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  1. Lymphoma in HIV:
    1. Immunoblastic (including body cavity): 60% ; CD4+ < 200
    2. Burkitt's: 20% 
    3. Primary brain lymphoma: 20% ; CD4+ < 50
  2. MC type of lymphoma in HIV: immunoblastic Q
  3. MC site of lymphoma in HIV: CNS Q
  4. MC cell type of lymphoma in HIV: B cell (90%)
CNS Lymphoma
  1. 60% primary
  2. 40% metastatic
  3. EBV DNA +
  4. 80% of HIV patients with lymphoma have EXTRANODAL lymphoma, of which the MC site is
  5. the CNS
  6. Presents with focal neuro-deficit
  7. MRI/CT: ring-enhancing lesions
**D/D of ring-enhancing lesion in HIV patient: PBL, Toxo, Chagas ds


Burkitt’s Lymphoma
c-myc translocation from chromosome 8 to chromosome 14 or 22

HIV related Burkitt’s

Endemic (African) Burkitt’s

Sporadic Burkitt’s

50% have EBV DNA

97% have EBV DNA


MC site is abdomen

MC site is mandible



Kaposi’s Sarcoma
  1. Causative- Viral Co-factor: KSHV or HHV-8
  2. HHV-8 also implicated in: Body Cavit lymphomas, Castleman’s disease, Multiple myeloma
  3. Multicentric vascular neoplasm that affects the skin, LN, GIT & lungs
  4. 4 types of Kaposi's:
    1. Classic / Chronic / European
    2. Endemic / African
    3. Transplant-associated
    4. HIV-associated
  5. No site of predilection
  6. Most commonly presents with skin lesions
  7. 40% of homosexual males with HIV develop KS; only 5% of other epidemiologic groups with HIV develop KS
  8. Occurrence unrelated to degree of immunosuppression (CD4 count)
  9. 33% of patients with KS will develop a second malignancy, MC lymphoma
  10. Clinical features
    1. Skin: Macular lesions in sun-exposed areas that exhibit Koebner's phenomenon
    2. Lymphadenopathy
    3. Lungs: Presents with SOB; Bilateral lower lobe infiltrate with pleural effusion
    4. GIT:
      1. Mucosal: Bleeding            
      2. Biliary tract: Obstructive jaundice
  11. Pathology:
    1. Spindle cell (LQ 2012) is the hallmark
    2. KS, arises as a cancer of lymphatic endothelium and forms vascular channels that fill with blood cells, giving the tumor its characteristic bruise-like appearance.
    3. KSHV proteins are uniformly detected in KS cancer cells.
    4. KS lesions contain tumor cells with a characteristic abnormal elongated shape, called spindle cells.
    5. The tumor is highly vascular (LQ 2012), containing abnormally dense and irregular blood vessels, which leak red blood cells into the surrou0nding tissue and give the tumor its dark color. 
    6. Inflammation around the tumor may produce swelling and pain.
    7. Although KS may be suspected from the appearance of lesions and the patient's risk factors, definite diagnosis can be made only by biopsy and microscopic examination, which will show the presence of spindle cells.
    8. Detection of the KSHV protein LANA (LQ 2012) in tumor cells confirms the diagnosis.
  12. Treatment:
    1. Indications of therapy: Organ / Life-threatening manifestations (e,g, Severe hypoxemia / massive GI bleeding); Cosmetically Unacceptable; Large lesion overlying a joint & interfering with ADL.
    2. Localized disease: Intralesional Cryotherapy / Vinblastine
    3. Extensive disease: TFNα / Liposomal Daunorubicin
    4. Most important determinant of response to therapy: CD4 count
  13. Prognostic indicators.
    1. Disease limited to LNs carries a good prognosis
    2. Disease with extensive oral lesions, ulceration or edema & disease involving viscera carries a poor prognosis
    3. Most common cause of death in KS: Infection

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