Oral plasmablastic lymphoma in an HIV-positive patient with an unusual survival rate
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Oral plasmablastic lymphoma in an HIV-positive patient with an unusual survival rate G. Fortuna • A. Pollio • J. C. Salas-Alanis U. Mariani
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Received: 23 April 2012 / Accepted: 22 May 2012 / Published online: 1 June 2012 Ó Springer-Verlag 2012 Fig. 1 a, b Expanding gingival mass extending from the right upper first incisor to the upper first ipsilateral molar, involving the gingival fornix up to obliterate it almost completely. c Histopathological examination revealed diffuse proliferation of large blastic lymphoid elements with prominent nucleoli and basophil cytoplasm, exhibiting either pleomorphic and binucleate or immunoblastic and plasmablastic shapes. Immunophenotypic analysis showed positivity for CD45, focal positivity for CD79a (d) and CD38, and negativity for CD20, CD3, CAM-5.2, and Tdt. The Ki-67 labeling index was about 95 %
G. Fortuna (&) A. Pollio Oral Medicine Unit, Department of Head and Neck Surgery, Ascalesi Hospital, Via Egiziaca a Forcella, 31, 80139 Naples, Italy e-mail: [email protected] J. C. Salas-Alanis Department of Dermatology, Facultad de Medicina y Hospital Universitario Dr. Jose´ E. Gonza´lez, Universidad Autonoma de Nuevo Leon, Avenida Gonzalitos No. 235 Norte, Colonia Mitras Centro, 64460 Monterrey, Nuevo Leo´n, Me´xico U. Mariani Oral Medicine Unit, Department of Odontostomatology, ‘‘Ospedali Riuniti di Bergamo’’, Largo Barozzi, 1, 24128 Bergamo, Italy
A 39-year-old woman presented with a 6-month history of slightly painful expanding gingival mass covered by an ulcerated and necrotizing epithelium (Fig. 1a, b). Histopathological (Fig. 1c) and immunophenotypic analysis (Fig. 1d) confirmed a diagnosis of lymphoma with diffuse large B cells with plasmablastic differentiation. The patient was reported to be HIV-positive. At the time of HIV diagnosis, the CD4? T cell count was 733 lL. A medical treatment was planned but the patient refused it and was lost to follow-up. After 13 years, when she received a diagnosis of oral plasmablastic lymphoma (PBL), her CD4? T cell count was 62 lL (the lowest ever reported), with viral load [500,000 copies/mL. A combined
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treatment with chemo/radiotherapy and highly active antiretroviral therapy was established and the patient entered in complete clinical remission, reaching a viral load of 0 copies/mL. No systemic involvement was seen due to HIV infection. Oral PBL, although quite common in HIV patients, is still a rare event [1] and needs a differential diagnosis with other malignancies, such as Kaposi’s sarcoma [2, 3]. Its prognosis is usually poor, as death might occur 1–24 months after the diagnosis, with an average survival period of 6 months [4]. As our patient, after 6 years from the time of PBL diagnosis, is in good health, it appears that an early detection and definitive diagnosis of such lesions in HIV-positive patients might result in an increase of their survival rate.
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G. Fortuna et al. Conflict of interest The authors have no conflict of interest to declare.
References 1. Rafaniello Ravi
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