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AIDS-related Burkitt's lymphoma. Morphologic and immunophenotypic study of biopsy specimens
A Carbone1, A Gloghini, G Gaidano
1Division of Pathology, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.
Insights
This study identifies a distinct subgroup of HIV-related lymphomas with intermediate features between small noncleaved cell (SNCC) and immunoblastic lymphoma (IBL). These intermediate lymphomas show unique characteristics, suggesting they are separate from established SNCC and IBL categories.
Area of Science:
- Oncology
- Immunology
- Virology
Background:
- HIV-associated lymphomas, particularly high-grade B-cell non-Hodgkin's lymphomas (NHL), present pleomorphic features complicating precise classification.
- Accurate subtyping of these lymphomas is crucial for understanding their distinct biological behaviors and guiding treatment strategies.
Purpose of the Study:
- To investigate and characterize lymphomas in HIV-infected patients that exhibit features intermediate between small noncleaved cell (SNCC) and immunoblastic lymphoma (IBL).
- To determine if these intermediate lymphomas represent a distinct clinicopathological entity.
Main Methods:
- Morphological and immunophenotypic analysis of 69 HIV-related systemic lymphoma specimens, including 42 SNCC, 20 IBL, and 7 intermediate cases.
- Assessment of p53 protein overexpression and Epstein-Barr virus (EBV) association in a subset of lymphomas.
- Analysis of host immune status, specifically CD4+ lymphocyte counts, in relation to lymphoma subtypes.
Main Results:
- Intermediate lymphomas displayed cellular features distinct from both SNCC and IBL.
- p53 overexpression and EBV association were observed in SNCC and intermediate lymphomas, while IBL cases were p53 negative but showed high EBV association.
- Patients with intermediate lymphomas had significantly lower CD4+ counts compared to SNCC patients, similar to IBL patients.
Conclusions:
- Lymphomas with intermediate features between SNCC and IBL constitute a distinct subgroup.
- These findings highlight the heterogeneity of HIV-related B-cell lymphomas and the need for refined classification systems.
Abstract:
In patients infected with HIV, high-grade B-cell non-Hodgkin's lymphomas (NHL), including the small noncleaved cell (SNCC) category, exhibit pleomorphic features, which makes precise definition difficult. Sixty-nine pathologic specimens with HIV-related systemic lymphomas, including 42 SNCC, 20 immunoblastic lymphomas (IBL), and 7 cases with features "intermediate" between SNCC and IBL were morphologically and immunophenotypically investigated. The host immune status was also analyzed in 57 of 69 patients. In 29 representative SNCC lymphomas, in 9 IBL cases, and an additional 3 intermediate lymphomas, both p53 protein overexpression and the association of Epstein-Barr virus (EBV) genetic information were assessed. Small noncleaved cell lymphomas included tumors exhibiting features of the 2 established subtypes (27 Burkitt's and 15 non-Burkitt's). In the seven intermediate cases, cells showed features intermediate between SNCC with plasmablastic differentiation and immunoblasts plasmacytoid. Immunoblast-like cells were also present. p53 protein overexpression and EBV association were found in a proportion of SNCC (14 of 29; 7 of 29) and intermediate (3 of 3; 2 of 3) lymphomas. Conversely, IBL cases were consistently p53 negative, but showed a high EBV association (7 of 9). All the evaluated patients with intermediate lymphomas had a considerably lower mean (76.6 per mm3 +/- 77.4 SD) and median (54 per mm3) number of CD4+ lymphocyte count than SNCC patients (mean 227.9 per mm3 +/- 186.9 SD, median 193 per mm3), thus mirroring IBL patients (mean 95.3 per mm3 +/- 82.8 SD, median 81 per mm3). All data provide evidence that lymphomas showing intermediate features constitute a distinct subgroup from either SNCC or IBL.