Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Early stage primary gastric diffuse large B-cell lymphoma in a young HIV-positive patient

Guilherme Harada; Aloísio Felipe-Silva; José Guilherme Nogueira da Silva

Downloads: 6
Views: 761


HIV infection is known to be associated with the development of a wide range of neoplasia. About 25 to 40% of HIV-positive patients will present some kind of malignancy in the course of the disease; among them 10% are non-Hodgkin lymphomas (NHL) and 20% of these are represented by the diffuse large B-cell lymphoma. HIV-positive patients have a relative risk of 110 times higher to develop neoplasia, than the non-infected population. The gastrointestinal (GI) tract is the most frequent extranodal site of involvement. However, the primary GI lymphoma is rare. The authors present a case of a 31-year-old male patient with a 16-year history of HIV infection, who deliberately withdrew the Highly Active Antiretroviral Therapy (HAART) regimen and was hospitalized because of a respiratory infection. Because of a long-term complaint of dyspepsia, an upper gastrointestinal endoscopy was performed disclosing a large elevated and ulcerated gastric lesion, which biopsy revealed a diffuse large B-cell lymphoma. Clinical, imaging and laboratory tests showed an early stage diagnosis: Lugano stage I. Although not frequent, the authors alert to considering this neoplasia in all HIV-positive patients with dyspeptic symptoms.


Lymphoma, Large B-Cell, Diffuse, Stomach Neoplasms, Lymphoma, AIDS-Related, Acquired Immunodeficiency Syndrome


Levine AM. AIDS-related malignancies. Curr Opin Oncol. 1994;6(5):489-91. []. PMid: [PMID:7827151]

Burgi A, Brodine S, Wegner Set al. Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer. 2005;104(7):1505-11. []. PMid: [PMID:16104038]

Coté TR, Biggar RJ, Rosenberg PS, et al, and the AIDS/Cancer Study Group. Non-Hodgkin’s lymphoma among people with AIDS: incidence, presentation and public health burden. Int J Cancer. 1997;73(5):645-50. PMid: [PMID:9398040].

Grabar S, Le Moing V, Goujard Cet al. Clinical outcome of patients with HIV-1 infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy. Ann Intern Med. 2000;133(6):401-10. []. PMid: [PMID:10975957]

Levine AM, Seneviratne L, Espina BMet al. Evolving characteristics of AIDS-related lymphoma. Blood. 2000;96(13):4084-90. PMid: [PMID:11110677].

Heise W. GI-lymphomas in immunosuppressed patients (organ transplantation; HIV). Best Pract Res Clin Gastroenterol. 2010;24(1):57-69. []. PMid: [PMID:20206109]

Carbone A. AIDS-related non-Hodgkin’s lymphomas: from pathology and molecular pathogenesis to treatment. Hum Pathol. 2002;33(4):392-404. []. PMid: [PMID:12055673]

Danzig JB, Brandt LJ, Reinus JF, Klein RS. Gastrointestinal malignancy in patients with AIDS. Am J Gastroenterol. 1991;86(6):715-8. PMid: [PMID:2038993].

Deeken JF, Tjen-A-Looi A, Rudek MAet al. The rising challenge of non-AIDS-defining cancers in HIV-infected patients. Clin Infect Dis. 2012;55(9):1228-35. []. PMid: [PMID:22776851]

Powitz F, Bogner JR, Sandor P, Zietz C, Goebel FD, Zoller WG. Gastrointestinal lymphomas in patients with AIDS. Z Gastroenterol. 1997;35(3):179-85. PMid: [PMID:9106981].

Dawson IM, Cornes JS, Morson BC. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg. 1961;49(213):80-9. []. PMid: [PMID:13884035]

Koch P, del Valle F, Berdel WE, et al, and the German Multicenter Study Group. Primary gastrointestinal non-Hodgkin’s lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol. 2001;19(18):3861-73. PMid: [PMID:11559724].

Lewin KJ, Ranchod M, Dorfman RF. Lymphomas of the gastrointestinal tract: a study of 117 cases presenting with gastrointestinal disease. Cancer. 1978;42(2):693-707. [<693::AID-CNCR2820420241>3.0.CO;2-J]. PMid: [PMID:354774]

Ducreux M, Boutron MC, Piard F, Carli PM, Faivre J. A 15-year series of gastrointestinal non-Hodgkin’s lymphomas: a population-based study. Br J Cancer. 1998;77(3):511-4. []. PMid: [PMID:9472653]

Ehrlich AN, Stalder G, Geller W, Sherlock P. Gastrointestinal manifestations of malignant lymphoma. Gastroenterology. 1968;54(6):1115-21. PMid: [PMID:5656330].

Papaxoinis G, Papageorgiou S, Rontogianni Det al. Primary gastrointestinal non-Hodgkin’s lymphoma: a clinicopathologic study of 128 cases in Greece. A Hellenic Cooperative Oncology Group study (HeCOG). Leuk Lymphoma. 2006;47(10):2140-6. []. PMid: [PMID:17071488]

Spinelli P, Lo Gullo C, Pizzetti P. Endoscopic diagnosis of gastric lymphomas. Endoscopy. 1980;12(5):211-4. []. PMid: [PMID:7428725]

Loehr WJ, Mujahed Z, Zahn FD, Gray GF, Thorbjarnarson B. Primary lymphoma of the gastrointestinal tract: a review of 100 cases. Ann Surg. 1969;170(2):232-8. []. PMid: [PMID:5796708]

Fischbach W, Goebeler-Kolve ME, Greiner A. Diagnostic accuracy of EUS in the local staging of primary gastric lymphoma: results of a prospective, multicenter study comparing EUS with histopathologic stage. Gastrointest Endosc. 2002;56(5):696-700. []. PMid: [PMID:12397278]

Harada N, Wiersema M, Wiersema L. Endosonography guided fine needle aspiration biopsy (EUS FNA) in the evaluation of lymphadenopathy: Staging accuracy of EUS FNA versus EUS alone. Gastrointest Endosc. 1997;45(4):AB31. [].

Rohatiner A, d’Amore F, Coiffier Bet al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol. 1994;5(5):397-400. PMid: [PMID:8075046].

Bellan C, De Falco G, Lazzi S, Leoncini L. Pathologic aspects of AIDS malignancies. Oncogene. 2003;22(42):6639-45. []. PMid: [PMID:14528289]

Ho-Yen C, Chang F, van der Walt J, Lucas S. Gastrointestinal malignancies in HIV-infected or immunosuppressed patients: pathologic features and review of the literature. Adv Anat Pathol. 2007;14(6):431-43. []. PMid: [PMID:18049132]

De Paepe P, Achten R, Verhoef Get al. Large cleaved and immunoblastic lymphoma may represent two distinct clinicopathologic entities within the group of diffuse large B-cell lymphomas. J Clin Oncol. 2005;23(28):7060-8. []. PMid: [PMID:16129841]

Ottensmeier CH, Stevenson FK. Isotype switch variants reveal clonally related subpopulations in diffuse large B-cell lymphoma. Blood. 2000;96(7):2550-6. PMid: [PMID:11001910].

Cinti C, Leoncini L, Nyongo Aet al. Genetic alterations of the retinoblastoma-related gene RB2/p130 identify different pathogenetic mechanisms in and among Burkitt’s lymphoma subtypes. Am J Pathol. 2000;156(3):751-60. []. PMid: [PMID:10702389]

Kramer MH, Hermans J, Wijburg Eet al. Clinical relevance of BCL2, BCL6, and MYC rearrangements in diffuse large B-cell lymphoma. Blood. 1998;92(9):3152-62. PMid: [PMID:9787151].

Huang JZ, Sanger WG, Greiner TCet al. The t(14;18) defines a unique subset of diffuse large B-cell lymphoma with a germinal center B-cell gene expression profile. Blood. 2002;99(7):2285-90. []. PMid: [PMID:11895757]

Kitayama Y, Honda S, Sugimura H. Epstein-Barr virus-related gastric pseudolymphoma in infectious mononucleosis. Gastrointest Endosc. 2000;52(2):290-1. []. PMid: [PMID:10922116]

Stein H, Warnke RA, Chan WC, Jaffe ES. Diffuse large B-cell lymphoma, not otherwise specified. In: Swerdlow S, Campo E, Harris NL, editors. International Agency for Research on Cancer. WHO classification of tumors of haematopoietic and lymphoid tissue. Genève: World Health Organization; 2008. p. 233-7.

Kobayashi Y, Hatta Y, Hojo Aet al. Long-term follow-up of localized, primary gastric diffuse large B-cell lymphoma treated with rituximab and CHOP. Exp Ther Med. 2012;3(2):304-8. PMid: [PMID:22969886].

Wu Y-X, Liu B, Chen L, Li JH, Chen SQ. Prognostic factors of primary gastric diffuse large B cell lymphoma: a retrospective study of 75 cases in China. Ann Hematol. 2013;92(6):861-2. []. PMid: [PMID:23238898]

Rezende REF, Mantelmacher M, Ferreira SCet al. Clinical, endoscopic and prognostic aspects of primary gastric non-hodgkin’s lymphoma associated with acquired immunodeficiency syndrome. Braz J Infect Dis. 2009;13(1):2-4. []. PMid: [PMID:19578621]


Publication date:

569696b264cc8b5cda711bf6 autopsy Articles

Autops Case Rep

Share this page
Page Sections