CNK/T‐cell brain lymphoma associated with Epstein‐Barr virus in a patient with AIDS

Abstract

We report a case of extranodal NK/T-cell lymphoma, nasal type, with exclusive cerebral localization in a patient with AIDS. The patient presented with neurological alterations, fever and convulsions, so the initial presumptive diagnosis was an opportunistic brain infection. MRI showed a left parietal necrotic lesion and a stereotactic brain biopsy was performed for pathological, microbiological and molecular studies. Histological sections showed an angiocentric and angiodestructive growth pattern and the immunophenotype of this tumor was CD56+, CD45+, CD3+ (cytoplasmic), Granzyme B+ and Perforin+. All the microbiological studies such as bacterial, fungi, micobacteria, Toxoplasma gondii and Cryptococcus determination were negatives. A PCR study with primer specific for EBV viral genome of Bam-Hi-w system was positive. Also, a rearrangement study showed T-cell gene rearrangement with monoclonal appearance. A diagnosis of extranodal NK/T-cell lymphoma was made and the patient died a few days later. This case represents a very rare example of NK/T-cell lymphoma of the brain in a patient with AIDS. The diagnosis of this kind of lymphomas requires a multimodality approach correlating clinical, morphological, immunophenotypic and molecular data.

NK/T cell non-Hodgkin lymphoma in a HIV-positive patient

“…However, in most of the patients, lymphoma was also identified in other sites, most commonly the liver, either at presentation or later in the course of their disease. Involvement of the colon, which occurs relatively frequently in HIV negative patients and was a major site of involvement in our patient, was not reported in the other seven cases identified in the literature [5][6][7][8][9][10][11].…”

“…All but one of the reported NK/T cell lymphomas in HIV/AIDS patients have been diagnosed in men (median age of 42 years) with low CD4 counts (<200/dl, where reported) [5,[7][8][9][10][11]. The remaining case occurred in an 18-month-old Chinese girl with perinatal HIV infection [6].…”

“…NK/T cell lymphomas have only rarely been diagnosed in patients with HIV/AIDS with fewer than ten cases reported in the literature [5][6][7][8][9][10][11]. Similar to our patient, two of the HIV/AIDS patients in the literature had CNS disease, including one who also had involvement of the orbit and the nasal/maxillary sinuses [7,9]. The latter patient, a 42-year-old male, presented with double vision and eye-droop as did our patient.…”

“…The NK/T cell lymphoma cases in HIV/AIDS have varied extensively with respect to immunophenotype, sites of disease, and clinical presentation [5][6][7][8][9][10][11]. We report here a unique case of NK/T cell lymphoma arising in the gastrointestinal tract and central nervous system of a severely immunodeficient HIV-positive woman with biopsy proven Kaposi sarcoma (KS).…”

Primary Central Nervous System T-Cell Lymphoma in Aids Patients: Case Report and Literature Review

“…Most of the reported cases are B-cell pcnsl. A search of the medline database for pcnsl in aids patients found only 6 cases [5][6][7][8][9] . Here, we present another case of an aids patient with T-cell pcnsl, treated successfully with and small new enhancing lesions bilaterally.…”