Tumwine Lynette K, Orem Jackson, Ayers Leona W
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda ; Sub-Saharan Africa Lymphoma Consortium (NCI/SSALC), USA.
Uganda Cancer Institute, P.O. Box 3955, Kampala, Uganda.
Int J Med Pharm Case Reports. 2014 Nov 15;2(5):110-116. doi: 10.9734/IJMPCR/2015/13625.
We describe the clinical, histopathological and immunophenotypic characteristics of an HIV-infected adult man on antiretroviral therapy who presented with an EBV-positive grey zone lymphoma.
A 56-year-old HIV infected man from Uganda presented with a four month history of progressive abdominal swelling and B-symptoms. He was on highly active antiretroviral therapy (HAART) and cotrimoxazole. He was afebrile (36.9°C), severely wasted (BMI 14.8), and mildly anaemic. On physical examination, he had a 15 by 8 cm mass in the hypogastrium and umbilical region. The total white cell count was 8.3×10/μL; neutrophils, 5.72×10/μL; haemoglobin 11.1g/dL, platelets 528×10/μL, LDH 197 IU/L and CD4 367/μL. Abdominal ultrasound and CT scan showed a tumour involving the mesentery, jejunum and mid ileum. At laparotomy, a biopsy was taken, fixed, processed and stained with Haematoxylin & Eosin (H & E). Histopathology demonstrated large pleomorphic cells admixed with inflammatory smaller cells, Reed-Sternberg-like cell variants and frequent abnormal mitoses. Biomarkers CD20, PAX5, CD30 were positive but ALK negative (immunohistochemistry and strong EBER positivity in hybridization. The patient improved on modified CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy.
The tumour had features intermediate between mediastinal large B cell lymphoma and classical Hodgkin lymphoma.
We present a case of EBV-positive grey zone lymphoma in an HIV-infected man on HAART therapy diagnosed and treated in a resource constrained medical setting. The histological features are unusual and represent a low incidence lymphoma that is recognized by mixed features reminiscent of Hodgkin's lymphoma and mediastinal large B-cell lymphoma.
我们描述了一名接受抗逆转录病毒治疗的HIV感染成年男性的临床、组织病理学和免疫表型特征，该患者患有EBV阳性灰色地带淋巴瘤。
一名来自乌干达的56岁HIV感染男性，有四个月进行性腹部肿胀和B症状病史。他正在接受高效抗逆转录病毒治疗（HAART）和复方新诺明治疗。他无发热（36.9°C），严重消瘦（BMI 14.8），轻度贫血。体格检查时，在下腹部和脐区有一个15×8厘米的肿块。白细胞总数为8.3×10⁹/μL；中性粒细胞5.72×10⁹/μL；血红蛋白11.1g/dL，血小板528×10⁹/μL，乳酸脱氢酶197 IU/L，CD4 367/μL。腹部超声和CT扫描显示肿瘤累及肠系膜、空肠和回肠中部。剖腹手术时，取活检组织，固定、处理并用苏木精和伊红（H&E）染色。组织病理学显示大的多形性细胞与炎性小细胞、里德-斯腾伯格样细胞变体混合，并有频繁的异常有丝分裂。生物标志物CD20、PAX5、CD30呈阳性，但ALK阴性（免疫组织化学和原位杂交中EBER强阳性）。患者接受改良CHOP（环磷酰胺、阿霉素、长春新碱和泼尼松龙）治疗后病情好转。
该肿瘤具有介于纵隔大B细胞淋巴瘤和经典霍奇金淋巴瘤之间的特征。
我们报告了一例在资源有限的医疗环境中诊断和治疗的接受HAART治疗的HIV感染男性的EBV阳性灰色地带淋巴瘤病例。其组织学特征不寻常，代表一种发病率低的淋巴瘤，其特征是具有让人联想到霍奇金淋巴瘤和纵隔大B细胞淋巴瘤的混合特征。
