Aids related lymphomas

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Aids related lymphomas

  1. 1. AIDS-related lymphomas www.freelivedoctor.com
  2. 2. HIV-associated diseases of hematopoietic system <ul><li>lymphadenopathy, anemia, leukopenia, thrombocytopenia, neoplasms </li></ul><ul><li>several potential etiologic factors </li></ul><ul><ul><li>direct result of HIV (but currently there is no convincing evidence of HIV directly causing malignant transformation) </li></ul></ul><ul><ul><li>manifestations of secondary infections and neoplasms </li></ul></ul><ul><ul><li>side effects of therapy </li></ul></ul>www.freelivedoctor.com
  3. 3. HIV-associated neoplasm of hematopoietic system pathophysiologic mechanism <ul><li>sustained polyclonal B-cell activation </li></ul><ul><li> emergence of monoclonal or oligoclonal B-cell population </li></ul><ul><li>high levels of cytokines in AIDS patients (IL-6 = growth factor for B-cells) </li></ul><ul><li>EBV (= polyclonal mitogen for B-cells) found in 50% of systemic lymphomas and 100% of primary CNS lymphomas </li></ul>www.freelivedoctor.com
  4. 4. AIDS-related lymphomas <ul><li>at least 6% of all patients with AIDS develop lymphoma at some time during the course of illness (120-fold increase in incidence) </li></ul><ul><li>lymphoma is a late manifestation of HIV infection </li></ul><ul><li>as HIV disease progresses, the risk of lymphomas increases </li></ul>www.freelivedoctor.com
  5. 5. AIDS-related lymphomas <ul><li>three groups (based on location) </li></ul><ul><ul><li>systemic </li></ul></ul><ul><ul><li>primary central nervous system </li></ul></ul><ul><ul><li>body cavity-based </li></ul></ul><ul><li>two major histological groups </li></ul><ul><ul><li>immunoblastic lymphoma </li></ul></ul><ul><ul><li>small non-cleaved cell lymphoma (Burkitt lymphoma) </li></ul></ul><ul><li>KSHV(KS herpes virus)(HSV 8) </li></ul><ul><li>associated with some body cavity-based B-cell lymphoma </li></ul>www.freelivedoctor.com
  6. 6. immunoblastic lymphomas <ul><li>account for ~60% of the cases of lymphoma in AIDS patients </li></ul><ul><li>generally high grade </li></ul><ul><li>more commonly seen in older patients </li></ul><ul><li>body cavity-based lymphoma </li></ul><ul><ul><li>variant of immunoblastic lymphoma </li></ul></ul>www.freelivedoctor.com
  7. 7. body cavity-based lymphoma <ul><li>variant of immunoblastic lymphoma </li></ul><ul><li>presents with lymphomatous pleural, pericardial, and/or peritoneal effusions </li></ul><ul><li>absence of discrete nodal or extranodal masses </li></ul><ul><li>human herpes virus type 8 DNA sequences have been found in the tumor cell genome </li></ul>www.freelivedoctor.com
  8. 8. small non-cleaved cell lymphoma (Burkitt lymphoma) <ul><li>accounts for ~20% of lymphomas in AIDS </li></ul><ul><li>most frequently seen in patients 10 to 19 years old </li></ul><ul><li>usually demonstrates characteristic c-myc translocations from CH8 to CH14 or 22 </li></ul><ul><li>>1000-fold increase in incidence </li></ul><ul><li>~50% of cases associated with EBV </li></ul>www.freelivedoctor.com
  9. 9. primary CNS lymphoma <ul><li>accounts for ~20% of AIDS lymphomas </li></ul><ul><li>usually positive of EBV </li></ul><ul><li>no specific age predilection </li></ul><ul><li>focal neurologic deficits </li></ul><ul><ul><ul><li>cranial nerve abnormalities </li></ul></ul></ul><ul><ul><ul><li>headache </li></ul></ul></ul><ul><ul><ul><li>seizure </li></ul></ul></ul><ul><li>one to three 3- to 5-cm lesions </li></ul><ul><li>located deep in white matter </li></ul>www.freelivedoctor.com
  10. 10. systemic lymphoma <ul><li>seen earlier stage in HIV infection than primary CNS lymphoma </li></ul><ul><li>involves GI tract, bone marrow, liver, lung </li></ul><ul><ul><ul><li>GI tract : ~25% of patients </li></ul></ul></ul><ul><ul><ul><li>bone marrow: ~20% of patients </li></ul></ul></ul><ul><ul><ul><li>liver & lung: ~10% of patients </li></ul></ul></ul>www.freelivedoctor.com

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