Caracterización y supervivencia de pacientes con linfoma de Hodgkin. Un reporte de 7años de un centro único / Characterization and survival of patients with Hodg-kin lymphoma. A 7-Year single-center study

Introducción: El Linfoma de Hodgkin (LH), es una neoplasia hematológica poco frecuente, donde las células neoplásicas forman una minoría del tumor y están rodeados por un medio inflamatorio reactivo que incluye linfocitos, eosinófilos, neutrófilos, histiocitos y células plasmáticas. El objetivo del presente estudio fue describir una población con esta patología y su supervivencia en 7 años de seguimiento. Metodología Este estudio longitudinal, se realizó en el Hospital Carlos Andrade Marín, de Quito, Ecuador, del período 2013-2019, con una muestra no probabilística, de pacientes con LH. Se registraron variables demográficas, clínicas, de laboratorio, clasificación Ann Arbor, clasificación histológica, tratamiento y respuesta, mortalidad y tiempo de supervivencia. Se utiliza estadística descriptiva; bivariado y un análisis de supervivencia. Resultados: Se analizan 73 casos, 43 hombres (58.9 %). El grupo de 61 a 70 años fue el más prevalente con 19 casos (26%). 1 caso (4.1 %) con VIH, 7 casos (9.6%) con inmunosupresores. Síntomas B en 49 casos (67.1%). Adenomegalias en 15 casos (20.5 %). Masa Bulky 5 casos (6.8 %). Fallecieron 22 casos (30.1 %). Supervivencia de 52.8 meses, el 83.6% de recibieron Adriamicina, Bleomicina, Vincristina y Dacarbazina como 1ra línea de tratamiento, con remisión completa en el 61.7%. El estadio IV de Ann Arbor con Hazard Ratio (HR): 3.47,(IC95%: 1.20 ­6.11, P= 0.04), depleción linfocitaria HR: 4.98 (IC95%: 1.31 ­9.47, P= 0.04).Hemoglobina < 10.5 g/dL HR: 2.40,(IC95%: 1.47­5.94, P= 0.03), Albúmina < 4 g/dL HR: 4.02, IC95%: 1.94­7.26, P= 0.01) y linfocitos < 600 células/µL HR: 4.57, (IC95%: 1.85 ­11.28, P= 0.001)Conclusión: La prevalencia de LH fue ligeramente mayor en hombres, con una relación de 1.1: 1. LA incidencia fue bimodal, entre 31-40 años y entre 61-70 años, con síntomas B y adenomegalias. Los estadios II y III (Ann Arbor) fueron los más frecuentes. La Hemoglobina y albúmina fue menor en los fallecidos. El tratamiento de primera línea tuvo remisión completa en el 61.7% de los casos. La ausencia de síntomas B, se relacionó con una mayor supervivencia; los estadios avanzados se relacionaron con peor supervivencia; la supervivencia fue mayor en pacientes que obtuvieron remisión completa con la primera línea de tratamiento; la supervivencia general fue menor a la encontrada en países desarrollados

In troduction: Hodgkin's Lymphoma (HL) is a rare hematological neoplasm where neoplastic cells form a minority of the tumor and are surrounded by a reactive inflammatory medium that includes lympho-cytes eosinophils, neutrophils, histiocytes, and plasma cells. The objective of the present study was to describe a population with this pathology and its survival in 7 years of follow-up.Met hodology: This longitudinal study was carried out at the Carlos Andrade Marín Hospital, in Quito, Ec-uador, from 2013-2019, with a non-probabilistic sample of patients with HL. Demographic, clinical, labor-atory variables, Ann Arbor classification, histological classification, treatment and response, mortality, and survival time were recorded. Descriptive statistics are used; bivariate and survival analysis.R esults: 73 cases were analyzed, 43 men (58.9%). The group of 61 to 70 years was the most prevalent, with 19 cases (26%). 1 case (4.1%) with AIDS and 7 cases (9.6%) with immunosuppressants. B symp-toms in 49 cases (67.1%). Enlarged lymph nodes in 15 cases (20.5%). Bulky mass 5 cases (6.8%). 22 cases died (30.1%). Survival of 52.8 months, 83.6% received Adriamycin, Bleomycin, Vincristine, and Dacarbazine as1st line of treatment, with complete remission in 61.7%. Ann Arbor stage IV with Hazard Ratio (HR): 3.47, (95% CI: 1.20 ­6.11, P= 0.04), lymphocyte depletion HR: 4.98 (95% CI: 1.31 ­9.47, P= 0.04). Hemoglobin < 10.5 g/dL HR: 2.40, (95% CI: 1.47 ­5.94, P= 0.03), Albumin < 4 g/dL HR: 4.02, 95% CI: 1.94 ­7.26, P= 0.01) and lymphocytes < 600 cells/ µL HR: 4.57, (95% CI: 1.85 ­11.28, P= 0.001).C o nclusion: The prevalence of HL was slightly higher in men, with a ratio of 1.1: 1. The incidence was bimodal, between 31-40 years and between 61-70 years, with B symptoms and enlarged lymph nodes. Stages II and III (Ann Arbor) were the most frequent. Hemoglobin and albumin were lower in the de-ceased. First-line treatment had complete remission in 61.7% of cases. The absence of B symptoms was related to more remarkable survival; advanced stages were related to worse survival; survival was higher in patients who achieved complete remission with the first line of treatment; overall survival was lower than that found indeveloped countries

Linfomas en pacientes con VIH: una asociación compleja y frecuente. Revisión narrativa de la literatura / HIV-related lymphomas: a complex and frequent association. A narrative review of the literature

En Colombia, la infección por el virus de la inmunodeficiencia humana (VIH) es una epidemia en aumento. Ante la mejoría de la supervivencia general con la terapia antirretroviral altamente efectiva, la aparición de neoplasias malignas ha ido desplazando las complicaciones infecciosas como principal problema en esta población. Los linfomas no Hodgkin son las neoplasias malignas definitorias de síndrome de inmunodeficiencia adquirida (SIDA) más frecuentes después del sarcoma de Kaposi, siendo el linfoma B difuso de células grandes y el linfoma de Burkitt las variantes más comunes; por otra parte, el riesgo de desarrollar linfoma de Hodgkin clásico es 5 a 20 veces mayor en pacientes positivos para VIH en comparación con la población general. Realizar un diagnóstico temprano es un reto, debido a infecciones oportunistas y a la presentación atípica de la enfermedad en este grupo de pacientes. El tratamiento de la enfermedad también supone un desafío debido a las comorbilidades y el estado funcional de los pacientes al momento del diagnóstico; sin embargo, en conjunto con esquemas combinados de quimioterapia y al uso concomitante de la terapia antirretroviral, se ha mejorado considerablemente el pronóstico, el cual actualmente se acerca al de los pacientes seronegativos. Por medio de esta revisión, se pretende describir las principales características de los linfomas asociados al VIH, de tal forma que permita a los trabajadores en salud, tener mayores elementos para el abordaje integral de esta población en nuestro país

In Colombia, human immunodeficiency virus (HIV) infection is a growing epidemic. Given the improvement in overall survival with highly effective antiretroviral therapy, cancer has been displacing infectious complications in this population. Non-Hodgkin's lymphoma is the most common AIDS defining malignancy after Kaposi's sarcoma. Diffuse large B-cell lymphoma and Burkitt's lymphoma are the most common variants; meanwhile, the risk of developing classical Hodgkin lymphoma is 5 to 20-fold higher compared to HIV-negative individuals. Making an early diagnosis is a challenge, due to opportunistic infections and the atypical presentation of the disease in this group of patients. Treatment of the disease is also a challenge given the comorbidities and patient condition at diagnosis; however, in conjunction with combined chemotherapy regimens and the concomitant use of antiretroviral therapy, the outcome of patients with AIDS-related lymphomas has significantly improved, currently approaching that of seronegative patients. The aim of this review article is to describe the main characteristics of the disease, in such a way that it allows health workers to have more elements for a comprehensive approach in patients with AIDS-related lymphomas in our country

Manejode linfoma primario de bazo en paciente con ViH-Sida: reporte de caso / Management of primary lymphoma of the spleen in a patient with HIV-AIDS: case report

Los linfomas primarios de bazo afectan al bazo y/o sus ganglios linfáticos inicialmente. Representan <1% de los linfomas e implican un reto diagnóstico, por baja prevalencia y sintomatología inusual. Por lo tanto, el objetivo de este trabajo fue describir el manejo y evolución de un paciente con VIH-SIDA y la presentación de un Linfoma primario de bazo.En este reporte presentamos el caso de un paciente masculino de 52 años con VIH sin apego a tratamiento debuta con dolor abdominal, fiebre y pérdida de peso de 2 meses de evolución. La tomografía computarizada properatoria revela esplenomegalia y lesiones hipodensas sospechosas de neoformación. Es intervenido, realizándose una laparotomía exploratoria, con esplenectomía. El estudio histopatológico reporta linfoma no Hodgkin.El linfoma primario de bazo es poco frecuente. Es necesario su conocimiento para su sospecha diagnóstica y un diagnóstico diferencial en pacientes con esplenomegalia.Primary splenic lymphomas involve the spleen and/or its lymph nodes. They represent <1% of lymphomas and they imply a diagnostic challenge due to its poor symptomatology and low prevalence.There for, the objects this work describe the management and evolution of a patient with HIV-AIDS and presentation of a primary lymphoma of the spleenIn this report we present the case of a 52-year-old male patient with HIV infection without treatment presented with abdominal pain, fever and a 2-month weight loss. The pre-operative computed tomography showed splenomegaly and hypodense lesions suspected to be tumoral. He was operated on, performing an exploratory laparotomy, performing an splenectomy. The histopathological study reported a non-Hodgkin lymphoma.Primary splenic lymphoma is a non frequent entity. It is necessary to be acquainted with it in order to suspect it.

Primary splenic lymphomas involve the spleen and/or its lymph nodes. They represent <1% of lymphomas and they imply a diagnostic challenge due to its poor symptomatology and low prevalence.There for, the objects this work describe the management and evolution of a patient with HIV-AIDS and presentation of a primary lymphoma of the spleenIn this report we present the case of a 52-year-old male patient with HIV infection without treatment presented with abdominal pain, fever and a 2-month weight loss. The pre-operative computed tomography showed splenomegaly and hypodense lesions suspected to be tumoral. He was operated on, performing an exploratory laparotomy, performing an splenectomy. The histopathological study reported a non-Hodgkin lymphoma.Primary splenic lymphoma is a non frequent entity. It is necessary to be acquainted with it in order to suspect it.

Primary extraperitoneal rectum lymphoma in AIDS patient / Linfoma primário de reto extraperitoneal em paciente SIDA

ABSTRACT Introduction The gastrointestinal lymphoma can be classified in primary or secondary, and this is important regarding diagnosis and subsequent treatment. Primary gastrointestinal lymphoma of the rectum is rare and therefore lacks data in medical literature. Its incidence has been increasing and that fact may be related to a higher incidence in immunosuppressive therapy and immunosuppressive diseases (such as AIDS). Metodology 19 articles have been reviewed, searched online on the Scielo and PubMed databases. The goal was to increase data available regarding this pathology and improve its therapy. Discussion Primary GI lymphoma of the rectum presents as hematochezia, rectal pain, change in bowel habits. PET/CT is the first choice exam to pursue investigation; however abdominal CT and MRI reveal sufficient information and are much more available in daily practice. Plasmablastyc lymphoma is an aggressive subtype and is usually associated with AIDS patients. There are no available treatment protocols for this specific type of lymphoma and colonic lymphoma's therapy is usually used for this patient (such as ECHOP and CHOP). Conclusion As rare as this pathology is, this article aims to improve the available data and provide useful information regarding diagnosis and therapy.

RESUMO Introdução O linfoma do TGI pode ser dividido entre primário e secundário, com importância diagnóstica e terapêutica. O linfoma primário de reto é patologia rara, pouco relatada em literatura médica. Sua incidência tem aumentado e possivelmente esse fenômeno esteja associado ao aumento no numero de pacientes com imunossupressão (seja por SIDA ou drogas imunossupressoras). Metodologia Foram revisados 19 artigos nas bases de dados Scielo e PubMed, com o objetivo de aumentar o número de relatos dessa patologia e consequentemente expandir o conhecimento disponível, visando melhorar a terapêutica e, principalmente, o diagnóstico desse tipo de linfoma. Discussão Quando o linfoma tem seu sítio primário no reto, as principais manifestações são sangramento, dor retal, tenesmo e mudança nos hábitos intestinais (diarreia ou constipação). O exame de investigação de escolha é o PET/CT, porém a TC e RNM fornecem as informações necessárias e são mais disponíveis na prática clínica. O linfoma plasmablástico é um subtipo bastante agressivo e associado aos pacientes com SIDA. Não existem ainda protocolos definidos para o tratamento do linfoma primário de reto, sendo optado por seguir a mesma terapêutica dos linfomas de cólon com esquemas EPOCH e CHOP. Conclusão Por se tratar de patologia rara e pouco descrita na literatura, espera-se que este relato contribua na formação de protocolos de tratamento específicos.

Linfoma de Burkitt en un escolar con infección perinatal por VIH lentamente progresiva / Burkitt's lymphoma in a school boy with slow progression perinatally acquired HIV

Resumen Las manifestaciones clínicas en los niños con infección por el virus de la inmunodeficiencia humana (VIH) de transmisión perinatal, pueden ser de inicio precoz o tardío. El linfoma asociado a VIH es una manifestación tardía que se asocia a estadios avanzados de inmunosupresión. Se presenta el caso de un escolar de 9 años con diagnóstico de novo de infección por VIH que debutó con un linfoma de Burkitt. En niños, la frecuencia de esta asociación es de 1-2% con pocos casos reportados en la literatura médica.

Children with perinatal human immunodeficiency virus (HIV) infection can present early or late clinical disease. HIV-associated lymphoma is a later manifestation that is associated with advanced immunosuppression (acquired immunodeficiency syndrome -AIDS). This is a case of a 9-year-old boy with recent diagnosis of HIV with Burkitt's lymphoma as first clinical manifestation. In children, the frequency of this association is very low and there are few cases reported.

Chylous ascites secondary to Hodgkin's lymphoma in a HIV/aids patient: case report and literature review

Study design: case report. Case report: Man, 42 years old, diagnosed with aids two years ago, had developed enlarging in abdominal volume six months from admission. Computed tomography imaging showed free liquid in peritoneal cavity and increased retroperitoneal and mesenteric lymph nodes, besides splenomegaly. Ascitic fluid had milky appearance and high triglycerides levels. Hodgkin's lymphoma (mixed cellularity) was confirmed by histopathological analysis of a video-laparoscopic lymph node biopsy, Ann Arbor IIIS staging. Chemotherapy and continuation of highly active antiretroviral therapy resulted in weight gain and reduction of abdominal volume. Chylous ascites is a rare condition, which has a vast differential diagnosis. Discussion: In our review, the majority (15/18, 83%) of chylous ascites in HIV/aids-patients are due to infectious causes (mainly Mycobacterium avium complex and tuberculosis infection), in highly immunocompromised patients (mean TCD4=87cell/mL). To the best of our knowledge, this is the first case of chylous ascites secondary to Hodgkin's lymphoma in a patient with aids. (AU)

Tipo de estudo: relato de caso. Relato de caso: Homem, 42 anos, diagnosticado com aids há dois anos, desenvolveu aumento de volume abdominal há seis meses da admissão. Tomografia computadorizada mostrou líquido livre na cavidade peritoneal, além de linfonodos mesentéricos e esplenomegalia. O líquido ascítico tinha aspecto leitoso e alto nível de triglicerídeos. Após amplo diagnóstico diferencial, diagnosticamos linfoma de Hodgkin tipo celularidade mista por biópsia linfonodal via videolaparoscópica, Ann Arbor IIIS. Quimioterapia e continuação da terapia antirretroviral de alta potência resultaram em ganho de peso e redução do volume abdominal. Ascite quilosa é uma entidade rara, que possui vários diagnósticos diferenciais. Discussão: Em nossa revisão, a maioria (15/18, 83%) dos casos de ascite quilosa em paciente com HIV/aids deveu-se a causa infecciosa (especialmente pelo Mycobacterium avium complex e tuberculose), em pacientes gravemente imunocomprometidos (linfócitos T-CD4 médio=84células/mm3). Até onde sabemos, este é o primeiro caso de ascite quilosa secundária a linfoma de Hodgkin em paciente com aids. (AU)

Linfoma primario de ano en un paciente con virus de la inmunodeficiencia humana/sida / Primary lymphoma of anus in a patient with human immunodeficiency virus/AIDS

Se presenta el caso clínico de un paciente de 47 años de edad con seropositividad del virus de inmunodeficiencia humana/sida desde hacía 5 años, quien acudió a la consulta de Cirugía en el Hospital Gubernamental de Mbabane en Suazilandia, por presentar un tumor anal; se diagnosticó hemorroides, pero el tumor continuó aumentando de tamaño, unido a sangrado e intenso dolor. Se realizó una biopsia por incisión que indicó la presencia de un linfoma de alto grado de malignidad. Posteriormente el paciente fue evaluado en la consulta de Oncología, donde se le indicaron los exámenes complementarios necesarios, los que revelaron que la neoplasia se encontraba en estadio IE; de manera que fue remitido a Sudáfrica para recibir quimioterapia combinada, con la cual desapareció la lesión maligna y se controló la enfermedad

The case report of a 47 years patient with the human immunodeficiency virus/AIDS for 5 years is presented. He went to the Surgery Service in the Government Hospital of Mbabane in Swaziland, due to an anus malignancy; hemorrhoids was diagnosed, but its size continued increasing, along with bleeding and acute pain. An incision biopsy that indicated the presence of a high grade lymphoma malignancy was carried out. Later on the patient was evaluated in the Oncology Service, where the necessary complementary exams were indicated, revealing that neoplasm was in IE stage; so he was referred to South Africa to receive combined chemotherapy, with which the malignant lesion disappeared and the disease was controlled

Linfoma de Burkitt oral asociado con el virus de inmunodeficiencia humana / Oral Burkitt's lymphoma associated with human immunodeficiency virus

Introduction: Burkitt's lymphoma is an aggressive form of B cell lymphoma generally diagnosed in children and young adults. This tumor has three variants: African (endemic), American (sporadic), and immunodeficiency-associated. Objective: present a case of Burkitt's lymphoma that manifested as a tumor mass in the upper right maxillary region of a patient with AIDS treated at Professor Edgar Santos University Hospital in Salvador, Bahia, Brazil. Clinical case: a male 20-year-old HIV-positive patient was referred from another hospital with a possible odontogenic infection that persisted after drainage and antibiotic therapy. The patient presented a tumor growth in the upper right gingival mucosa. After biopsy, histopathological findings were suggestive of Burkitt's lymphoma. An immunohistochemical panel was positive for CD20 and Bcl6 and negative for CD3, Bcl2, and terminal deoxynucleotidyl transferase antibodies. The Ki67 expression level was 80 percent. The final diagnosis was immunodeficiency-associated Burkitt's lymphoma. The patient was successfully treated with cytoreductive chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone), followed by high-dose methotrexate, cyclophosphamide, doxorubicin and vincristine, alternating with high-dose cytarabine, ifosfamide and etoposide. No signs of recurrence have been noted during the follow-up period. Conclusions: Burkitt's lymphoma is an aggressive neoplasia with a rapidly progressing clinical course. Therefore, differential diagnosis from other benign oral diseases is of great importance(AU)

Introducción: el linfoma de Burkitt es una forma agresiva de linfoma de células B generalmente diagnosticado en niños y adultos jóvenes. El tumor tiene tres variantes: africana (endémica), americana (esporádica) y asociada con la inmunodeficiencia. Objetivo: presentar un caso de linfoma de Burkitt que se manifestó como una masa tumoral en la región maxilar superior derecha en un paciente con SIDA tratado en el Hospital Universitario Profesor Edgard Santos en Salvador, Bahia, Brasil. Caso clínico: un hombre VIH-positivo de 20 años de edad fue remitido de otro hospital con una posible infección odontogénica que persistió después del drenaje y tratamiento antibiótico. El paciente presentaba un abultamiento tumoral en la mucosa gingival superior derecha. Después de la biopsia, los resultados histopatológicos sugirieron la presencia de linfoma de Burkitt. Un panel inmunohistoquímico fue positivo para CD20 y Bcl6, y negativo para CD3, Bcl2 y para anticuerpos contra la desoxinucleotidil transferasa terminal. El nivel de expresión del Ki67 fue de 80 por ciento. El diagnóstico final fue linfoma de Burkitt asociado a la inmunodeficiencia. El paciente fue tratado con éxito con quimioterapia citorreductiva (ciclofosfamida, doxorrubicina, vincristina y prednisona), seguida de ciclofosfamida, doxorrubicina, vincristina y metotrexato en altas dosis, alternando con ifosfamida, etopósido y citarabina en altas dosis. No se observaron señales de recurrencia durante el período de seguimiento. Conclusiones: el linfoma de Burkitt es una neoplasia agresiva con rápida evolución clínica. Por lo tanto, el diagnóstico diferencial de otras enfermedades bucales benignas es de gran importancia(AU)

Oral plasmablastic lymphoma as the first manifestation of AIDS

Abstract Plasmablastic lymphoma is a non-Hodgkin lymphoma characterized by its plasmacytic differentiation and predilection for the oral cavity. It is among the lymphomas most commonly associated with AIDS. This report details a case of a HIV-positive patient with a 1-month history of an exophytic mass in the gingival area of the upper left quadrant. The diagnosis of plasmablastic lymphoma was made based on its histopathological and immunophenotypical features. She was treated with chemotherapy followed by autologous hematopoietic stem cell transplantation. Despite complete resolution of the lesion, the patient died of cardiorespiratory arrest. This case illustrates plasmablastic lymphoma as the first clinical manifestation of AIDS, highlighting the importance of differentiating between a potentially malignant lesion and other pathologic processes.

Primary cutaneous plasmablastic lymphoma revealing clinically unsuspected HIV infection

Abstract: Plasmablastic lymphoma is a rare subtype of diffuse large B-cell lymphoma more frequently diagnosed in immunosuppressed patients, mainly HIV-infected. Primary cutaneous plasmablastic lymphoma is extremely rare, and in this patient it was the first clinical manifestation of unsuspected HIV-infection.

Accuracy of dose planning for prostate radiotherapy in the presence of metallic implants evaluated by electron spin resonance dosimetry

Radiotherapy is one of the main approaches to cure prostate cancer, and its success depends on the accuracy of dose planning. A complicating factor is the presence of a metallic prosthesis in the femur and pelvis, which is becoming more common in elderly populations. The goal of this work was to perform dose measurements to check the accuracy of radiotherapy treatment planning under these complicated conditions. To accomplish this, a scale phantom of an adult pelvic region was used with alanine dosimeters inserted in the prostate region. This phantom was irradiated according to the planned treatment under the following three conditions: with two metallic prostheses in the region of the femur head, with only one prosthesis, and without any prostheses. The combined relative standard uncertainty of dose measurement by electron spin resonance (ESR)/alanine was 5.05%, whereas the combined relative standard uncertainty of the applied dose was 3.35%, resulting in a combined relative standard uncertainty of the whole process of 6.06%. The ESR dosimetry indicated that there was no difference (P>0.05, ANOVA) in dosage between the planned dose and treatments. The results are in the range of the planned dose, within the combined relative uncertainty, demonstrating that the treatment-planning system compensates for the effects caused by the presence of femur and hip metal prostheses.

Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease. .

A Case of Rectal Squamous Cell Carcinoma with Metachronous Diffuse Large B Cell Lymphoma in an HIV-Infected Patient

Diffuse large B cell lymphoma (DLBCL) is one of the most common acquired immune deficiency syndrome (AIDS)-defining malignancies among human immunodeficiency virus-infected patients, and rectal cancer has recently emerged as a prevalent non-AIDS-defining malignancy. We report a case of rectal squamous cell carcinoma that was metachronous with DLBCL in an HIV-infected patient who was receiving highly active antiretroviral therapy. The patient was diagnosed with DLBCL and showed complete remission after chemotherapy. Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma. Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported. After concurrent chemoradiation therapy, curative resection was performed.

Soft-tissue masses as presentation of non-Hodgkin's lymphoma in AIDS patients / Massas de tecidos moles como apresentacao do linfoma nao-Hodgkin em pacientes com AIDS

Primary soft tissue Non-Hodgkin lymphomas are very rare and account only for 0.1 % of the cases. Generally, Non-Hodgkin lymphomas of the soft tissue present as large subcutaneous masses without evidence of nodal or skin involvement. We describe four cases of primary Non-Hodgkin lymphomas of the soft tissue in patients infected with the human immunodeficiency virus. The most common site of involvement was the chest wall in all the patients; histopathological and immunophenotypic examination of the biopsy smears revealed two cases of plasmablastic lymphomas, one Burkitt and one diffuse large B-cell lymphoma. Non-Hodgkin lymphomas should be included in the differential diagnosis of soft tissue masses in human immunodeficiency virus - seropositive patients.

Os linfomas Não-Hodgkin primários de tecidos moles são muito raros e responsáveis por somente 0,1% dos casos. Geralmente, os linfomas Não-Hodgkin de tecidos moles se apresentam como massas subcutâneas sem evidência de comprometimento dos nódulos ou da pele. Descrevemos aqui quatro casos de linfomas Não-Hodgkin primário de tecidos moles em pacientes infectados pelo vírus da imunodeficiência humana. O local mais comum de comprometimento foi a parede torácica em todos os pacientes; os exames histopatológico e imunofenotípico do esfregaço da biópsia revelaram dois casos de linfoma plasmablástico, um linfoma de Burkitt e um linfoma difuso de grandes células B. O linfoma Não-Hodgkin deve ser incluído no diagnóstico diferencial de massas de tecidos moles nos pacientes soropositivos para vírus da imunodeficiência humana.

Linfomas asociados a infección por VIH en pacientes del Hospital Clínico San Borja Arriarán / Fundación Arriarán2001-2008 / Lymphomas associated with HIV infection in patients at the Hospital San Borja Arriarán /Fundación Arriarán 2001-2008, Santiago, Chile

Introduction: Hodgkin lymphomas (HL) and non Hodgkin lymphomas (NHL) are frequently associated to acquired immunodeficiency syndrome in adults. Objective: To systematize the clinical features and histological characteristics of lymphomas in AIDS patients, its treatment and outcomes in our institution. Patients and Methods: Retrospective analysis of patients with HIV-associated lymphoma between January 2001 and December 2008 at the San Borja Arriarán Hospital complex. Results: Information was obtained from 30 patients with NHL and 7 with HL, with a median of 40 years. The majority of tumors were Burkitt lymphoma (47%), diffuse large cell lymphoma B-cell (37%) and NHL of T lineage (10%). There was no CNS or cavities lymphoma. Almost all patients (86.7%) with NHL were treated with CHOP chemotherapy, 57% of those receiving treatment had progression or relapse from complete remission. A rescue chemotherapy was indicated in 4 patients. 73% of patients receiving CHOP, complete 5 to 6 cycles of chemotherapy. The use of CHOP chemotherapy for the subgroup of patients with Burkitt lymphoma achieved low rates of complete remission and frequent relapse and disease progression, showing that CHOP was ineffective in improving survival, especially in high risk patients. We found statistically significant differences in survival according to IPIae (International prognostic Index age-adjusted). Conclusion: Non-Hodgkin lymphoma in HIV patients treated with chemotherapy protocols PAlNDA persists in our environment as a disease with a poor prognosis compared with findings in the international literature. The incorporation of new drugs of proven utility as rituximab and specific schemes chemotherapy could improve these results. The establishment of prognostic groups established by IPIae can guide clinical work for the use of chemotherapy tailored to their specific risk and optimized according to histological type.

Introducción: Los linfomas de Hodgkin (LH) y no Hodgkin (LNH) se asocian con alta frecuencia al síndrome de inmunodeficiencia humana en adultos. Objetivo: Sistematizar los aspectos clínicos e histológicos de los linfoma que afectan a pacientes con SIDA, su tratamiento y resultados globales en nuestra institución. Pacientes y Métodos: Análisis retrospectivo de pacientes con linfoma asociado a VIH entre enero de 2001 y diciembre de 2008 en el complejo hospitalario San Borja Arriarán. Resultados: Se obtuvo información de 30 pacientes con LNH y 7 LH, con una mediana de 40 años. Los tipos histológicos predominantes fueron linfoma de Burkitt (47 %), linfoma difuso de células grandes de estirpe B (37 %) y LNH de estirpe T (10%). No se diagnosticaron LNH del SNC ni linfoma de cavidades. Casi la totalidad de los pacientes (86,7%) con LNH se trataron con esquema CHOP, 57% de quienes recibieron tratamiento presentaron progresión o recaída desde remisión completa, ofreciéndoles una quimioterapia de rescate a cuatro pacientes. El 73% de los pacientes que recibieron CHOP lograron completar entre cinco y seis ciclos de quimioterapia. El uso de quimioterapia CHOP para el subgrupo de pacientes con linfoma de Burkitt alcanzó bajos porcentajes de remisión completa y mayoritariamente progresó la enfermedad, siendo esta quimioterapia, inefectiva para mejorar la sobrevida, especialmente en los pacientes de riesgo alto. Se encontraron diferencias estadísticamente significativas en sobrevida según el IPIae (índice internacional pronóstico ajustado por edad) al ingreso. Conclusión: El LNH en los pacientes con VIH tratados con los protocolos de quimioterapia PANDA persiste en nuestro medio como una enfermedad de muy mal pronóstico comparado con los resultados en la literatura internacional. La incorporación de nuevos fármacos de demostrada utilidad como rituximab y esquemas específicos de quimioterapia podrían mejorar estos resultados. El establecimiento de grupos pronósticos establecidos por IPIae puede orientar el trabajo clínico para el uso de quimioterapia ajustada a su riesgo específico y optimizado según tipo histológico.

Linfoma primario del sistema nervioso central en una paciente con sida / Primary lymphoma of the central nervous system in an AIDS patient

Varón de 36 años con diagnóstico de infección VIH-1 por siete años y sin tratamiento que presentó convulsiones generalizadas en los últimos cinco meses y marcada baja de peso. Se le halló hemiparesia izquierda y rigidez de nuca moderada disartria y un tumor palpable frontoparietal derecho. La tomografía reveló un tumor de 11 x 9 cm en la zona frontal, con edema peritumoral que comprimía los ventrículos laterales y desviaba la línea media en más de 5 mm. La biopsia reveló un linfoma primario difuso, a células B grandes, VEB (+), CD 20 (+), Ki 67:80%. El conteo de CD4 fue 9 células/mm3 y la carga viral VIH fue 54 352 copias/mL. Fue tratado con TARGA, mejorando su condición general y disminuyendo las convulsiones.

A 36 year-old man with a 7-year diagnosis of HIV infection and without treatment had generalized seizures during the last five months and, besides, marked weight loss. On examination, he had a left hemiparesis and nuchal rigidit, dysarthria and a palpable tumor in the right frontoparietal area. CT-scan revealed a right front-parietal tumor of 11 x 9 cm in the frontal area with peritumoral edema compressing the lateral ventricles and more than 5 mm midline deviation. A brain biopsy showed a primary lymphoma (diffuse large B-cell), EBV (+), CD 20 (+), Ki 67:80%., cd4: 9 cells/mm3, HIV viral load: 54352 copies/mL. He was treated with highly antiretroviral therapy (HAART) alone and his general condition improved and the seizures diminished.

Expression of immunohistochemical markers in patients with AIDS-related lymphoma

AIDS-related lymphomas (ARL) present high biological heterogeneity. For better characterization of this type of lymphoma, the objectives of the present study were to evaluate the expression of immunohistochemical markers of cell differentiation (CD10, Bcl-6, MUM-1) and determine cell origin profile according to Hans' classification of diffuse large B-cell lymphoma in AIDS patients. This study included 72 consecutive patients with ARL diagnosed at the University Hospital, Universidade Federal do Rio de Janeiro (UFRJ) and at the Brazilian Instituto Nacional de Câncer (INCA) from 2000 to 2006. The morphologic distribution of the lymphomas was the following: 61 percent were diffuse large B-cell lymphomas (DLBCLs), 15 percent were Burkitt's lymphomas, 13 percent were plasmablastic lymphomas, 10 percent were high-grade lymphomas and 1 percent was follicular lymphoma. The positivity for each immunohistochemical marker in DLBCLs, Burkitt's lymphoma and plasmablastic lymphoma was respectively: CD20, 84 percent, 100 percent, and 0; CD10, 55 percent, 100 percent, and 0; Bcl-6, 45 percent, 80 percent, and 0; MUM-1, 41 percent, 20 percent, and 88 percent. A higher positivity of CD20 (84 percent x 56 percent, p = 0.01) was found in DLBCL compared to non-DLBCL; in Burkitt's lymphomas a higher positivity of CD10 (100 percent x 49 percent, p = 0.04) and Bcl-6 (80 percent x 39 percent, p = 0.035) were found compared to non-Burkitt's lymphomas. Germinal center (GC) profile was detected in 60 percent of DLBCLs. Our study suggests particular findings in ARL, as the most frequent phenotype was GC, different from HIV-negative patients.

Linfoma relacionado a infección por virus de la inmunodeficiencia humana en un hospital público de Santiago, Chile / HIV-related lymphoma in a public hospital in Chile. Analysis of 55 cases

Background: Cancer is the third cause of death in patients infected with human immunodeficiency virus (HIV) and lymphoma is the most common type. Aim: To describe the clinical characteristics, histology, risk factors and prognosis of these patients, in a Chilean public hospital in Chile. Material and Methods: Records of 55 patients (45 males) aged between 23 and 67years with lymphoma and HIV positive serology, diagnosed between 1992-2008, were reviewed. Results: Six patients (11%) had Hodgkin lymphoma (HL) and the rest, non-Hodgkin lymphoma (NHL). B-cell phenotype constituted 83.7% of NHL cases. The most common subtypes of all the lymphoma were diffuse large B cell lymphoma in 24 cases (43.6%), Burkitt lym-phoma in 12 cases (21.8%), andplasmablastic lymphoma in 5 cases (9.1%). Thirty five patients (64%) underwent curative intended chemotherapy (CT) concomitantly with highly active antiretroviral therapy (HAART). Three year survival of the whole cohort was 27%. By multivariate analysis, the most important prognostic factors for long term survival, were complete responses to CT, (p < 0.01) and a low international prognostic index (IPI) score for NHL, (p = 0.01). HAART, histologic subtype and CD4 lymphocyte count at diagnosis, did not influence survival. Conclusions: The most important prognostic factors for HIV patients with lymphoma, were achieving CR with CT and low IPI score. Prognosis remains poor, even with HAART therapy.

Detecção do vírus de Epstein-Barr (EBV), expressão de FOXP3 e avaliação da carga viral para EBV como marcadores prognósticos nos linfomas relacionados à AIDS / Epstein-Barr virus (EBV) detection, FOXP3 expression and evaluation of EBV viral load as prognostic markers in Aids-related lymphomas

Introdução: Pacientes com infecção pelo HIV têm risco aumentado para o desenvolvimento de linfomas não-Hodgkin de células B comparado à população geral. Dentre os mecanismos que podem estar relacionados a esta patologia, encontra-se a reativação do vírus de Epstein-Barr secundária a imunossupressão. O papel do sistema imune para desenvolvimento de tumores é citado há longa data, e seu equilíbrio é mantido pelos linfócitos T regulatórios, cujo principal regulador e marcador é o fator de transcrição FOXP3. Neste estudo, avaliamos a presença de EBER e FOXP3 em amostras diagnósticas, além da carga viral para o vírus de Epstein-Barr em pacientes com linfomas relacionados à Aids a fim de avaliar e correlacionar os resultados como marcadores prognósticos nesta população. Métodos: Análise prospectiva da carga viral para Epstein-Barr no plasma e em células mononucleares do sangue periférico em 15 pacientes com linfomas relacionados à Aids acompanhados no Serviço de Hematologia do Instituto de Infectologia Emílio Ribas e do Hospital das Clínicas/Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo. As mensurações foram realizadas para cada paciente por reação da cadeia de polimerase em tempo real ao diagnóstico, término do tratamento e três meses após o término do tratamento. Dois grupos controles constituídos de 26 pacientes infectados pelo HIV em uso de anti-retroviral e sem diagnóstico de linfoma ou infecção oportunista e 30 indivíduos saudáveis também foram analisados para comparação da carga viral para o vírus de Epstein-Barr. Amostras coletadas por biópsia para o diagnóstico de linfoma foram submetidas a análise imuno-histoquímica para FOXP3 e para EBER por hibridização in situ. Resultados: 13 pacientes eram do sexo masculino e dois do sexo feminino, dos quais 14 foram tratados com quimioterapia e um com radioterapia de sistema nervoso central. Nove de 15 pacientes (60%) completaram o tratamento proposto...

Introduction: Patients with HIV infection have increased risk for development of non-Hodgkins lymphoma compared to general population. Among mechanisms that could be related to this disease is the reactivation of Epstein-Barr virus infection secondary to immunosuppression. The role of immune system in development of tumors was reported a long time ago, and balance of this system is maintained by regulatory T cells; FOXP3 transcription factor is the main regulator and marker of these cells. In this study we evaluated the presence of EBER and FOXP3 in diagnostic samples, and also viral load of Epstein-Barr virus in patients with Aids-related lymphoma to evaluate and correlate the results as prognostic markers in this population. Methods: Prospective analysis of viral load of Epstein-Barr virus in plasma and peripheral blood mononuclear cells from 15 patients with Aids-related lymphoma treated at Instituto de Infectologia Emílio Ribas and Hospital das Clínicas/Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo. Viral load measures were performed by real time polymerase chain reaction at diagnosis of lymphoma, completion of treatment and three months afterwards. Two control groups composed by 26 HIV-positive patients in use of HAART and without diagnosis of lymphoma or opportunistic infection and 30 healthy persons were also analyzed for viral load comparison. Biopsy samples performed to lymphoma diagnosis were submitted to immunohistochemistry for FOXP3 and in situ hybridization to EBER. Results: 13 patients were male and two females, 14 were treated with chemotherapy and one with radiotherapy of central nervous system. Nine of 15 patients (60%) completed treatment achieving complete remission. Median viral load of Epstein-Barr virus before treatment was 13 copies/106 in peripheral blood mononuclear cells (1-1472 copies/106) and 70 copies/mL (0-24900 copies/mL) in plasma. After treatment it was 0,5/106 (0-109,5)...