Case Report
Plasmoblastic Lymphoma as Cause of Perianal Fistula: A Case Report and Literature Review
Journal of the International Association of Providers of AIDS Care 1–4 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2325957414553838 jiapac.sagepub.com
Firoozeh Isfahani, MD1, Surabhi Amar, MD1,2, Harikrishna Dave, MD3, and Daniel Gridley, MD4
Abstract We report the case of a 33-year-old HIV-infected man who presented with a recurrent, nonhealing perianal fistula. After multiple benign biopsies, the diagnosis of plasmablastic lymphoma (PBL) eventually was made. The patient underwent chemotherapy and radiation with a complete response. Perianal fistulas are frequent in HIV-positive patients, but PBL as a cause is extremely rare. This often delays the diagnosis and treatment of this highly aggressive disease. We review the literature and discuss the pitfalls in the diagnosis and management of the disease. Keywords anal plasmablastic lymphoma, perianal fistula
Introduction Perianal fistulas are the second most common manifestation of perianal disease in HIV-positive patients.1 Common causes of perianal fistula include viral, bacterial, and fungal infections; venereal diseases; cancers; anal fissures; radiation; and trauma. Among the malignant causes, squamous cell carcinoma is the most frequently reported, with lymphomas being unusual in this location. We report the case of plasmablastic lymphoma (PBL) presenting as a perianal fistula in an HIVinfected patient. Plasmablastic lymphoma is a rare, highly aggressive subtype of diffuse large B-cell lymphoma (DLBCL) usually seen in HIV-positive patients. It is commonly seen in the oral cavity, anal PBL is rare with only 10 reported cases. The rarity of the diagnosis and difficulty in obtaining large biopsy samples can often delay diagnosis and hence treatment of this highly aggressive malignancy.
RNA was 31 404 copies/mL, CD4 count was 66/mm3, lactate dehydrogenase was 754 U/L, and the test for Epstein-Barr virus (EBV) by polymerase chain reaction on peripheral blood was negative. He was diagnosed with an anal fistula and underwent a fistulotomy. Four weeks postprocedure, the patient returned with complaints of frequent soiling of his undergarments. Physical examination confirmed a 1 1 cm2 draining perianal ulcer, with an open fistulotomy tract. Patient underwent a colonoscopy, which revealed a perianal ulcer in the presence of an otherwise normal colonic mucosa. Biopsies were obtained from the edges of the fistulotomy tract, which revealed sheets of neoplastic cells, with scattered positivity for CD79a and nonspecific staining with plasma cell markers, k, and lambda stains. This was reported as a poorly differentiated malignant neoplasm, and more tissue was requested for further evaluation. Repeat CT scan of the abdomen and pelvis showed
Case Report
1
A 33-year-old HIV-infected man presented with a 2-month history of perianal pain, subjective fevers, and diarrhea. He had been diagnosed with HIV 8 years ago but had been noncompliant with therapy for the last 3 years. Physical examination revealed a raised, 2 1 cm2 perianal ulcer extending from the anus to the left buttock. Digital rectal examination was negative for any anorectal mass. Computed tomography (CT) scan of the abdomen and pelvis did not report any evidence of focal fluid collection, masses, or lymphadenopathy in the rectal area. Complete blood count was normal, HIV-1
Corresponding Author: Firoozeh Isfahani, Department of Medicine, Maricopa Integrated Health System, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA. Email: [email protected]
Department of Medicine, Maricopa Integrated Health System, Phoenix, AZ, USA 2 Division of Hematology–Oncology, Maricopa Integrated Health System, Phoenix, AZ, USA 3 Department of Pathology, Maricopa Integrated Health System, Phoenix, AZ, USA 4 Department of Radiology, Maricopa Integrated Health System, Phoenix, AZ, USA
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Journal of the International Association of Providers of AIDS Care
Figure 1. A, Pretreatment CT scan of the pelvis showing a 10.9 8.9 cm2 mass (white arrow) in the anal area. B, Posttreatment CT scan of the pelvis showing complete resolution of the rectal wall thickening and perianal mass. CT indicates computed tomography.
posterior rectal wall thickening, an enterocutaneous fistula, and a 1.4-cm right inguinal lymphadenopathy. No retroperitoneal lymphadenopathy was noticed. An open biopsy was scheduled as an outpatient. Patient delayed the biopsy and eventually presented 4 weeks later with severe anal pain and discharge. Computed tomography scan revealed a 10.9 8.9 cm2 fluid collection in the anal area with bilateral-enlarged inguinal nodes (Figure 1A). Excisional biopsies of the left inguinal lymph node and the perianal mass revealed a poorly differentiated malignant neoplasm composed of large cells with scant cytoplasm and eccentric large round nucleus with prominent nucleoli and increased mitotic activity, consistent with monotypic plasmablasts (Figure 2A). These cells expressed CD38 and CD138 with k light chain restriction (Figure 2B), while being negative for CD20, CD45, and CD56. Bone marrow biopsy did not reveal any involvement with lymphoma. A diagnosis of stage IIA bulky anal PBL was made. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen was initiated. After just 3 cycles of treatment, there was complete healing of the anal fistula with resolution of the rectal wall thickening and inguinal lymphadenopathy. He went on to complete 6 cycles of chemotherapy followed by 5 weeks of radiation therapy (3000 cGy with accumulated dose of 4190 cGy). A CT scan done 5 months after completing treatment did not reveal any residual disease (Figure 1B). Patient subsequently moved to a different state and was lost to follow up.
Discussion Plasmablastic lymphoma is an aggressive and rare variant of DLBCL and accounts for approximately 3% of all HIV-
Figure 2. A, Hematoxylin and eosin stain. Diffuse infiltration of large plasmablastic cells with tangible body macrophages. B, Immunoperoxidase stain CD138 strongly positive.
related non-Hodgkin lymphomas.2 It was first described in 1997 in the oral cavity of an HIV-positive patient.3 Although mostly reported in HIV-positive patients, it has been reported in other immunocompromised states and even in immunocompetent individuals.4,5 Plasmablastic lymphoma was initially
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Isfahani et al
3
Table 1. Cases of Perianal PBL Reported in Literature. Treatment Case
Reference
1 2 3 4 5 6 7 8 9 10 11
Brahmania et al5 Chetty et al15 Chetty et al15 Chetty et al15 Colomo et al8 Dong et al12 Lim et al13 Plaza et al16 Smith et al17 Tavora et al14 Isfahani et al
Age, Yr/Sex
HIV
EBV
HHV-8
Chemo
RT
Survival/Duration
Presenting Symptom
59/M 56/M 31/F 24/F 47/M 39/M 47/F 57/F 67/M 33/M 33/M
þ þ þ þ þ þ þ þ
þ þ þ þ þ þ þ ND þ
ND ND ND ND þ þ ND ND ND
CHOP NR CHOP CHOP NR CHOP NR CHOP
þ NR NR NR NR þ
NER/6 mo LFU DOD/early LFU NR DOD/6 mo NR NR NER/6 y NR LFU/5 mo
Fistula Mass Bleeding Mass Mass NR Fistula Crohn Fistula Mass Fistula
Abbreviations: CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; DOD, died of disease; EBV, Epstein-Barr virus; F, female; HHV-8, Human Herpes virus 8; LFU, lost follow-up; M, male; ND, not done; NER, no evidence of recurrence; NR, not reported; PBL, plasmablastic lymphoma; RT, radiation therapy.
thought to be an exclusively oral disease,3 but subsequent reports described its occurrence at sites like the stomach,6 lungs,7 skin lymph nodes, soft tissue, and bone marrow.8–11 There are fewer than 50 reported cases of extra oral PBL in HIV-positive patients, of which only 7 were reported to originate in the anal canal.8,12–15 Most of them presented with bleeding and anal mass. Three other cases of anal PBL have also been reported in non-HIV-positive patients.5,16,17 The findings are summarized in Table 1. Pathologic features of PBL are characterized by large monotypic cells with large nucleus and prominent nucleoli and blastoid morphology. These cells show strong expression of plasma cell markers like CD38 and CD138 but weak/absent expression of B-cell markers such as CD20 and CD45.8 Pathogenesis of PBL is strongly associated with EBV infection.2 Human herpesvirus 8 has also been linked to PBL but not as strongly as EBV, and its exact role remains unclear.12–14 Plasmablastic lymphoma is a highly aggressive tumor and is poorly responsive to treatment. Most commonly used therapy is CHOP with or without radiation therapy. More aggressive regimens such as cyclophosphamide, oncovin, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine have also been used with limited success. Prognosis is based on the response to highly active antiretroviral therapy and immunologic status. Median survival in 1 series was only 15 months despite therapy.18
Conclusion Plasmablastic lymphomas should be considered as a possible diagnosis in any HIV-infected patient presenting with a nonhealing perianal lesion or fistula. As illustrated by our case, initial benign biopsies can often mask this highly aggressive tumor. Delay in diagnosis can be prevented by having a low threshold for performing an open or excisional biopsy in cases of recurrent perianal fistulas not responding to conventional therapy.
Authors’ Note This article has not been submitted for publication elsewhere, although it has been previously presented as a poster at an American College of Physicians Meeting.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Barrett WL, Callahan TD, Orkin BA. Perianal manifestations of human immunodeficiency virus infection. Dis Colon Rectum. 1998;41(5):606–612. 2. Guan B, Zhang X, Ma H, Zhou H, Zhou X. A meta-analysis of highly active anti-retroviral therapy for treatment of plasmablastic lymphomas. Ann Saudi Med. 2010;30(2):123–128. 3. Delecluse HJ, Anagnostopoulos I, Dallenbach F, et al. Plasmablastic lymphomas of the oral cavity: a new entity associated with the human immunodeficiency virus infection. Blood. 1997;89(4): 1413–1420. 4. Teruya-Feldstein J, Chiao E, Filippa DA, et al. CD20-negative large-cell lymphoma with plasmablastic features: a clinically heterogeneous spectrum in both HIV-positive and -negative patients. Ann Oncol. 2004;15(11):1673–1679. 5. Brahmania M, Sylwesterowic T, leitch H. Plasmablastic lymphoma in the ano-rectal junction presenting in an immunocompetent man: a case report. J Med Case Rep. 2011;5:168–173. 6. Pruneri G, Graziadei G, Baldini L, Baldini L, Neri A, Buffa R. Plasmablastic lymphoma of the stomach. A case report. Hematology. 1998;83(1):87–89. 7. Lin Y, Rodrigues GD, Turner JF, Vasef MA. Plasmablastic lymphoma of the lung: report of a unique case and review of the literature. Arch Pathol Lab Med. 2001;125(2):282–285.
Downloaded from jia.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 15, 2014
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Journal of the International Association of Providers of AIDS Care
8. Colomo L, Loong F, Rives S, et al. Diffuse large B-cell lymphomas with plasmablastic differentiation represents a heterogeneous group of disease entities. Am J Surg Pathol. 2004; 28(6);736–747. 9. Dales JP, Harket A, bagneres D, et al. Plasmablastic lymphoma in a patient with HIV infection: an unusual case located in the skin. Ann Pathol. 2005;25(1):45–49. 10. Jordan LB, Lessells AM, Goodlad JR. Plasmablastic lymphoma arising in a cutaneous site. Histopathology. 2005;46(1):113–115. 11. Verma S, Nuovo GJ, porcu P, Baiocchi RA, Crowson AN, Magro CM. Epstein-Barr virus and human herpesvirus-8-associated primary cutaneous plasmablastic lymphoma in the setting of renal transplantation. J Cutan Pathol. 2005;32(1):35–39. 12. Dong HY, Scadden DT, de Leval L, Tang Z, Isaacson PG, Harris NL. Plasmablastic lymphoma in HIV-positive patients: an aggressive Epstein Barr virus-associated extra medullary plasmacytic neoplasm. Am J Surg Pathol. 2005;29(12):1633–1641.
13. Lim JH, Lee MH, Lee MJ, et al. Plasmablastic lymphoma in anal canal. Cancer Res Treat. 2009;41(3):182–185. 14. Tavora F, Gonzalez-Cuyar LF, Sun CC, Burke A, Zhao XF. Extra-oral plasmablastic lymphoma: report of a case and review of literature. Human Pathol. 2006;37(9):1233–1236. 15. Chetty R, Hlatswayo N, Muc R, Sabaratnam R, Gatter K. Plasmablstic lymphoma in HIV þ patients: an expanding spectrum. Histopathology. 2003;42(6):605–609. 16. Plaza R, Ponferrada A, Benito DM, et al. Plasmablastic lymphoma associated to Crohn’s disease and hepatitis C virus chronic infection. J Crohns Colitis. 2011;5(6):628–632. 17. Smith DL II, Cataldo PA. Perianal lymphoma in a heterosexual and nonimmunocompromised patient, report of a case and review of the literature. Dis Colon Rectum. 1999;42(7):605–609. 18. Castillo J, Pantanowiz L, Dezube BJ. HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases. Am J Hematol. 2008;83(10):804–809.
Downloaded from jia.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 15, 2014
Plasmoblastic Lymphoma as Cause of Perianal Fistula: A Case Report and Literature Review
Journal of the International Association of Providers of AIDS Care 1–4 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2325957414553838 jiapac.sagepub.com
Firoozeh Isfahani, MD1, Surabhi Amar, MD1,2, Harikrishna Dave, MD3, and Daniel Gridley, MD4
Abstract We report the case of a 33-year-old HIV-infected man who presented with a recurrent, nonhealing perianal fistula. After multiple benign biopsies, the diagnosis of plasmablastic lymphoma (PBL) eventually was made. The patient underwent chemotherapy and radiation with a complete response. Perianal fistulas are frequent in HIV-positive patients, but PBL as a cause is extremely rare. This often delays the diagnosis and treatment of this highly aggressive disease. We review the literature and discuss the pitfalls in the diagnosis and management of the disease. Keywords anal plasmablastic lymphoma, perianal fistula
Introduction Perianal fistulas are the second most common manifestation of perianal disease in HIV-positive patients.1 Common causes of perianal fistula include viral, bacterial, and fungal infections; venereal diseases; cancers; anal fissures; radiation; and trauma. Among the malignant causes, squamous cell carcinoma is the most frequently reported, with lymphomas being unusual in this location. We report the case of plasmablastic lymphoma (PBL) presenting as a perianal fistula in an HIVinfected patient. Plasmablastic lymphoma is a rare, highly aggressive subtype of diffuse large B-cell lymphoma (DLBCL) usually seen in HIV-positive patients. It is commonly seen in the oral cavity, anal PBL is rare with only 10 reported cases. The rarity of the diagnosis and difficulty in obtaining large biopsy samples can often delay diagnosis and hence treatment of this highly aggressive malignancy.
RNA was 31 404 copies/mL, CD4 count was 66/mm3, lactate dehydrogenase was 754 U/L, and the test for Epstein-Barr virus (EBV) by polymerase chain reaction on peripheral blood was negative. He was diagnosed with an anal fistula and underwent a fistulotomy. Four weeks postprocedure, the patient returned with complaints of frequent soiling of his undergarments. Physical examination confirmed a 1 1 cm2 draining perianal ulcer, with an open fistulotomy tract. Patient underwent a colonoscopy, which revealed a perianal ulcer in the presence of an otherwise normal colonic mucosa. Biopsies were obtained from the edges of the fistulotomy tract, which revealed sheets of neoplastic cells, with scattered positivity for CD79a and nonspecific staining with plasma cell markers, k, and lambda stains. This was reported as a poorly differentiated malignant neoplasm, and more tissue was requested for further evaluation. Repeat CT scan of the abdomen and pelvis showed
Case Report
1
A 33-year-old HIV-infected man presented with a 2-month history of perianal pain, subjective fevers, and diarrhea. He had been diagnosed with HIV 8 years ago but had been noncompliant with therapy for the last 3 years. Physical examination revealed a raised, 2 1 cm2 perianal ulcer extending from the anus to the left buttock. Digital rectal examination was negative for any anorectal mass. Computed tomography (CT) scan of the abdomen and pelvis did not report any evidence of focal fluid collection, masses, or lymphadenopathy in the rectal area. Complete blood count was normal, HIV-1
Corresponding Author: Firoozeh Isfahani, Department of Medicine, Maricopa Integrated Health System, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA. Email: [email protected]
Department of Medicine, Maricopa Integrated Health System, Phoenix, AZ, USA 2 Division of Hematology–Oncology, Maricopa Integrated Health System, Phoenix, AZ, USA 3 Department of Pathology, Maricopa Integrated Health System, Phoenix, AZ, USA 4 Department of Radiology, Maricopa Integrated Health System, Phoenix, AZ, USA
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Journal of the International Association of Providers of AIDS Care
Figure 1. A, Pretreatment CT scan of the pelvis showing a 10.9 8.9 cm2 mass (white arrow) in the anal area. B, Posttreatment CT scan of the pelvis showing complete resolution of the rectal wall thickening and perianal mass. CT indicates computed tomography.
posterior rectal wall thickening, an enterocutaneous fistula, and a 1.4-cm right inguinal lymphadenopathy. No retroperitoneal lymphadenopathy was noticed. An open biopsy was scheduled as an outpatient. Patient delayed the biopsy and eventually presented 4 weeks later with severe anal pain and discharge. Computed tomography scan revealed a 10.9 8.9 cm2 fluid collection in the anal area with bilateral-enlarged inguinal nodes (Figure 1A). Excisional biopsies of the left inguinal lymph node and the perianal mass revealed a poorly differentiated malignant neoplasm composed of large cells with scant cytoplasm and eccentric large round nucleus with prominent nucleoli and increased mitotic activity, consistent with monotypic plasmablasts (Figure 2A). These cells expressed CD38 and CD138 with k light chain restriction (Figure 2B), while being negative for CD20, CD45, and CD56. Bone marrow biopsy did not reveal any involvement with lymphoma. A diagnosis of stage IIA bulky anal PBL was made. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen was initiated. After just 3 cycles of treatment, there was complete healing of the anal fistula with resolution of the rectal wall thickening and inguinal lymphadenopathy. He went on to complete 6 cycles of chemotherapy followed by 5 weeks of radiation therapy (3000 cGy with accumulated dose of 4190 cGy). A CT scan done 5 months after completing treatment did not reveal any residual disease (Figure 1B). Patient subsequently moved to a different state and was lost to follow up.
Discussion Plasmablastic lymphoma is an aggressive and rare variant of DLBCL and accounts for approximately 3% of all HIV-
Figure 2. A, Hematoxylin and eosin stain. Diffuse infiltration of large plasmablastic cells with tangible body macrophages. B, Immunoperoxidase stain CD138 strongly positive.
related non-Hodgkin lymphomas.2 It was first described in 1997 in the oral cavity of an HIV-positive patient.3 Although mostly reported in HIV-positive patients, it has been reported in other immunocompromised states and even in immunocompetent individuals.4,5 Plasmablastic lymphoma was initially
Downloaded from jia.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 15, 2014
Isfahani et al
3
Table 1. Cases of Perianal PBL Reported in Literature. Treatment Case
Reference
1 2 3 4 5 6 7 8 9 10 11
Brahmania et al5 Chetty et al15 Chetty et al15 Chetty et al15 Colomo et al8 Dong et al12 Lim et al13 Plaza et al16 Smith et al17 Tavora et al14 Isfahani et al
Age, Yr/Sex
HIV
EBV
HHV-8
Chemo
RT
Survival/Duration
Presenting Symptom
59/M 56/M 31/F 24/F 47/M 39/M 47/F 57/F 67/M 33/M 33/M
þ þ þ þ þ þ þ þ
þ þ þ þ þ þ þ ND þ
ND ND ND ND þ þ ND ND ND
CHOP NR CHOP CHOP NR CHOP NR CHOP
þ NR NR NR NR þ
NER/6 mo LFU DOD/early LFU NR DOD/6 mo NR NR NER/6 y NR LFU/5 mo
Fistula Mass Bleeding Mass Mass NR Fistula Crohn Fistula Mass Fistula
Abbreviations: CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; DOD, died of disease; EBV, Epstein-Barr virus; F, female; HHV-8, Human Herpes virus 8; LFU, lost follow-up; M, male; ND, not done; NER, no evidence of recurrence; NR, not reported; PBL, plasmablastic lymphoma; RT, radiation therapy.
thought to be an exclusively oral disease,3 but subsequent reports described its occurrence at sites like the stomach,6 lungs,7 skin lymph nodes, soft tissue, and bone marrow.8–11 There are fewer than 50 reported cases of extra oral PBL in HIV-positive patients, of which only 7 were reported to originate in the anal canal.8,12–15 Most of them presented with bleeding and anal mass. Three other cases of anal PBL have also been reported in non-HIV-positive patients.5,16,17 The findings are summarized in Table 1. Pathologic features of PBL are characterized by large monotypic cells with large nucleus and prominent nucleoli and blastoid morphology. These cells show strong expression of plasma cell markers like CD38 and CD138 but weak/absent expression of B-cell markers such as CD20 and CD45.8 Pathogenesis of PBL is strongly associated with EBV infection.2 Human herpesvirus 8 has also been linked to PBL but not as strongly as EBV, and its exact role remains unclear.12–14 Plasmablastic lymphoma is a highly aggressive tumor and is poorly responsive to treatment. Most commonly used therapy is CHOP with or without radiation therapy. More aggressive regimens such as cyclophosphamide, oncovin, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine have also been used with limited success. Prognosis is based on the response to highly active antiretroviral therapy and immunologic status. Median survival in 1 series was only 15 months despite therapy.18
Conclusion Plasmablastic lymphomas should be considered as a possible diagnosis in any HIV-infected patient presenting with a nonhealing perianal lesion or fistula. As illustrated by our case, initial benign biopsies can often mask this highly aggressive tumor. Delay in diagnosis can be prevented by having a low threshold for performing an open or excisional biopsy in cases of recurrent perianal fistulas not responding to conventional therapy.
Authors’ Note This article has not been submitted for publication elsewhere, although it has been previously presented as a poster at an American College of Physicians Meeting.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Barrett WL, Callahan TD, Orkin BA. Perianal manifestations of human immunodeficiency virus infection. Dis Colon Rectum. 1998;41(5):606–612. 2. Guan B, Zhang X, Ma H, Zhou H, Zhou X. A meta-analysis of highly active anti-retroviral therapy for treatment of plasmablastic lymphomas. Ann Saudi Med. 2010;30(2):123–128. 3. Delecluse HJ, Anagnostopoulos I, Dallenbach F, et al. Plasmablastic lymphomas of the oral cavity: a new entity associated with the human immunodeficiency virus infection. Blood. 1997;89(4): 1413–1420. 4. Teruya-Feldstein J, Chiao E, Filippa DA, et al. CD20-negative large-cell lymphoma with plasmablastic features: a clinically heterogeneous spectrum in both HIV-positive and -negative patients. Ann Oncol. 2004;15(11):1673–1679. 5. Brahmania M, Sylwesterowic T, leitch H. Plasmablastic lymphoma in the ano-rectal junction presenting in an immunocompetent man: a case report. J Med Case Rep. 2011;5:168–173. 6. Pruneri G, Graziadei G, Baldini L, Baldini L, Neri A, Buffa R. Plasmablastic lymphoma of the stomach. A case report. Hematology. 1998;83(1):87–89. 7. Lin Y, Rodrigues GD, Turner JF, Vasef MA. Plasmablastic lymphoma of the lung: report of a unique case and review of the literature. Arch Pathol Lab Med. 2001;125(2):282–285.
Downloaded from jia.sagepub.com at TEXAS SOUTHERN UNIVERSITY on December 15, 2014
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Journal of the International Association of Providers of AIDS Care
8. Colomo L, Loong F, Rives S, et al. Diffuse large B-cell lymphomas with plasmablastic differentiation represents a heterogeneous group of disease entities. Am J Surg Pathol. 2004; 28(6);736–747. 9. Dales JP, Harket A, bagneres D, et al. Plasmablastic lymphoma in a patient with HIV infection: an unusual case located in the skin. Ann Pathol. 2005;25(1):45–49. 10. Jordan LB, Lessells AM, Goodlad JR. Plasmablastic lymphoma arising in a cutaneous site. Histopathology. 2005;46(1):113–115. 11. Verma S, Nuovo GJ, porcu P, Baiocchi RA, Crowson AN, Magro CM. Epstein-Barr virus and human herpesvirus-8-associated primary cutaneous plasmablastic lymphoma in the setting of renal transplantation. J Cutan Pathol. 2005;32(1):35–39. 12. Dong HY, Scadden DT, de Leval L, Tang Z, Isaacson PG, Harris NL. Plasmablastic lymphoma in HIV-positive patients: an aggressive Epstein Barr virus-associated extra medullary plasmacytic neoplasm. Am J Surg Pathol. 2005;29(12):1633–1641.
13. Lim JH, Lee MH, Lee MJ, et al. Plasmablastic lymphoma in anal canal. Cancer Res Treat. 2009;41(3):182–185. 14. Tavora F, Gonzalez-Cuyar LF, Sun CC, Burke A, Zhao XF. Extra-oral plasmablastic lymphoma: report of a case and review of literature. Human Pathol. 2006;37(9):1233–1236. 15. Chetty R, Hlatswayo N, Muc R, Sabaratnam R, Gatter K. Plasmablstic lymphoma in HIV þ patients: an expanding spectrum. Histopathology. 2003;42(6):605–609. 16. Plaza R, Ponferrada A, Benito DM, et al. Plasmablastic lymphoma associated to Crohn’s disease and hepatitis C virus chronic infection. J Crohns Colitis. 2011;5(6):628–632. 17. Smith DL II, Cataldo PA. Perianal lymphoma in a heterosexual and nonimmunocompromised patient, report of a case and review of the literature. Dis Colon Rectum. 1999;42(7):605–609. 18. Castillo J, Pantanowiz L, Dezube BJ. HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases. Am J Hematol. 2008;83(10):804–809.
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