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Plasmablastic lymphoma of the anal canal in an HIV-infected patient.

Chagas LA, Camilo GB, Machado DC, Vidal DR, de Oliveira CE, Toledo GC, Oria GP, Silva Mde F, Oliveira RV, Lopes AJ - Am J Case Rep (2014)

Bottom Line: Plasmablastic lymphoma is one such neoplasm that generally presents with involvement of the oral cavity; cases of extra-oral involvement are rare.We report a case of plasmablastic lymphoma in a 46-year-old woman for whom the initial clinical manifestation was a painless perineal tumor accompanied by fecal incontinence.The possibility of this neoplasm should be considered in patients with HIV/acquired immune deficiency syndrome (HIV/AIDS) because its early diagnosis is essential so that the start of the treatment is not delayed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

ABSTRACT

Background: The advent of antiretroviral therapy increased the life expectancy of human immunodeficiency virus (HIV)-positive patients and, consequently, the morbidity and mortality due to neoplasms. Plasmablastic lymphoma is one such neoplasm that generally presents with involvement of the oral cavity; cases of extra-oral involvement are rare.

Case report: We report a case of plasmablastic lymphoma in a 46-year-old woman for whom the initial clinical manifestation was a painless perineal tumor accompanied by fecal incontinence.

Conclusions: The possibility of this neoplasm should be considered in patients with HIV/acquired immune deficiency syndrome (HIV/AIDS) because its early diagnosis is essential so that the start of the treatment is not delayed.

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Related in: MedlinePlus

Biopsy of the anal canal (hematoxylin and eosin [H&E]). At lower magnification (A), diffuse proliferation of blue cells is observed. At medium magnifications (B and C), a “starry-sky” pattern is observed, typical of high-grade lymphoid neoplasms, with the figures consisting of histiocytes phagocytizing apoptotic cell remains. Morphologically, cells of different sizes are observed: smaller cells with plasmacytoid characteristics and larger, more atypical cells. At medium magnification (D), there is evidence of necrotic areas and apoptotic figures, which are characteristic of malignant tumors. At higher magnification (E), diffuse and monomorphically proliferating atypical cells can be observed. These cells are of medium and large sizes, with moderate cytoplasm and large irregular nuclei with vesicular chromatin and evident, sometimes multiple, nucleoli. Apoptotic and mitotic figures are emphasized.
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f6-amjcaserep-15-543: Biopsy of the anal canal (hematoxylin and eosin [H&E]). At lower magnification (A), diffuse proliferation of blue cells is observed. At medium magnifications (B and C), a “starry-sky” pattern is observed, typical of high-grade lymphoid neoplasms, with the figures consisting of histiocytes phagocytizing apoptotic cell remains. Morphologically, cells of different sizes are observed: smaller cells with plasmacytoid characteristics and larger, more atypical cells. At medium magnification (D), there is evidence of necrotic areas and apoptotic figures, which are characteristic of malignant tumors. At higher magnification (E), diffuse and monomorphically proliferating atypical cells can be observed. These cells are of medium and large sizes, with moderate cytoplasm and large irregular nuclei with vesicular chromatin and evident, sometimes multiple, nucleoli. Apoptotic and mitotic figures are emphasized.

Mentions: The patient underwent nuclear magnetic resonance imaging, which revealed a voluminous expansive formation in the anal canal, with descending exophytic appearance, measuring 13.3×8.8×7.6 cm and associated with multiple enlarged lymph nodes in the retroperitoneum, hepatic hilum, and mesentery and iliac chains bilaterally (Figures 2–5). A biopsy of the lesion and immunohistopathological analysis of the fragment were performed, and plasmablastic lymphoma was diagnosed (Figures 6 and 7). In histopathological analysis, the Epstein-Barr virus polymerase chain reaction was negative. Hyper-CVAD chemotherapy (cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine) was then initiated.


Plasmablastic lymphoma of the anal canal in an HIV-infected patient.

Chagas LA, Camilo GB, Machado DC, Vidal DR, de Oliveira CE, Toledo GC, Oria GP, Silva Mde F, Oliveira RV, Lopes AJ - Am J Case Rep (2014)

Biopsy of the anal canal (hematoxylin and eosin [H&E]). At lower magnification (A), diffuse proliferation of blue cells is observed. At medium magnifications (B and C), a “starry-sky” pattern is observed, typical of high-grade lymphoid neoplasms, with the figures consisting of histiocytes phagocytizing apoptotic cell remains. Morphologically, cells of different sizes are observed: smaller cells with plasmacytoid characteristics and larger, more atypical cells. At medium magnification (D), there is evidence of necrotic areas and apoptotic figures, which are characteristic of malignant tumors. At higher magnification (E), diffuse and monomorphically proliferating atypical cells can be observed. These cells are of medium and large sizes, with moderate cytoplasm and large irregular nuclei with vesicular chromatin and evident, sometimes multiple, nucleoli. Apoptotic and mitotic figures are emphasized.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4260690&req=5

f6-amjcaserep-15-543: Biopsy of the anal canal (hematoxylin and eosin [H&E]). At lower magnification (A), diffuse proliferation of blue cells is observed. At medium magnifications (B and C), a “starry-sky” pattern is observed, typical of high-grade lymphoid neoplasms, with the figures consisting of histiocytes phagocytizing apoptotic cell remains. Morphologically, cells of different sizes are observed: smaller cells with plasmacytoid characteristics and larger, more atypical cells. At medium magnification (D), there is evidence of necrotic areas and apoptotic figures, which are characteristic of malignant tumors. At higher magnification (E), diffuse and monomorphically proliferating atypical cells can be observed. These cells are of medium and large sizes, with moderate cytoplasm and large irregular nuclei with vesicular chromatin and evident, sometimes multiple, nucleoli. Apoptotic and mitotic figures are emphasized.
Mentions: The patient underwent nuclear magnetic resonance imaging, which revealed a voluminous expansive formation in the anal canal, with descending exophytic appearance, measuring 13.3×8.8×7.6 cm and associated with multiple enlarged lymph nodes in the retroperitoneum, hepatic hilum, and mesentery and iliac chains bilaterally (Figures 2–5). A biopsy of the lesion and immunohistopathological analysis of the fragment were performed, and plasmablastic lymphoma was diagnosed (Figures 6 and 7). In histopathological analysis, the Epstein-Barr virus polymerase chain reaction was negative. Hyper-CVAD chemotherapy (cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine) was then initiated.

Bottom Line: Plasmablastic lymphoma is one such neoplasm that generally presents with involvement of the oral cavity; cases of extra-oral involvement are rare.We report a case of plasmablastic lymphoma in a 46-year-old woman for whom the initial clinical manifestation was a painless perineal tumor accompanied by fecal incontinence.The possibility of this neoplasm should be considered in patients with HIV/acquired immune deficiency syndrome (HIV/AIDS) because its early diagnosis is essential so that the start of the treatment is not delayed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

ABSTRACT

Background: The advent of antiretroviral therapy increased the life expectancy of human immunodeficiency virus (HIV)-positive patients and, consequently, the morbidity and mortality due to neoplasms. Plasmablastic lymphoma is one such neoplasm that generally presents with involvement of the oral cavity; cases of extra-oral involvement are rare.

Case report: We report a case of plasmablastic lymphoma in a 46-year-old woman for whom the initial clinical manifestation was a painless perineal tumor accompanied by fecal incontinence.

Conclusions: The possibility of this neoplasm should be considered in patients with HIV/acquired immune deficiency syndrome (HIV/AIDS) because its early diagnosis is essential so that the start of the treatment is not delayed.

Show MeSH
Related in: MedlinePlus