A Rare Case of HIV-Associated Plasmablastic Lymphoma of Anal Canal

Abstract

Plasmablastic lymphoma, an acquired immunodeficiency syndrome defining malignancy, is a subtype of diffuse large B-cell lymphoma. It is classically described in the oral cavity, the extraoral presentation being rare. Owing to its rarity and aggressiveness, plasmablastic lymphoma poses a diagnostic and therapeutic challenge to the treating physician. A 40-year-old male, recently diagnosed with HIV infection, presented with bleeding per rectum and spurious diarrhea. Examination revealed proliferative growth in the anal canal. Biopsy of the lesion was diagnostic of plasmablastic lymphoma. Computed tomography and magnetic resonance imaging were done to stage the lesion and assess the local extent, respectively. A multidisciplinary board discussion was done, and the patient was instituted on antiretroviral therapy and chemoradiotherapy. Following six cycles of chemotherapy and 25 fractions of radiotherapy, he achieved complete remission.

Plasmablastic lymphoma in an HIV-negative patient with complete remission after chemotherapy with DA-EPOCH

“…Isolated cases of plasmablastic lymphoma have been reported in the rectum with a presentation similar to that of the case presented, such as a rectal mass with signs of local inflammation. The mass tends to be painful on palpation, friable to the touch and protrudes through the anal canal with local invasion of surrounding tissues, which can be accompanied by rectal bleeding and pain on defecation [5][6][7][8]. Only scarce cases of plasmablastic lymphoma of the rectum have been reported in HIVnegative patients.…”

“…Among the prognostic factors, complete remission after chemotherapy, Ki-67 expression greater than 80%, and male sex stand out, with response to chemotherapy being the most associated with total survival [6][7][8].…”

“…There is currently no standard handling for PL. However, several organizations recommend CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)chemotherapy schemes and more intense chemotherapy schemes such as EPOCH (infusion of etoposide, vincristine, doxorubicin + bolus of cyclophosphamide and prednisone), CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, methotrexate altering with ifosfamide, etoposide and cytarabine), and hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone) [6][7][8].…”

Anal lymphoma: a tumor with insufficient attention

“…We excluded articles with no specific case description, tumor location not in the anus or anal canal, or no pathological diagnosis of non-Hodgkin lymphoma. Finally, 12 case studies were selected for review [ 1 , 5 – 15 ], as shown in Fig. 1 .…”