原发性肛肠淋巴瘤——AIDS的新发现

自4年前AIDS开始流行以来,在男性同性恋病人中非何杰金氏淋巴瘤(Non-Hodgkin’s Lymp-homas,NHL)的发病率持续增加,显著高于一般人群。该病控制中心最近也确认,在人类免疫缺陷病毒(human immunodeficiency virus,HIV)阳性的AIDS病人中发现了NHL。发生在先天性免疫机能缺陷和器官移植病人中,与AIDS相关的NHL病例已具有许多淋巴瘤的临床病理学特征;它们不同于出现在普通人群淋巴瘤的特点。与AIDS相关     

佛山市南海区HIV感染者/AIDS患者中恶性肿瘤常见类型及生存分析

目的：了解佛山市南海区艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者中常见的恶性肿瘤类型及患者生存状况。方法：在艾滋病综合防治信息管理系统中选择2010年1月1日至2017年3月31日在广东省人民医院南海医院登记并有随访记录的41例HIV/AIDS合并恶性肿瘤患者作为研究组,选择同期广东省人民医院南海医院收治的全部非HIV感染的恶性肿瘤患者作为对照,分析HIV/AIDS合并恶性肿瘤的常见类型,运用Cox回归模型分析HIV/AIDS合并恶性肿瘤患者的预后生存情况。结果：HIV恶性肿瘤患者平均年龄(41.7±7.9)岁,明显低于非HIV恶性肿瘤(58.7±14.8)岁,差异有统计学意义(t=7.346, P<0.001)。HIV恶性肿瘤患者的常见类型为,恶性淋巴瘤、子宫颈癌和卡波济肉瘤,合计占65.85%。恶性淋巴瘤、子宫颈癌及其他各类恶性肿瘤患者的CD4+T淋巴细胞计数水平均表现为HIV人群明显低于非HIV人群,差异具有统计学意义(P<0.05)。临床分期为IV期是HIV恶性肿瘤患者预后死亡的独立危险因素(RR=3.838, P<0.05);而采用HARRT治疗和抗肿瘤治疗联合疗法(RR=0.062)、诊断恶性肿瘤时CD4+T淋巴细胞计数越高(RR=0.177)是HIV恶性肿瘤患者预后死亡的保护因素(P<0.05)。结论: 本地区HIV/AIDS人群发生恶性肿瘤的主要类型为恶性淋巴瘤、子宫颈癌和卡波济肉瘤。HIV合并恶性肿瘤时的CD4+T淋巴细胞数显著低于非HIV恶性肿瘤患者。临床分期、治疗情况、CD4+T淋巴细胞水平是影响患者生存的主要因素。     

原发中枢神经系统淋巴瘤(一)

结外原发非霍奇金淋巴瘤 (NHL)受侵的部位常意味着不同的生物学特征和临床表现。原发中枢神经系统淋巴瘤(PCNSL)指发生于脑和脊髓的结外NHL ,是少见的恶性肿瘤 ,分别占中枢神经系统恶性肿瘤和恶性淋巴瘤的 5 %和1%～ 2 %。早在 1974年即被认为是一种独立的疾病[1] 。临床上 ,PCNSL可发生于免疫功能正常的人群或有先天性或获得性免疫缺陷 (AIDS)的患者 ,后者HIV感染是最主要的危险因素 ,且常发生于AIDS晚期。免疫功能正常和免疫功能异常PCNSL在病理类型和临床表现上均有差别。健康人群和AIDS患者中PCNSL的发病率均有不同程…     

HIV/AIDS 相关淋巴瘤研究进展

人类免疫缺陷病毒（HIV）／获得性免疫缺陷综合征（AIDS）相关淋巴瘤（ARL）是一组异质性肿瘤,预后较差。近年来阐明的发病机制包括 HIV 引起的免疫损伤、EB 病毒的感染及基因的改变。ARL 的病理类型主要有4种,即弥漫大 B 细胞淋巴瘤、Burkitt 淋巴瘤、原发渗出性淋巴瘤和浆母细胞淋巴瘤。形态学特征、免疫标记和遗传学特点的联合应用有助于诊断和鉴别诊断,从而有利于及时治疗和改善预后。     

皮肤恶性肿瘤与人免疫缺陷病毒疾病

随着人免疫缺陷病毒(HIV)感染率的上升,某些皮肤肿瘤的发生率也在增加,如恶性黑素瘤、鳞状细胞癌、基底细胞癌、HIV相关Kaposi肉瘤(KS)、皮肤T细胞淋巴瘤(CTCL)等。淋巴瘤：①霍奇金病发生率为正常人群的5～16倍。②非霍奇金淋巴瘤的发生率很高,HIV感染者患非霍奇金淋巴瘤的危险增加100～350倍。应用抗逆     

皮肤恶性肿瘤与人免疫缺陷病毒疾病

随着人免疫缺陷病毒(HIV)感染率的上升,某些皮肤肿瘤的发生率也在增加,如恶性黑素瘤、鳞状细胞癌、基底细胞癌、HIV相关Kaposi肉瘤(KS)、皮肤T细胞淋巴瘤(CTCL)等。淋巴瘤：①霍奇金病发生率为正常人群的5～16倍。②非霍奇金淋巴瘤的发生率很高,HIV感染者患非霍奇金淋巴瘤的危险增加100～350倍。应用抗逆     

获得性免疫缺陷综合征合并淋巴瘤24例

 【摘要】　目的　总结获得性免疫缺陷综合征（AIDS）合并淋巴瘤的临床特点。方法　收集24例AIDS合并淋巴瘤患者临床资料,并从流行病学、临床表现、实验室检查、治疗及预后等指标进行回顾性分析。结果　24例人类免疫缺陷病毒（HIV）感染无症状或AIDS合并淋巴瘤患者,根据淋巴组织肿瘤WHO（2001）分型,其中B细胞肿瘤15例,占62.5 %;T细胞和NK细胞肿瘤7例,占29.2 %;霍奇金淋巴瘤2例,占8.3 %。结论　HIV感染后易合并淋巴组织肿瘤,以B细胞肿瘤多见,因此,淋巴瘤患者须行HIV抗体检查,以尽早确诊和治疗。     

HIV感染的胃肠道表现

HIV感染常累及胃肠道和肝胆,由于粘膜免疫缺陷,胃肠道是机会性感染和恶性肿瘤的好发部位,感染主要决定于宿主的免疫力,可发生原虫、细菌、病毒以及真菌感染。艾滋病进展期常出现多器官受累,恶性肿瘤主要是卡波济肉瘤和腹部淋巴瘤,腹泻及腹痛是主要的临床症状,检出病原体对指导针对性治疗十分必要。当HIV感染有腹部症状时,务必对其作出鉴别诊断。     

爱滋病与肿瘤

爱滋病(AIDS)由人免疫缺陷病毒(HIV)引起,其特征是平常健康的人出现细胞免疫不全,高丙种球蛋白血症、机会性感染和/或肿瘤等.近年来,对AIDS的少见和晚期表现有了进一步认识,AIDS及AIDS高危人群肿瘤发生率升高.Kaplan在200名HIV抗体阳性者中发现肿瘤29例,肿瘤发生率14.5%;75名AIDS的肿瘤发生率为33%,与Longo报道的40%接近(1).     

HIV相关的非何杰金淋巴瘤

HIV相关非何杰金淋巴瘤(HIV-NHL)见于约5％的HIV感染者,至1989年向亚特兰大疾病控制中心疫报的病例,共97258例,其中2824例(2.9％)伴有NHL。NHL的发病数60倍于美国一般人群的发病数。2824例HIV-NHL中1686例为免疫母细胞淋巴瘤,590例为Burkitt淋巴瘤,548例神经系统原发性受累。一组55例艾滋病或严重AIDS相关综合征病人,曾用不同的抗病毒治疗,观察13～35个月,8例(14.5％)出现高度恶性的NHL。发病率增加可能是因为HIV感染的病人得到及时的治疗,生命得到延长的缘故。     

The molecular basis of acquired immunodeficiency syndrome-related lymphomagenesis

Acquired immunodeficiency syndrome (AIDS)-related lymphomas consistently display a B-cell phenotype and are histogenetically related to germinal center (GC) or post-GC B cells in the overwhelming majority of cases. The pathogenesis of AIDS-related lymphoma is a multistep process involving factors provided by the host, as well as alterations intrinsic to the tumor one. Host factors involved in AIDS-related lymphomagenesis include reduced immunosurveillance particularly against Epstein-Barr virus (EBV)-infected B cells, human immunodeficiency virus (HIV)-induced alteration of endothelial functions, B-cell stimulation and selection by antigen, HIV-induced deregulation of several cytokine loops, and possibly the host's genetic background. The molecular pathways of viral infection and lesions of cancer related genes associated with AIDS-related lymphoma vary substantially in different clinicopathologic categories of the disease and highlight the marked degree of biological heterogeneity of these lymphomas. Although the reasons for the heterogeneity of AIDS-related lymphoma are not totally clear, it is generally believed that the host's background selects for which specific molecular pathway of AIDS-related lymphoma is activated in a given patient.     

Characteristics of indolent non-Hodgkin lymphoma in patients with type 1 human immunodeficiency virus infection

BACKGROUND: There is recent evidence that the incidence of indolent non-Hodgkin lymphoma (NHL) appears to be increased in persons with the acquired immunodeficiency syndrome (AIDS). The current study was conducted to describe the clinical, immunologic, and pathologic characteristics of indolent B-cell lymphoma in patients infected with the human immunodeficiency virus (HIV). METHODS: The current report was a retrospective study of 10 cases of indolent NHL identified from the AIDS-Lymphoma Registry at the University of Southern California School of Medicine. These patients were compared with 336 consecutive patients with systemic intermediate/high-grade AIDS-related NHL who were diagnosed and treated at a single institution. RESULTS: The pathology of the indolent cases included follicular lymphoma (five patients), small lymphocytic lymphoma (two patients), and one case each of mucosa-associated lymphoid tissue (MALT), monocytoid B-cell, and marginal zone lymphoma. When comparing the indolent lymphomas with the intermediate/high-grade AIDS-NHL cases, no differences were observed with regard to demographic characteristics or history of prior opportunistic infection. HIV patients with indolent lymphomas were found to have a significantly higher median CD4+ lymphocyte count compared with patients with intermediate/high-grade NHL (531 /mm3 vs. 90 /mm3) (P < 0.0001). Bone marrow involvement was significantly more common in indolent NHL cases (50%) versus intermediate/high-grade NHL cases (17%) (P = 0.02). The median survival for patients with indolent NHL was significantly longer compared with patients with intermediate/high-grade NHL (66.8 months vs. 7.1 months) (P = 0.007). CONCLUSIONS: Indolent lymphomas occurring in patients infected with HIV appear to differ from intermediate/high-grade lymphomas with regard to immune status and propensity for bone marrow involvement and prolonged survival. The median survival in the group of HIV-seropositive patients with indolent NHL examined in the current study was found to be comparable to that reported in HIV-negative individuals.     

Incidence and management of AIDS-related lymphoma

Over time, the spectrum of the acquired immune deficiency syndrome (AIDS) epidemic has changed, especially with the advent of highly active antiretroviral therapy (HAART). The goal of this article is to delineate changes occurring in the incidence and management of lymphoma over the course of the AIDS epidemic. Lymphoma usually occurs rather late in the course of human immunodeficiency virus (HIV) infection and is the cause of death in up to 20% of HIV-infected individuals. It is seen in all population groups at risk for HIV and is more common in men than in women. It is usually diagnosed in patients with markedly decreased CD4 cell counts, consistent with prolonged periods of HIV infection and subsequent immunosuppression. Recent data from several large series have demonstrated a substantial decline in the median CD4 cell count among patients with newly diagnosed AIDS-related lymphoma despite the recent widespread use of HAART. While still somewhat controversial, use of HAART has generally not produced a significant decline in the incidence of AIDS-related lymphoma. Patients treated with low-dose vs standard-dose chemotherapy for AIDS-related lymphoma have achieved similar response and survival rates, although standard-dose therapy is associated with greater toxicity. Adapting therapy to prognostic factors has not produced a significant improvement in survival. Use of antiretroviral therapy along with chemotherapy appears safe, and may be associated with longer survival. An infusional regimen called EPOCH (etoposide, prednisone, vincristine [Oncovin], cyclophosphamide, doxorubicin HCl) shows promise in the future management of AIDS-related lymphoma. No regimen is currently considered the standard of therapy for patients with relapsed AIDS-related lymphoma, and survival is short in this setting.     

Acquired immunodeficiency syndrome-related lymphoma in the era of highly active antiretroviral therapy

The treatment and outcome of human immunodeficiency virus (HIV) infection altered dramatically in the mid-1990s with the introduction of highly active antiretroviral therapy (HAART). Highly active antiretroviral therapy, where available, has led to a dramatic decline in mortality from HIV and a decrease in the incidence of opportunistic infections and Kaposi sarcoma. This article addresses the effects that HAART has had on acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL). Metaanalysis of numerous cohort studies confirmed that the incidence of AIDS-related NHL has decreased since the advent of HAART. This decline is most marked for primary cerebral lymphomas and systemic immunoblastic lymphoma but has not been demonstrated for Burkitt lymphoma. In addition to genetic predisposing factors, age, nadir CD4 cell count, and lack of HAART therapy predict the development of NHL. The clinical presentation of AIDS-related NHL has not changed, but several institutions have reported an improvement in survival since the introduction of HAART. Moreover, HAART has been combined safely with systemic chemotherapy in the management of NHL, and this approach results in a more modest decrease in immune function than when chemotherapy is administered alone. This has led to a more aggressive approach to the management of AIDS-related NHL and response rates and overall survival durations that are approaching those seen in stage-matched high-grade lymphomas in the immunocompetent population.     

AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy

Human immunodeficiency virus (HIV)-infected patients are at increased risk of developing cancer, particularly in the later stages of acquired immune deficiency syndrome (AIDS). Despite the advent of highly active anti-retroviral therapy (HAART), malignancy in this population is a leading cause of morbidity and mortality. Kaposi's sarcoma (KS) and AIDS-related non-Hodgkin's lymphoma (ARL) are the most common AIDS-defining malignancies. AIDS-related KS varies from minimal to fulminant disease. Treatment decisions for AIDS-related KS are guided largely by the presence and extent of symptomatic disease. In addition to HAART, excellent treatments exist for both localized disease (topical gel, radiotherapy, and intralesional therapy) and advanced disease (liposomal anthracyclines, paclitaxel). Novel therapies that have become available to treat AIDS-related KS include angiogenesis inhibitors and antiviral agents. ARL comprises a heterogeneous group of malignancies. With the immune restoration afforded by HAART, standard-dose chemotherapies now can be safely administered to treat ARL with curative intent. The role of analogous treatments used in HIV-negative patients, including monoclonal antibodies and autologous stem cell transplantation, requires further clarification in HIV-positive patients. HIV-infected patients also appear to be at increased risk for developing certain non-AIDS-defining cancers, such as Hodgkin's lymphoma and multiple myeloma. Although the optimal treatment of these neoplasms is at present uncertain, recent advances in chemotherapy, antiretroviral drugs, and supportive care protocols are allowing for more aggressive management of many of the AIDS-related cancers. This article provides an up-to-date review of the epidemiology, pathogenesis, clinical features, and treatment of various AIDS-related malignancies that are likely to be encountered by an oncologist practicing in the current HAART era.     

Malignant plasma cell tumors in human immunodeficiency virus-infected patients

The development of malignant neoplasms in patients with the acquired immune deficiency syndrome (AIDS) or with a positive human immunodeficiency virus (HIV) antibody test is a well known phenomenon. According to the guidelines from the Centers for Disease Control (Atlanta, GA), the presence of intermediate-grade or high-grade B-cell non-Hodgkin's lymphoma in HIV antibody-positive patients is considered a diagnostic criterion for AIDS. The authors describe two cases of malignant plasma cell tumors in two young HIV-infected patients. In light of this and other reports of plasma cell tumors in patients at risk for AIDS or with a positive HIV antibody test, the finding of another manifestation of B-cell neoplasia in these patients may enlarge the spectrum of AIDS-related tumors.     

Therapeutic challenges of AIDS-related non-Hodgkin's lymphoma in the United States and East Africa

Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.     

The evidence-based treatment of AIDS-related non-Hodgkin's lymphoma

As we enter the third decade of the AIDS epidemic, it is apparent that a large number of cancers are more common in people with the human immunodeficiency virus type 1 (HIV). Non-Hodgkin's lymphoma (NHL) remains the second most common tumour in such patients. At the onset of the epidemic, dose-intense combination regimens were used but these were quickly abandoned in favour of dose-modified strategies because of difficulties in tolerating aggressive chemotherapy in the presence of underlying immunosuppression. With the improvements in supportive care including more effective anti-retroviral therapies, colony-stimulating factors and prophylaxis against opportunistic infections, we are returning to the traditional chemotherapeutic approaches similar to those utilised in the non-HIV infected individual including infusional regimens. In this review, we discuss the evidence for choosing particular therapies in patients with AIDS-related NHL.     

Colorectal and anal cancer in HIV/AIDS patients: a comprehensive review

Highly active antiretroviral therapy (HAART) has significantly altered the epidemiology of cancer that is diagnosed in individuals who are infected with the human immunodeficiency virus (HIV). Studies have shown a dramatic decrease in the incidence of and mortality from AIDS-related malignancies (primarily Kaposi sarcoma and non-Hodgkin's lymphoma), while the incidence of and mortality from non-AIDS defining malignancies is on the rise. While the risk of colorectal cancer (CRC) in HIV-infected individuals is controversial and has received limited study, there has been accumulating evidence that suggests an increased risk of developing anal cancer (AC) during the HAART era. This article reviews the current literature reporting on CRC and AC in the HIV-infected population, with a specific on cancer: incidence, screening, clinical characteristics, and treatment outcomes.     

Plasmablastic lymphoma presenting as an arm mass in an individual negative for human immunodeficiency virus: a case report

Plasmablastic lymphoma is an aggressive diffuse large B-cell lymphoma classically arising in the oral cavities and jaws of individuals infected with the human immunodeficiency virus (HIV). More recently, cases of plasmablastic lymphoma have been identified in individuals negative for HIV. We report a case of plasmablastic lymphoma presenting as a rapidly expanding upper extremity mass in a 66-year-old individual negative for HIV. Aggressive multiple-agent chemotherapy resulted in a dramatic improvement of all symptoms. Increasing awareness of plasmablastic lymphoma in individuals who are HIV negative can allow for a better understanding of its clinical course and for specific chemotherapeutic regimens to be developed.