Primary synovial diffuse B-cell lymphoma is a rare clinical condition. The condition presents primarily with localized joint symptoms such as swelling, pain and reduced range of motion. It may or may not be associated with lymphadenopathy, hepatosplenomegaly or B-type constitutional symptoms. We report a case of a 74-year-old woman who presented with persistent left knee pain and swelling after left knee replacement secondary to osteoarthritis. There was a concern for mechanical loosening of internal left knee prosthetic joint. On revision surgery (14 weeks after the initial surgery), hypertrophied synovium with areas of fibrotic scars, necrotic tissue and dark colored masses was resected. She was found to have diffuse large B-cell lymphoma (DLBCL) after histological analysis. In cases with persistent joint symptoms or postoperative complications, arthroscopy or arthrotomy should be considered and any atypical appearing tissue should be sent for histopathological analysis.
Because T-regulatory cells (Tregs) can harmfully impair HIV-specific responses or beneficially limit immune activation, we compared the number of Tregs in lymph nodes from 48 HIV+ patients and 106 HIV- subjects. By using a microscope counting grid, we found that the mean ± SD number of Tregs in lymph nodes was 3 times greater in HIV+ males than HIV+ females (23.5 ± 20.7 vs 7.8 ± 7.7; P = .0006) and almost twice as great in HIV+ males than HIV- males (23.5 ± 20.7 vs 13.5 ± 15.5; P = .04). There were fewer Tregs in HIV+ females than in HIV- females (mean ± SD, 7.8 ± 7.7 vs 13.4 ± 13.3; P = .04). HIV+ males compared with HIV+ females had higher viral loads (VLs) and lower peripheral blood (PB) CD4 cell counts (mean ± SD, 239,841 ± 307,494 vs 73,038 ± 146,763 copies/mL and 262 ± 207 vs 466 ± 278/mm(3); P = .02 and P = .01, respectively). Our data show that Tregs in lymph nodes from HIV+ patients are positively correlated with VL and negatively correlated with PB CD4 counts. These findings suggest that Tregs might impair an HIV-specific immune response, which could be modified by sex, or, alternatively, an increased VL causes increased Tregs.
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