Oral plasmablastic lymphoma in an HIV-positive patient with an unusual survival rate

Excerpt

A 39-year-old woman presented with a 6-month history of slightly painful expanding gingival mass covered by an ulcerated and necrotizing epithelium (Fig. 1a, b). Histopathological (Fig. 1c) and immunophenotypic analysis (Fig. 1d) confirmed a diagnosis of lymphoma with diffuse large B cells with plasmablastic differentiation. The patient was reported to be HIV-positive. At the time of HIV diagnosis, the CD4⁺ T cell count was 733 μL. A medical treatment was planned but the patient refused it and was lost to follow-up. After 13 years, when she received a diagnosis of oral plasmablastic lymphoma (PBL), her CD4⁺ T cell count was 62 μL (the lowest ever reported), with viral load >500,000 copies/mL. A combined treatment with chemo/radiotherapy and highly active antiretroviral therapy was established and the patient entered in complete clinical remission, reaching a viral load of 0 copies/mL. No systemic involvement was seen due to HIV infection. Oral PBL, although quite common in HIV patients, is still a rare event [1] and needs a differential diagnosis with other malignancies, such as Kaposi’s sarcoma [2, 3]. Its prognosis is usually poor, as death might occur 1–24 months after the diagnosis, with an average survival period of 6 months [4]. As our patient, after 6 years from the time of PBL diagnosis, is in good health, it appears that an early detection and definitive diagnosis of such lesions in HIV-positive patients might result in an increase of their survival rate.

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