-transplanted, a relative immunosuppression was found in most cases (systemic inflammatory disease, history of cancer, increased age associated with weakened immune system). We have also described a new subtype, PBL arising in a chronic localized inflammatory site, without any sign of immunosuppression. At presentation, 19% of patients showed oral involvement. Immunophenotype showed CD138 positivity in 88% of cases and CD20 negativity in 90% of cases. Chemotherapy was administered to 80% of patients, with a complete response (CR) rate of 55%. The median overall survival (OS) was 32 months. In univariate analysis, HIV positive status showed better OS when compared with HIV negative status. In multivariate analysis, International Prognostic Index score, chemotherapy and CR were associated with survival benefit. This cohort, the largest reported to date, increases the spectrum of knowledge on PBL, rarely described. However, specific guidelines to clarify treatment are lacking, and may improve the poor prognosis of this rare disease.

Gastric plasmablastic lymphoma – case report

Plasmablastic lymphoma (PBL) is a rare, clinically aggressive B-cell lymphoma which was initially described involving the oral cavity of HIV positive patients. Subsequent reports have expanded its clinical spectrum to involve a broad spectrum of sites, other forms of immunosuppression and elderly patients without specific immune compromise. Gastric involvement is documented but uncommon, with seven reported cases of gastric plasmablastic lymphoma in the literature. We describe a case of gastric PBL in a non-immunocompromised 71 year old male. Endoscopic gastric biopsy showed an atypical sheet-like proliferation of large atypical cells with a range of plasma cell differentiation, including mature plasma cells, atypical binucleate cells, plasmablasts and immunoblasts. The tumour cells were positive for CD 45 (weak), CD 138, MUM-1, and EBV EBER in situ hybridisation, and showed Kappa light chain restriction. It is important to consider plasmablastic lymphoma in the differential diagnosis of large cell malignancies at any site and patient population, as weak CD 45 expression and lack of B and T cell markers may otherwise delay the diagnosis of lymphoma.

Plasmablastic lymphoma of the right testis

Plasmablastic lymphoma (PBL) is a very rare disease. In 1997 Delecluse et al. reported a series of aggressive nonHodgkin’s lymphomas arising in the oral cavity of HIVpositive patients. In terms of clinical behavior, PBL is highly aggressive with short survival. This is the first report of PBL of the testis in Japan. A 76-year-old man had notable right-side scrotal swelling in September 2009 and underwent a medical examination in our hospital in October of the same year. Ultrasonographic examination demonstrated an enlarged right testis with a heterogeneous echo pattern. Levels of serum testicular tumor markers, including b-human chorionic gonadotrophin, a-fetoprotein and lactate dehydrogenase were all normal. We suspected that it might be a testicular tumor, so right high orchiectomy was performed in October 2009. Macroscopically, the tumor was ash gray in color, and there was no presence of bleeding or necrotic tissue (Fig. 1a). It consisted of diffusely proliferative, relatively uniform large cells with abundant cytoplasm. In particular, the tumor cells were plasmablastic-like and there were almost no mature plasma cells (Fig. 1b). Immunohistochemistry revealed the tumor cells to be positive for CD138, CD56 and epithelial membrane antigen; and negative for CD20, CD79a, CD3, CD10, CD30, cytokeratin and S100 protein. The pathological diagnosis was PBL. There was no evidence of human herpes virus-8 infection (according to polymerase chain reaction analysis), Epstein–Barr virus (according to in situ hybridization) and HIV. Pathologically, PBL is characterized by an immunoblastic or plasmablastic morphology and a plasma cell immunophenotype, and thus, its differentiation from other large B cell lymphomas or plasmablastic plasma cell neoplasms is often problematic. The immunophenotype of PBL tumor cells is almost identical to that of plasma cells; in particular, the expression of leukocyte common antigen and CD20 is absent or weak, but that of plasmacytic markers, such as CD138, is strongly positive. PBL has a well-established association with immunosuppression, and most particularly with HIV infection: approximately 80% of PBL patients are HIV-infected. Cases of PBL have also been reported after solid organ transplantation and in association with steroid therapy for autoimmune disease. PBL typically occurs in the oral cavity. However, PBL of the testis is very rare. Schichman et al. reported the first case. This report documents the third case of PBL of the testis in the world. Although cases of PBL have been reported from countries across the world , there has been only one report from Japan in the English-language published work. This may be because HIV infection is less prevalent in Japan than in other countries. The number of PBL cases in Japan may increase in the future.

Frequency and enzymatic activity of Candida albicans isolated from the oral cavity of HIV-positive patients at Fortaleza, Ceará

Candida albicans and other species are usually involved in opportunistic infections in patients with acquired immunological deficiency syndrome (AIDS). The virulence mechanisms by which this yeast expresses its pathogenicity include adherence patterns, ability to form pseudomycelia and production of extracellular enzymes, among others. The objective of this research was to verify the frequency of Candida and the production of proteinase and phospholipase in 52 strains of Candida albicans from the oral cavity of patients infected by HIV treated at Hospital Sao Jose, AIDS reference and training center in Fortaleza, Ceara. Samples were collected of patients, with or without oral lesions characteristic of candidosis. From 100 patients, 80% presented positivity for Candida: 65% (52) were identified as C. albicans, 27.5% (22) as C. tropicalis, 2.5% (2) as C. glabrata, 2.5% (2) as C. krusei and 2.5% (2) as C. guilliermondii. Among the strains of C. albicans isolated from the oral cavity, proteinase and phospholipase were detected in 69.2% and 73%, respectively. The results suggested that C. albicans was the most frequent species observed, with intermediate expression of proteinase and phospholipase.