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Plasmablastic Lymphoma of Gingiva Mimicking a Reactive Lesion: A Case Report
Neeta Bagul,G. S. Mamatha,Aditi Mahalle
Case Reports in Dentistry , 2012, DOI: 10.1155/2012/259307
Abstract: Oral plasmablastic lymphoma (PBL) is a rare malignancy, associated with HIV or other immunocompromised conditions. The lesion constituted a new subtype of diffuse large B-cell lymphoma and proposed a distinct entity based on its basic morphology, its clinical behaviour involving predominantly extramedullary sites (particularly oral cavity), and its limited antigenic phenotype data suggesting plasmacytic differentiation. Authors here report a case of apparently healthy individual aged 35 years, presenting one-month history of swelling associated with loosened teeth around upper anteriors. Following incisional biopsy, routine histopathologic and immunohistochemical studies, the diagnosis of plasmablastic lymphoma was given.
A Case of Cutaneous Plasmablastic Lymphoma in HIV/AIDS with Disseminated Cryptococcus  [PDF]
Jun Gong,Serhan Alkan,Sidharth Anand
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/862585
Abstract: We present a case of a patient with HIV/AIDS who presented with a tender left lower extremity cutaneous mass over a site of previous cryptococcal infection and was found to have plasmablastic lymphoma (PBL). The incidence of PBL is estimated to account for less than 5% of all cases of non-Hodgkin lymphoma (NHL) in HIV-positive individuals. In fact, there were only two reports of extraoral PBL at the time of a 2003 review. PBL in HIV-positive individuals is an aggressive malignancy that tends to occur in middle-aged males with low CD4 counts, high viral loads, and chronic HIV infection. The definitive diagnosis can be made with biopsy which typically shows malignant lymphoid cells that stain positive for plasma cell markers and negative for B-cell markers. The most common treatment is chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens, but the overall survival rate is poor despite its relative responsiveness to chemotherapy. This case highlights the challenges that remain in improving clinical outcomes, the importance of antiretroviral therapy and HIV disease control, and a potential association between a chronic inflammatory state caused by disseminated Cryptococcus and tumorigenesis in individuals with PBL. 1. Introduction Kaposi’s sarcoma, non-Hodgkin lymphoma (NHL), and invasive cervical carcinoma are among the three AIDS-defining malignancies, and, of these, Kaposi’s sarcoma and AIDS-related non-Hodgkin lymphoma are the most common [1]. AIDS-related NHL can be categorized into systemic NHL, primary CNS lymphoma, and primary effusion lymphoma [2]. In HIV-infected individuals, systemic NHL is the most common and can be further divided into subtypes such as diffuse large B-cell lymphoma (DLBCL), Burkitt’s lymphoma, T-cell lymphoma, and plasmablastic lymphoma (PBL), to name a few [2]. Others have described plasmablastic lymphoma as a unique variant of DLBCL with a propensity to develop in HIV-positive patients with frequent involvement of the oral cavity [3–5]. At the time of a 2003 review, there were only 2 reports of extraoral plasmablastic lymphoma [4]. Of the NHL subtypes seen in HIV-positive individuals, the incidence of DLBCL is estimated to account for almost 50% of the cases while the incidence of plasmablastic lymphoma is estimated to account for less than 5% of the cases [3, 4]. The median age of presentation for PBL is 38 years with a greater predominance in males [5]. PBL also tends to occur in HIV-positive individuals with absolute CD4 counts less than 200?CMM, mean viral loads greater
Plasmablastic Lymphoma of Gingiva Mimicking a Reactive Lesion: A Case Report  [PDF]
Neeta Bagul,G. S. Mamatha,Aditi Mahalle
Case Reports in Dentistry , 2012, DOI: 10.1155/2012/259307
Abstract: Oral plasmablastic lymphoma (PBL) is a rare malignancy, associated with HIV or other immunocompromised conditions. The lesion constituted a new subtype of diffuse large B-cell lymphoma and proposed a distinct entity based on its basic morphology, its clinical behaviour involving predominantly extramedullary sites (particularly oral cavity), and its limited antigenic phenotype data suggesting plasmacytic differentiation. Authors here report a case of apparently healthy individual aged 35 years, presenting one-month history of swelling associated with loosened teeth around upper anteriors. Following incisional biopsy, routine histopathologic and immunohistochemical studies, the diagnosis of plasmablastic lymphoma was given. 1. Introduction Plasmablastic lymphoma is a unique AIDS-related lymphoma, which was first described in the jaws and oral cavity of HIV-infected persons [1, 2]. The disease accounts for 2.6% of all HIV-related non-Hodgkin lymphomas [3]. The lymphoma has also been reported in HIV-negative persons, particularly those who have immunosuppression. The lymphoma is listed in the World Health Organization 2001 classification as a variant of diffuse large B-cell lymphoma [4]. It usually develops in middle-aged adults [4], but can also occur in the pediatric age group [5]. The lymphoma involves predominantly the gingival and palatal mucosa, causing thickening and ulceration with a tendency to infiltrate adjacent bone [3]. The clinical appearance may mimic periodontal disease, Kaposi sarcoma, or melanoma [6]. Radiographic changes include widening of the periodontal ligament space and loss of the lamina dura [7]. Plasmablastic lymphoma of oral mucosa contains a monomorphic population of plasmablasts with no or minimal plasmacytic differentiation. The histological findings of a diffuse infiltrative growth pattern, brisk mitotic activity, and necrosis, along with the fact that they are rapidly growing destructive tumors, supports their designation as a high-grade malignant lymphoma. Plasmablasts are lymphoid cells that morphologically resemble B-cell immunoblasts but have acquired a plasma cell immunophenotype (i.e., loss of B-cell markers and surface immunoglobulin with the acquisition of plasma cell surface markers). Thus, unlike immunoblasts, plasmablasts fail to express CD45 (leukocyte common antigen) as well as the B-cell marker CD20 and are only variably immunoreactive for CD79a—a broader-spectrum B-cell marker. They are also negative for pan-T-cell markers. Positive staining for plasma cell markers such as VS38c, CD38, MUM-1, and CD138
Orbital plasmablastic lymphoma: a clinico-pathological correlation of a rare disease and review of literature  [cached]
Mulay K,Ali MJ,Reddy VA,Honavar SG
Clinical Ophthalmology , 2012,
Abstract: Kaustubh Mulay,1 Mohammad Javed Ali,2 Vijay Anand Reddy,2 Santosh G Honavar21Ocular Pathology Service, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India; 2Oncology Service, LV Prasad Eye Institute, Hyderabad, Andhra Padresh, IndiaAbstract: Ocular involvement by plasmablastic lymphoma is extremely rare with very few reports in the literature. Its morphological and immunological resemblance to plasma cell myeloma makes it a diagnostic challenge, while its clinical course, which is characterized by recurrence and death, makes therapy a challenge for clinicians. We present three cases of plasmablastic lymphoma, each of which has distinct clinicoradiological features, and we also review the literature on orbital plasmablastic lymphomas.Keywords: plasmablastic lymphoma, ocular, myeloma, orbit
Plasmablastic Lymphoma of Gingiva as Primary Oral Manifestation in Previously Undiagnosed HIV Patient – A Case Report
Kamlesh N. Dekate,Vineet Kini,Shwetha V. Kumar,Jigna Pathak
International Journal of Oral & Maxillofacial Pathology , 2011,
Abstract: Non-Hodgkin's lymphomas are the third most common group of malignant lesions in the oral cavity and maxillofacial region. Most such lymphomas have been shown to be predominantly of B- cell lineage. Plasmablastic lymphoma of the oral cavity is an aggressive B-cell lymphoma associated with Human Immunodeficiency Virus infection and is classified as an individual nosological entity by the World Health Organization Classification of Tumours of Hematopoietic and Lymphoid Tissues. It clinically presents with a rapid growth and histologically shows a diffuse pattern with a high mitotic index. Based solely on clinical and microscopic features, separation of Plasmablastic lymphoma from other categories of Non-Hodgkin’s lymphoma is very difficult. Therefore demonstration of distinguishing pattern of expression of immunohistochemical markers is an essential component of the diagnostic protocol. Hence we report a case of Plasmablastic Lymphoma in a healthy person with previously undiagnosed Human Immunodeficiency Virus.
A meta-analysis of highly active anti-retroviral therapy for treatment of plasmablastic lymphoma  [cached]
Guan Bing,Zhang Xinhua,Ma Henhui,Zhou Hangbo
Annals of Saudi Medicine , 2010,
Abstract: Background and Objectives: Plasmablastic lymphoma is a recently described B-cell derived lymphoma. The prognosis of plasmablastic lymphoma patients is usually poor. We performed a systematic review of the literature on the use of highly active anti-retroviral therapy (HAART) and the prognosis of plasmablastic lymphoma. Methods : A comprehensive search of relevant databases, including Medline, Embase, the Cochrane Controlled Trials Register, the Cochrane Library, and the Science Citation Index yielded ten randomized controlled trials. Trials were divided into two groups according to therapy. The rates of plasmablastic lymphoma were analyzed using a fixed-effects model. Sensitivity analyses (on publication type, statistical model) were performed to further detect and evaluate clinically significant heterogeneity. Tests of survival for plasmablastic lymphoma were also performed by using Kaplan-Meier method. Results : Meta-analysis result showed that the prognosis of plasmablastic lymphoma patients was statistically different in the patients receiving HAART in addition to chemotherapy and/or radiotherapy than in the patients receiving the chemotherapy and/or radiotherapy alone (pooled relative risk=3.04; P=.03). Survival analyses also displayed a statistically significant difference (χ2 =6.22, P=.013). Conclusion : HAART in addition to chemotherapy and/or radiotherapy is effective in improving the prognosis of plasmablastic lymphoma. However, the small sample sizes increase the likelihood of bias in the studies in this meta-analysis, and therefore, the results should be taken cautiously.
Flexible and Accurate Detection of Genomic Copy-Number Changes from aCGH  [PDF]
Oscar M Rueda ,Ramón Díaz-Uriarte
PLOS Computational Biology , 2007, DOI: 10.1371/journal.pcbi.0030122
Abstract: Genomic DNA copy-number alterations (CNAs) are associated with complex diseases, including cancer: CNAs are indeed related to tumoral grade, metastasis, and patient survival. CNAs discovered from array-based comparative genomic hybridization (aCGH) data have been instrumental in identifying disease-related genes and potential therapeutic targets. To be immediately useful in both clinical and basic research scenarios, aCGH data analysis requires accurate methods that do not impose unrealistic biological assumptions and that provide direct answers to the key question, “What is the probability that this gene/region has CNAs?” Current approaches fail, however, to meet these requirements. Here, we introduce reversible jump aCGH (RJaCGH), a new method for identifying CNAs from aCGH; we use a nonhomogeneous hidden Markov model fitted via reversible jump Markov chain Monte Carlo; and we incorporate model uncertainty through Bayesian model averaging. RJaCGH provides an estimate of the probability that a gene/region has CNAs while incorporating interprobe distance and the capability to analyze data on a chromosome or genome-wide basis. RJaCGH outperforms alternative methods, and the performance difference is even larger with noisy data and highly variable interprobe distance, both commonly found features in aCGH data. Furthermore, our probabilistic method allows us to identify minimal common regions of CNAs among samples and can be extended to incorporate expression data. In summary, we provide a rigorous statistical framework for locating genes and chromosomal regions with CNAs with potential applications to cancer and other complex human diseases.
Case of relapsed AIDS-related plasmablastic lymphoma treated with autologous stem cell transplantation and highly active antiretroviral therapy  [cached]
Hiroki Goto,Shotaro Hagiwara,Risen Hirai,Takahiko Miyama
Rare Tumors , 2011, DOI: 10.4081/rt.2011.e11
Abstract: Plasmablastic lymphoma is a rare and aggressive malignancy strongly associated with HIV infection. The refractory/relapsed disease rate is high, and the survival rate is characteristically poor. There are no satisfactory salvage regimens for relapsed cases. We successfully performed autologous stem cell transplantation using a regimen consisting of MCNU (ranimustine), etoposide, cytarabine, and melphalan in a Japanese patient with relapsed AIDS-related plasmablastic lymphoma of the oral cavity. Highly active antiretroviral therapy continued during the therapy. Therapy-related toxicity was tolerable, and a total of 40 Gy of irradiation was administered after autologous stem cell transplantation. The patient has remained in complete remission for 16 months since transplantation.
Orbital plasmablastic lymphoma: a clinico-pathological correlation of a rare disease and review of literature
Mulay K, Ali MJ, Reddy VA, Honavar SG
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S38282
Abstract: bital plasmablastic lymphoma: a clinico-pathological correlation of a rare disease and review of literature Case Series (1194) Total Article Views Authors: Mulay K, Ali MJ, Reddy VA, Honavar SG Published Date December 2012 Volume 2012:6 Pages 2049 - 2057 DOI: http://dx.doi.org/10.2147/OPTH.S38282 Received: 18 September 2012 Accepted: 23 October 2012 Published: 11 December 2012 Kaustubh Mulay,1 Mohammad Javed Ali,2 Vijay Anand Reddy,2 Santosh G Honavar2 1Ocular Pathology Service, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India; 2Oncology Service, LV Prasad Eye Institute, Hyderabad, Andhra Padresh, India Abstract: Ocular involvement by plasmablastic lymphoma is extremely rare with very few reports in the literature. Its morphological and immunological resemblance to plasma cell myeloma makes it a diagnostic challenge, while its clinical course, which is characterized by recurrence and death, makes therapy a challenge for clinicians. We present three cases of plasmablastic lymphoma, each of which has distinct clinicoradiological features, and we also review the literature on orbital plasmablastic lymphomas.
Plasmablastic lymphoma of the small intestine: Case report and literature review  [cached]
Hong-Wei Wang,Wen Yang,Jun-Zhong Sun,Jiang-Yang Lu
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i45.6677
Abstract: Plasmablastic lymphoma (PBL) is a rare aggressive B-cell lymphoproliferative disorder, which has been characterized by the World Health Organization as a new entity. Although PBL is most commonly seen in the oral cavity of human immunodeficiency virus (HIV)-positive patients, it can also be seen in extra-oral sites in immunocompromised patients who are HIV-negative. Here we present a rare case of PBL of the small intestine in a 55-year-old HIV-negative male. Histopathological examination of the excisional lesion showed a large cell lymphoma with plasmacytic differentiation diffusely infiltrating the small intestine and involving the surrounding organs. The neoplastic cells were diffusely positive for CD79a, CD138 and CD10 and partly positive for CD38 and epithelial membrane antigen. Approximately 80% of the tumor cells were positive for Ki-67. A monoclonal rearrangement of the kappa light chain gene was demonstrated. The patient died approximately 1.5 mo after diagnosis in spite of receiving two courses of the CHOP chemotherapy regimen. In a review of the literature, this is the first case report of PBL with initial presentation in the small intestine without HIV and Epstein-Barr virus infection, and a history of hepatitis B virus infection and radiotherapy probably led to the iatrogenic immunocompromised state.
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