Plasmablastic lymphoma (PBL) is a distinct subtype of non-Hodgkin B-cell lymphoma, originally described with a strong predilection to the oral cavity of human immunodeficiency virus (HIV)-infected individuals. Data regarding patient age and gender, HIV status, initiation of and response to highly active antiretroviral therapy (HAART), tumor extent, pathology, treatment, and outcome were extracted from 112 cases of PBL identified in the literature. The median age at presentation was 38 years with a male predominance of 7:1, and the median CD4+ count was 178 cells/mm(3). PBL presented on average 5 years after diagnosis of HIV. Common primary sites of presentation included the oral cavity, gastrointestinal tract, and lymph nodes. Most cases presented with either stage I or stage IV disease. There was a variable expression of B-cell markers in tumor cells, but plasma cell markers were expressed in all cases. EBV was detected in 74%. Chemotherapy was used to treat 55% patients and was combined with radiotherapy in 21% cases. Complete response was obtained in 66% of treated cases; the majority of these responses were seen after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). The refractory/relapsed disease rate was 54%. Death occurred in 53% of patients, with a median overall survival of 15 months. Sex, CD4+ count, viral load, clinical stage, EBV status, primary site of involvement, and use of CHOP failed to show an association with survival. PBL is an aggressive B-cell lymphoma that presents in both oral and extra-oral sites of chronically HIV-infected immunosuppressed young men.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajh.21250

HIV-associated plasmablastic lymphoma: Lessons learned from 112 published cases

CD20-negative large-cell lymphoma with plasmablastic features: a clinically heterogenous spectrum in both HIV-positive and -negative patients

Forty cases of oral cavity non-Hodgkin's lymphoma (NHL) were evaluated for sex, age, location, clinical presentation, and World Health Organization (WHO) histological subtype. Fifty-three percent were female and the mean age was 71. The upper jaw (maxilla or palatal bone), mandible, palatal soft tissue, and vestibule and gingivae (maxillary or mandibular soft tissue involvement only) were, respectively, the most common locations. Swelling, ulceration, and radiographic destruction of bone were the most frequent signs. Most of the lymphomas were of B cell lineage (98%), and the majority of these B cell lymphomas (58%) were histologically subtyped as diffuse large B cell lymphoma, which is considered to have an aggressive clinical course. An immunohistochemical panel was used in the majority of cases to confirm the lineage and to help characterize the subtype. B and T cell specific markers were used to show lineage of the neoplastic cells. Additional markers were used to help confirm specific subtypes that characteristically show specific positivity to some of these antibodies. Molecular studies to detect monoclonal immunoglobulin heavy chain (IgH) gene rearrangements and Bcl-1 and Bcl-2 gene translocations were performed in cases in which the diagnosis was in question. The current WHO classification is also reviewed in detail.

Oral non-Hodgkin's lymphoma : review of the literature and World Health Organization classification with reference to 40 cases

Human herpes virus type 8 (HHV8) has been strongly associated with Kaposi sarcoma, primary effusion lymphoma (PEL), and Castleman's disease. To our knowledge, infection by this virus has not been strongly associated with other hematopathologic malignancies. We examined five oral cavity lymphomas from men with AIDS for HHV8 and HIV-1 by reverse transcriptase in situ polymerase chain reaction, as well as for Epstein-Barr virus (EBV) (EBER-1, -2) using in situ hybridization and HHV8 protein with immunohistochemistry. Four of these tumors were plasmablastic lymphomas; the final case was diffuse large B-cell lymphoma. Most of the neoplastic cells in these five lymphomas contained HHV8 RNA and protein. Further, the four plasmablastic lymphoma cases had tumor cells that contained EBV. HIV-1 RNA was not detected in the tumor cells but was noted in surrounding benign T cells. In comparison, HHV8 RNA was not detected in any of the five oral cavity lymphomas from people who did not have acquired immunosuppression nor in five lymphomas from AIDS patients that were located at a site other than the oral cavity. It is concluded that oral cavity lymphomas from people with AIDS are strongly associated with infection by HHV8 and EBV. Given the poor prognosis of oral cavity lymphomas in immunocompromised patients, therapy directed against the HHV8 and EBV infection may be of therapeutic value.

Oral plasmablastic lymphomas in AIDS patients are associated with human herpesvirus 8.

The effect of highly active antiretroviral therapy (HAART) on survival in HIV-infected patients with Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL) is unknown. Our study examines survival after HAART for these 2 malignancies. Analyses were performed using data from 387 HIV-infected men in the Multicenter AIDS Cohort Study (MACS) after a diagnosis of either KS or NHL in 1990–99. Potential prognostic factors, including HAART, were evaluated in univariate analyses using Kaplan-Meier survival curves and log-rank tests. Multivariate survival analyses were conducted using Cox's time-dependent proportional hazards models, adjusting for CD4+ cell levels at the time of cancer diagnosis and other covariates. Forty-three of 287 KS patients (15%) and 13 of 100 NHL patients (13%) had been treated with HAART. HAART treatment was associated with improved survival for KS and NHL patients (log-rank p = 0.0001 for each group). In multivariate analyses, HAART was associated with an 81% reduced risk of death among KS patients [relative hazard (RH) 0.19, 95% confidence limits (CL) (0.08, 0.45)], compared to those not exposed to HAART and an 84% reduced risk [RH 0.16, 95% CL (0.04, 0.64)] among NHL patients. Relative hazards estimates were similar for those with HAART initiation before and after NHL diagnosis. The use of HAART prolongs overall survival among HIV-positive men diagnosed with KS and NHL. HAART appears to be effective in improving survival even when initiated after the diagnosis of NHL and KS. © 2002 Wiley-Liss, Inc.

Effect of highly active antiretroviral therapy on survival among HIV‐infected men with Kaposi sarcoma or non‐Hodgkin lymphoma

Non-Hodgkin's lymphoma is the second most common HIV-associated malignancy. This report details a case of the recently described entity plasmablastic lymphoma of the mouth in a patient who was later found to have severe HIV disease. The tumor manifested as a large ulcerated mass of the left maxillary alveolus, causing bony destruction and tooth mobility. Histologic examination of lesional tissue revealed a lymphoid tumor with a high proliferation rate containing lymphoplasmacytoid cells that were reactive to the plasma cell marker VS38c but not to CD20 or CD79a; these are features of the recently reported non-Hodgkin's lymphoma termed plasmablastic lymphoma. This is only the second report of an unusual tumor that has a predilection for the orofacial tissues.

Oral plasmablastic lymphoma in previously undiagnosed HIV disease

The effect of human immunodeficiency virus-1 protease inhibitors on the frequency of human herpesvirus 8 DNA detection from peripheral blood of human immunodeficiency virus-positive persons was evaluated. Thirty-three human immunodeficiency virus-seropositive male patients were studied longitudinally. DNA from open reading frame 26 of the human herpesvirus 8 genome was amplified by the polymerase chain reaction from the CD45+ fraction of peripheral blood before and after the introduction of protease inhibitor therapy. Human herpesvirus 8 IgG status, CD4+ cell counts, and human immunodeficiency virus-1 plasma viral load were also assessed before and after therapy. When both reverse transcriptase inhibitor and protease inhibitor treatment were introduced at the same time, there was an increase in CD4+ T cell counts (P=0.0041), a decrease in human immunodeficiency virus plasma load (P=0.0584), and a decrease in the detection rate of human herpesvirus 8 DNA (P=0.0077). Introducing protease inhibitor to patients already receiving reverse transcriptase inhibitor treatment was associated with an increase in CD4+ T cell counts (P=0.0003), a decrease in human immunodeficiency virus plasma viral load (P=0.0911), and a decrease in the human herpesvirus 8 detection rate (P=0.0412). No significant changes in the titters of anti-human herpesvirus 8 IgG were observed. Treatment with human immunodeficiency virus-1 protease inhibitors is therefore associated with the clearance of human herpesvirus 8 DNA from peripheral blood of human immunodeficiency virus-infected patients. The concomitant decrease in the human immunodeficiency virus plasma load and increase in the peripheral CD4+ cell count suggest that an amelioration in the immune defect following reduction in the burden of human immunodeficiency virus-1 infection is responsible for the clearance of human herpesvirus 8 by protease inhibitors.

Effect of human immunodeficiency virus-1 protease inhibitors on the clearance of human herpesvirus 8 from blood of human immunodeficiency virus-1-infected patients.

To assess the diagnostic accuracy and safety of photodynamic diagnosis (PDD) in upper urinary tract urothelial carcinoma (UUTUC).A systematic literature search was conducted. Included studies were ...

Photodynamic diagnosis in upper urinary tract urothelial carcinoma: A systematic review.

Objective Trigeminal sensory neuropathy is an uncommon but often significant orofacial symptom There are few detailed descriptions of the problem in the dental literature The aim of this study was to evaluate the clinical presentation and management of a cohort of patients presenting with anesthesia/paresthesia affecting one or more divisions of the trigeminal nerve unrelated to any identifiable traumatic cause Study Design Nine patients with trigeminal neuropathy were examined Each patient underwent a standard protocol of examination and hematologic, serologic, radiologic, and histopathologic investigations, as appropriate Results Trigeminal neuropathy was found to be secondary to distant malignancy in 4 patients and to connective tissue disease in 2 patients In each of 3 other patients, there was no obvious cause for the neuropathy Patients with malignancy as the cause of their neuropathy tended to have involvement of more than one division of the trigeminal nerve and/or other neurologic features Conclusions Trigeminal sensory neuropathy may herald underlying distant malignancy or connective tissue disease Anesthesia and paresthesia of the orofacial region are therefore serious clinical symptoms that must be carefully investigated before a diagnosis of idiopathic disease is made (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:572-6)

Longstanding trigeminal sensory neuropathy of nontraumatic cause

Objective: The purpose of this study was to evaluate the effect of wheatgrass (Triticum aestivum L.) on atherogenic lipoproteins, inflammation, and menopausal symptoms. Methods: Fifty-nine hyperlipidemic women were randomized into control (n = 30) and intervention groups (n = 29). Intervention group was administered 3.5 g of freeze-dried wheatgrass powder in encapsulated form daily for 10 weeks, while the control group received no intervention. Results: The intervention group experienced a reduction of 5.4% in total cholesterol (TC), 4.4% in low-density lipoprotein cholesterol, and 9.5% in triacylglycerols (TAG); however, high-density lipoprotein (HDL) also reduced by 6% following 10 weeks of intervention. Compared with the control group, the baseline-adjusted post-intervention levels of TC, TAG, and Apolipoprotein B (Apo B) were significantly lower in the experimental group compared with the control group (p = 0.043, 0.045, and 0.016, respectively). Prevalence of menopausal symptoms saw nonsignif...

Impact of Wheatgrass (Triticum aestivum L.) Supplementation on Atherogenic Lipoproteins and Menopausal Symptoms in Hyperlipidemic South Asian Women - A Randomized Controlled Study.

Nitya Kumar

Papers

Oral plasmablastic lymphoma in previously undiagnosed HIV disease

Effect of human immunodeficiency virus-1 protease inhibitors on the clearance of human herpesvirus 8 from blood of human immunodeficiency virus-1-infected patients.

Photodynamic diagnosis in upper urinary tract urothelial carcinoma: A systematic review.

Longstanding trigeminal sensory neuropathy of nontraumatic cause

Impact of Wheatgrass (Triticum aestivum L.) Supplementation on Atherogenic Lipoproteins and Menopausal Symptoms in Hyperlipidemic South Asian Women - A Randomized Controlled Study.