HIV-Associated Anal Squamous Cell Cancer: An Otherwise Preventable Disease

Abstract

cytoplasmic vacuoles. The nuclei were round with clumped chromatin and the nucleoli were very prominent, which is classic for Burkitt's lymphoma (Fig 2). The urine flow cytometry showed an abnormal B-cell population expressing CD10, CD19, and CD79a with no expression of nTdT, similar to the lymphoblasts in the peripheral blood at initial presentation. However, the cells in the urine lost expression of lambda light chains and CD20. It has been shown that roughly 6% of lymphoma cells isolated from body cavities and effusions lose expression of surface light chains. 7 Similarly, prior treatment with rituximab can lead to loss of CD20 expression by lymphoma cells. 8,9 These two phenomena likely account for the loss of light chain and CD20 expression in the urine specimen. The urine flow cytometry and cell morphology were felt to be diagnostic for relapsed Burkitt's lymphoma. The patient received salvage chemotherapy with subsequent symptomatic improvement and normalization of the serum creatinine. However, he ultimately developed progressive renal failure and died. In conclusion, urine flow cytometry can be a useful diagnostic tool when GU involvement by high-grade lymphoma is suspected. This case also illustrates that rapid processing of urine samples can preserve morphology and increase the number of viable cells submitted for analysis with flow cytometry.

Evolving spectrum and incidence of non-AIDS-defining malignancies

“…HIV-associated invasive anal carcinoma can be treated with standard combined chemotherapy and radiation [43-45]. Chemotherapy regimens include mitomycin (or cisplatin) and 5-fluorouracil (5-FU).…”

Diagnosis and management of anal cancer

“…The high incidence of SCCA in solid organ transplant patients, recently confi rmed by a large series from Austria, indicates the pivotal role of immunosuppression in SCCA development, irrespective of sexual practice [ 5 ]. Thus, epidemiologic data clearly indicate that SCCA is a preventable disease, with progression facilitated by immune suppression [ 6 ].…”

Prognostic Significance of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography in Anal Squamous Cell Carcinoma: A Systematic Review and a Meta-Analysis

“…HIV and human papilloma virus- (HPV-) coinfected patients are at high risk of developing precancerous anal lesions (anal intraepithelial neoplastic lesions) and anal malignancies. Progression and persistence of HPV-associated lesions are known to be enhanced by human immunodeficiency virus- (HIV-) related immunosuppression, which may result in the reactivation of previously acquired HPV infection and loss of control of HPV viral replication [4], the phenomenon which explains the high risk of anal SCC in HIV-infected patients [2].…”