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Aids related lymphomas

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