spontaneous regression of an HIV-associated plasmablastic lymphoma in the oral cavity: a case report

Case Details

Disease Location

Oral cavity, left maxilla

Personal Characteristics

35 -year-old male past history of HIV infection and pneumocystitis carinii pneumonia and oral thrush (pneumonia and oral thrush were treated and resolved prior) may 2005 reported quitting alcohol and cigarettes 5 years earlier

Clinical Characteristics

Was referred due to an odontogenic infection of the left maxilla CD4 count at presentation was 296/µl and viral load was undetectable. Before haart treatment in 2005, CD4 count was 37/µl with high viral load (>750k virons/ml), initial symptoms started in oct 2004 with noted pain in left maxillary molar region. Was thought to be an offending tooth, and underwent extraction. Pain resolved, but the lesion continued to increase in size and interfered with eating initial exam noted a friable purple-red fungating mass 3x5 cm at the posterior of the left maxillary arch, the lesion was nonfluctuant and nontender to palpation. Panoramic radiograph showed signficiant bone loss of left maxilla. Incisional biopsy as obtained, the specimen underwent immunohistochemical studies cells were focally positive for cd79a, ki-67 stain showed a labeling index of approx. 50%. Cells were negative for CD3, 10, 31, 45, keratin, hmb45, and CD30. CD20 was faintly positive. Findings were confirmed by another department where additional stains for CD138 and vs38c were performed, both were strongly positive but CD20 was negative. Alk1 was negative at both facilities. Approx. 50% of the neoplastic b cells were positive for ebv. Histologic sections showed sheets of aty[ical large lymphoid cells with moderate amounts of eosinophilic cytoplasm with some having plasmacytic to immature plasmablastic features. Final pathology rendered diagnosis of HIV-associated plasmablastic variant of diffuse large b-cell lymphoma (pbl) CT scan of the midface during follow-up showed advanced bony deterioration of the left maxillary alveolus extending into the left maxillary sinus at 2 weeks after, CT scan of chest, abdomen, and pelvis showed no evidence of extranodal involvement liver needle biopsy noted non-nectrotizing granulomas

Remission Characteristics

A week after, there was note of decreased lesion size and the mucosal tissue appeared more normal in coloring. The lesion remained nontender and the patient reported being able to eat normally. At two weeks, there was no clinical evidence aside from a 3x3mm firm, bluish area along the buccal aspect of the maxillary ridge. New incisional biopsies were obtained and flow cytometry immunophenotypes were ordered. They showed no residual lymphoma population near total remission before starting chemo bone marrow aspiration and core ciopsy revealed no lymphoma liver needle biopsy showed no malignancy 1 month from initial evaluation, completely devoid of clinical symptoms complete regression before chemotherapy treatment

Treatment & Mechanisms

Proposed Remission Mechanisms

Restoration of immune system secondary to haart

Clinical Treatment

Started haart january 2005 consisting of atazanavir sulfate, ritonavir, and lamivudine. Oral surgery in 2004 biopsy chemotherapy bone marrow aspiration and biopsy liver needle biopsy

Non-Clinical Treatment

None reported