Oral lymphoma in HIV infection

This study reports the main clinical and histological features, and the treatment and outcomes of six HIV-associated oral lymphomas.

During the period 1991-1995, six cases of lymphoma presenting in the oral cavity were diagnosed in this clinic. All six patients were men ranging in age from 36 to 62 years with CD4 counts below 100 cells mm-3.

In five patients, oral lymphoma was the first AIDS defining disease. Four lesions occurred on the gingiva, one on the palate and one on the tongue. The duration of symptoms prior to presentation ranged from 2 weeks to 14 months. In all but one patient, the lesions presented as red, exophytic masses and were diagnosed clinically as Kaposi's sarcoma. None of the five lesions presenting on the palate or gingiva showed radiographic evidence of bone destruction. Metastatic work-up failed to diagnose lymphoma elsewhere in the five cases where this was performed. Histological diagnoses included two small, non-cleaved (Burkitt's type) lymphomas, two immunoblastic lymphomas, one large cell lymphoma and one small, non-cleaved (non-Burkitt's) lymphoma.

These findings highlight the uncommon clinical presentation of this disease and despite its relative rarity, demonstrate the need to maintain a high degree of suspicion in any unusual oral lesion in this group of patients.