The Spectrum of Malignancies among Adult HIV Cohort in Poland between 1995 and 2012: A Retrospective Analysis of 288 Cases

The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland.

A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test.

Results: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm³ (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. 

The most frequent malignancies were: NHL (26.39%), KS (17.01%), ICC (11.81%), HD (7.99%), lung cancer (6.25%) and HCC (4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender, advanced age: 50–60 years and ≥ 60 years, longer duration of HIV-infection and successful HAART were independent predictors of NADMs overall, respectively.

Conclusions

In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

Below:  Estimated prevalence of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs). The latter are divided into virus related (NADMs-VR) and virus unrelated (NADMs-VUR) over the presented periods of time

Full article at: http://goo.gl/unAlxb

By:  Jacek Kowalski,1 Grażyna Cholewińska,1 Karolina Pyziak-Kowalska,1 Elżbieta Jabłonowska,2 Grażyna Barałkiewicz,3Anna Grzeszczuk,4 Magdalena Leszczyszyn-Pynka,5 Anita Olczak,6 Maria Jankowska,7 Tomasz Mikuła,8 Monika Bociąga-Jasik,9 Ewa Firląg-Burkacka,8 and Andrzej Horban8

¹Hospital for Infectious Diseases in Warsaw, Warsaw, Poland

²University of Lodz, Lodz, Poland

³Poznan University of Medical Sciences, Poznan, Poland

⁴Medical University of Bialystok, Bialystok, Poland

⁵Pomeranian Medical University, Szczecin, Poland

⁶Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland

⁷Medical University of Gdansk, Gdansk, Poland

⁸Medical University of Warsaw, Warsaw, Poland

⁹Jagiellonian University Medical College, Krakow, Poland

Corresponding author.

Address for correspondence: Jacek Kowalski, Hospital for Infectious Diseases in Warsaw, Wolska 37, 01-201 Warsaw, Poland. e-mail:moc.liamg@2891ikslawokkecaj

 

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An Unusual Case of Invasive Kaposi's Sarcoma with Primary Effusion Lymphoma in an HIV Positive Patient: Case Report and Literature Review

We report a case of AIDS-related Kaposi's sarcoma (KS) with Primary Effusion Lymphoma (PEL) in a 28-year-old, African American male. Kaposi's sarcoma is an AIDS defining disease and typically will disseminate early in the course of the disease affecting the skin, mucous membranes, gastrointestinal tract, lymph nodes, and lungs. This case reports an unusual presentation of the disease along with primary effusion lymphoma. Although the most common organ systems affected by KS are the respiratory and the gastrointestinal systems, the lungs of this patient did not show any evidence of KS. Additionally, the patient demonstrates the rarely seen liver and unique pancreatic involvement by KS along with unusual synchronous bilateral pleural and peritoneal cavity involvement by PEL, adding to the distinct pattern of invasive AIDS-related Kaposi's sarcoma.

Below: CT scans of the chest and abdomen show large bilateral pleural effusions (a) and severe ascites (b). There is a 4.2 cm mass in the head of the pancreas (c).

Below:  Cytologic evaluation of the pleural fluid shows large atypical lymphoid cells (arrows) ((a) H&E, ×100) expressing HHV8, CD30, and CD138 ((b), (c), and (d), resp.). The atypical cells show high proliferation index highlighted by Ki-67 immunostain (e) and positive staining for Epstein-Barr Virus (EBV) by in situ hybridization (f).

Below: The cut surface of liver shows a well-demarcated perivascular infiltration marked by reddish-brown tumorous tissue (arrows) (a). The head of the pancreas shows a reddish-brown infiltrating lesion (arrows) (d). Representative microscopic sections show spindle cells proliferation involving hepatic lobules ((b) H&E, ×20) and pancreatic acini ((e) H&E, ×10) with positive staining for HHV-8 antibody consistent with Kaposi's sarcoma ((c), (f)).

Below:  Kaposi's sarcoma with well-circumscribed areas of raised hemorrhagic mucosa in large intestine ((a), (b)) and stomach ((c), (d)).

Full article at: http://goo.gl/rYNzVa

By: Alexandra Millet, 1 Sanmeet Singh, 1 Genelle Gittens-Backus, 1 Kim Ann Dang, 1 and Babak Shokrani 2 , *

*Babak Shokrani: Email: ude.drawoh@inarkohs_b

1Howard University College of Medicine, Washington, DC 20059, USA

2Department of Pathology, Howard University Hospital, Washington, DC 20060, USA

Academic Editor: Francesco A. Mauri

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Vascular Tumor on the Forehead of an HIV Patient

Below:  Solid red tumoration of 1 × 0.5 cm, located the forehead. Note the vascular appearance of the lesion

Below:   A biopsy of the lesion shows a vascular proliferation predominately on the upper dermis (H and E stain, ×20)

Below:  A closer view reveals that the lesion is composed of unusual thick vessels for this localization, showing a well developed muscular layer. All around there are some smaller vessels (H and E stain, ×10)

Cirsoid aneurysm is a small vascular proliferation characterized by small to medium-sized channels with features of arteries and veins, that present as small, blue or red asymptomatic papule. We report a case of a crisoid aneurysm on the forhead of an HIV patient that suggested a Kaposi sarcoma as a differential diagnosis.

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Oral Kaposi's Sarcoma: Sole Presentation in HIV Seropositive Patient

Below:  (a) Extra-oral view depicting cervical lymphadenopathy (arrow head) (b) Bluish-red nodular enlargement of the left hard palate

Below:  Photomicrograph of the histopathologic section reveals fibrous connective tissue stroma with numerous irregular slit like spaces containing extravasated red blood cells and surrounded by ill-defined fascicles of spindle shaped cells (H-E)

Below:  Chest radiograph

Acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS) occurs with increased frequency in all HIV transmission groups and at a particularly high rate among homosexual men. It usually presents initially as violaceous cutaneous lesions, but oral mucosa, lymph nodes and visceral organs may be affected, sometimes without skin involvement. KS in a 20-year-old HIV-seropositive patient with oral involvement as the sole presentation of the disease is presented herewith; thus contributing a new AIDS-related KS case reported in Indian Literature.

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