Burkitt's lymphoma nodular cystic hepatosplenic, in HIV patient. Case report / Linfoma de Burkitt hepatoesplénico quístico nodular, en paciente con VIH. Reporte de caso

Background: Patients with human immunodeficiency virus (HIV) are more likely to develop cancer. Malignant lymphomas are the main cancer group seen in these patients. Diffuse large B-cell lymphoma including central nervous system lymphoma and Burkitt's lymphoma account for 90% of HIV-related non-Hodgkin's lymphomas. Clinical case: A 22-year-old man with fever up to 39 ° C, malaise, excessive tiredness and night sweats, loss of 8 kg of weight, abdominal pain in the right hypochondrium, all 5 months before hospitalization. Hemoglobin: 9.5 g/dL, leukocytes 5.13 x 103/mm3, platelets 124 000 cel/mm3; albumin 2.9 g/dL, alanine aminotransferase 28 IU/L, aspartate aminotransferase 105 IU/L; HIV reactive, beta 2 microglobulin: 20 000 ng/mL. Viral load for HIV 100 034 cp/mL, CD4: 76 cel/mcL (5%). It was performed abdominal ultrasound and denoted cysts in the liver and spleen. Abdominal-pelvic computed tomography with hepatosplenomegaly, retroperitoneal and inguinal adenopathies and free fluid in abdominal cavity. Splenectomy was performed and Burkitt's lymphoma was reported in the histopathological study. Conclusion: HIV predisposes patients to any type of cancer. Intra-abdominal findings should be a warning of lymphoma suspicious and may occur from infiltration of the small intestine, solid organ and soft tissues.

Introducción: los pacientes con virus de inmunodeficiencia humana (VIH) son más propensos a desarrollar cáncer. Los linfomas malignos son el principal grupo de cáncer que se observa en estos pacientes. El linfoma difuso de células grandes B, incluido el del sistema nervioso central y el linfoma de Burkitt, constituyen 90% de los linfomas no Hodgkin relacionados con VIH. Caso clínico: hombre de 22 años de edad, con fiebre de hasta 39 °C, malestar general, cansancio excesivo y sudoración nocturna, pérdida de 8 kg de peso y dolor abdominal en hipocondrio derecho, 5 meses previos a su hospitalización. Se reportó hemoglobina de 9.5 g/dL, leucocitos 5.13 x 103/mm3, plaquetas 124 000 cel/mm3; albúmina 2.9 g/dL; alanino aminotransferasa 28 UI/L, aspartato aminotransferasa 105 UI/L; VIH reactivo, beta 2 microglobulina 20 000 ng/mL. Carga viral para VIH 100 034 cp/mL, CD4 76 cel/mcL (5%). El ultrasonido abdominal mostró quistes en hígado y bazo. La tomografía abdominopélvica reportó hepatoesplenomegalia, adenopatías retroperitoneales e inguinal y líquido libre en cavidad abdominal. Se realizó esplenectomía y en el estudio histopatológico se reportó Linfoma de Burkitt. Conclusión: El VIH predispone a los pacientes a cualquier tipo de cáncer. Los hallazgos intraabdominales deben hacer sospechar de linfoma y se puede presentar desde infiltración del intestino delgado, órgano sólido y tejidos blandos.

Sarcoma de Kaposi en el recto, reporte de un caso / Kaposi´s sarcoma in the rectum: case report

En 1872, el dermatólogo austro-húngaro Moritz Kaposi describió -por primera vez- esta enfermedad clínica y la llamó Sarcoma Múltiple Pigmentado Idiopático, que afecta a varones judíos y de áreas mediterráneas. En 1956 describieron una variedad endémica en África ecuatorial. En la década de los 60 se describió una tercera variedad en pacientes sometidos a trasplante renal e inmunodeprimidos. En la década de los 80 se comunicaron los primeros casos asociados al Virus de la Inmunodeficiencia Humana. Caso clínico: Se presentó el caso de un paciente portador del Virus de la Inmunodeficiencia Humana que fue atendido en el Hospital Carlos Andrade Marín de la ciudad de Quito, por presentar lesiones exofíticas distribuidas en la región inguinal, genital y ano-perineal, con secreción amarillenta de mal olor, edema de la bolsa escrotal y del muslo derecho. El diagnosticó fue Sarcoma de Kaposi asociada al virus de Inmunodeficiencia Humana. La evolución desfavorable y el estadio avanzado de la enfermedad provocaron la muerte del paciente. Discusión: El Sarcoma de Kaposi (SK) es una neoplasia maligna vascular, más frecuente en pacientes inmunocomprometidos, conlleva una alta morbilidad y mortalidad. El diagnóstico requiere una confirmación histológica de la celularidad neoplásica y la presencia del VHH-8.

In 1872 the Austro Hungarian dermatologist Moritz Kaposi described this clinical entity for the first time and called Idiopathic Pigmented Multiple Sarcoma that affected male Jews from Mediterranean areas. In 1956 an endemic variety in equatorial Africa was reported. In the 1960s, a third variety was described in patients undergoing renal transplantation and receiving immunosuppression. In the 80s appeared in patients infected with the Human Immunodeficiency Virus. Case report: The case of a patient previously diagnosed as a carrier of human immunodeficiency virus treated at Carlos Andrade Marín Hospital, Quito Ecuador, for having exophytic lesions distributed in the inguinal, genital and ano-perineal regions, with a fetid yellowish discharge, scrotal and right thigh edema. A diagnosis of Kaposi's sarcoma associated to acquired immunodeficiency virus was made. After an unsatisfactory evolution and due to the advanced stage of the disease, the patient died. Discussion: Kaposi's Sarcoma (KS) is a malignant vascular neoplasm, more frequent in immunocompromised patients. It has a high morbidity and mortality. The diagnosis requires histological confirmation of neoplastic cellularity and the presence of HHV-8.

Oral plasmablastic lymphoma as the first manifestation of AIDS

Abstract Plasmablastic lymphoma is a non-Hodgkin lymphoma characterized by its plasmacytic differentiation and predilection for the oral cavity. It is among the lymphomas most commonly associated with AIDS. This report details a case of a HIV-positive patient with a 1-month history of an exophytic mass in the gingival area of the upper left quadrant. The diagnosis of plasmablastic lymphoma was made based on its histopathological and immunophenotypical features. She was treated with chemotherapy followed by autologous hematopoietic stem cell transplantation. Despite complete resolution of the lesion, the patient died of cardiorespiratory arrest. This case illustrates plasmablastic lymphoma as the first clinical manifestation of AIDS, highlighting the importance of differentiating between a potentially malignant lesion and other pathologic processes.

Early stage primary gastric diffuse large B-cell lymphoma in a young HIV-positive patient.

HIV infection is known to be associated with the development of a wide range of neoplasia. About 25 to 40% of HIV-positive patients will present some kind of malignancy in the course of the disease; among them 10% are non-Hodgkin lymphomas (NHL) and 20% of these are represented by the diffuse large B-cell lymphoma. HIV-positive patients have a relative risk of 110 times higher to develop neoplasia, than the non-infected population. The gastrointestinal (GI) tract is the most frequent extranodal site of involvement. However, the primary GI lymphoma is rare. The authors present a case of a 31-year-old male patient with a 16-year history of HIV infection, who deliberately withdrew the Highly Active Antiretroviral Therapy (HAART) regimen and was hospitalized because of a respiratory infection. Because of a long-term complaint of dyspepsia, an upper gastrointestinal endoscopy was performed disclosing a large elevated and ulcerated gastric lesion, which biopsy revealed a diffuse large B-cell lymphoma. Clinical, imaging and laboratory tests showed an early stage diagnosis: Lugano stage I. Although not frequent, the authors alert to considering this neoplasia in all HIV-positive patients with dyspeptic symptoms.

Linfoma esofágico primário / Primary esophageal lymphoma

We describe the case of a 54 year old woman seen with an esophageal mass diagnosed as a primary esophageal lymphoma. The main symptom was dysphagia of seven months duration. The treatment consisted in resection of the tumor, and reconstruction of the defect with a reversed pleural flap, followed by a chemotherapy regimen that consisted of five drugs, cyclophosphamid, prednisone, doxorubicin, rituximab and vincristine (R-CHOP). The patient developed an esophageal pleural fistula treated with pleural drainage and irrigation that closed in 45 days. Two and one half years later she is doing well and disease free.