Marais Leonard C, Ferreira Nando
Tumour, Sepsis and Reconstruction Unit, Grey's Hospital, Townbush Road, Pietermaritzburg 3201, KwaZulu-Natal, South Africa.
ISRN Oncol. 2013 Mar 14;2013:219369. doi: 10.1155/2013/219369. Print 2013.
Background. HIV infection has reached epidemic proportions in South Africa, with an estimated prevalence of 21.5% in adults living in the province of KwaZulu-Natal. Several malignancies have been identified as part of the spectrum of immunosuppression-related manifestations of HIV infection. Very few reports, however, exist regarding the occurrence of non-AIDS-defining sarcomas in the extremities or limb girdles. Methods. A retrospective review was performed on all adult patients, between the ages of 30 and 60 years, with histologically confirmed osteosarcomas of the appendicular skeleton referred to a tertiary-level orthopaedic oncology unit. Results. Five out of the nine patients (62.5%) included in the study were found to be HIV positive. The average CD4 count of these patients was 278 (237-301) cells/mm(3), indicating advanced immunological compromise. Three of the malignancies in HIV-positive patients occurred in preexisting benign or low-grade tumours. Conclusion. A heightened index of suspicion is required in HIV patients presenting with unexplained bone and joint pain or swelling. Judicious use of appropriate radiological investigation, including magnetic resonance imaging of suspicious lesions and timely referral to an appropriate specialized orthopaedic oncology unit, is recommended.
背景。HIV感染在南非已呈流行态势，据估计夸祖鲁 - 纳塔尔省成年居民中的患病率为21.5%。几种恶性肿瘤已被确认为HIV感染免疫抑制相关表现谱的一部分。然而，关于四肢或肢带部位非艾滋病定义性肉瘤的发生情况，报告极少。方法。对所有年龄在30至60岁之间、组织学确诊为附肢骨骼骨肉瘤并转诊至三级骨科肿瘤科室的成年患者进行回顾性研究。结果。该研究纳入的9名患者中有5名（62.5%）被发现HIV呈阳性。这些患者的平均CD4细胞计数为278（237 - 301）个/mm³，表明存在严重的免疫功能损害。HIV阳性患者中的3例恶性肿瘤发生于先前存在的良性或低级别肿瘤。结论。对于出现不明原因骨与关节疼痛或肿胀的HIV患者，需要提高警惕。建议合理使用适当的影像学检查，包括对可疑病变进行磁共振成像，并及时转诊至合适的专业骨科肿瘤科室。
