Nasopharyngeal lymphoid tissue masses in patients with human immunodeficiency virus-1. Histologic findings and clinical correlation

Abstract

Background. Although the histologic changes in lymph nodes in patients infected with the human immunodeficiency virus‐1 (HIV‐1) are well described, the histology and resulting clinical symptoms of hyperplastic nasopharyngeal lymphoid tissue (NPLT) in these patients are not widely known, particularly to pathologists and oncologists. Methods. Nine patients with HIV‐1 presented with a nasopharyngeal mass, nasal stuffiness, nasal bleeding, hearing loss, and cervical lymphadenopathy in various combinations. Tonsillar tissue was biopsied or removed from all nine. Results. The tonsillar tissue showed a spectrum of the changes of reactive lymphoid hyperplasia. Conclusions. Clinicians and pathologists must be aware of the spectrum of histologic changes and clinical features relating to biopsies from NPLT to interpret the changes correctly and to avoid a misdiagnosis of malignant lymphoma.

Concurrent FDG Avid Nasopharyngeal Lesion and Generalized Lymphadenopathy on PET-CT Imaging Is Indicative of Lymphoma in Patients with HIV Infection

“…In a report by Barzan et al [7], 80% of 36 HIV-positive patients had pathologically confirmed nasopharyngeal lymphatic tissue hypertrophy. Most published observations suggested that nasopharyngeal lesions in HIV-infected patients were reactive and represented follicular hyperplasia [8, 9], but malignant lesions were also reported in nasopharyngeal lesions of patients with HIV infection [10]. There was a case report about malignant transformation of nasopharyngeal lymphoid hypertrophy [11].…”

Epstein-Barr Virus–Associated Nasopharyngeal Carcinoma and Local Polymorphic B-Cell Lymphoproliferative Disorder in a Patient With HIV Disease

“…The diagnosis of nasopharyngeal carcinoma is based on a maintained high-level clinical suspicion and is obtained with clinical (ear, nose, and throat) and fiberoptic examination, and appropriate radiological imaging: CT and magnetic resonance imaging scans are complementary for the initial screening, whereas PET technique proves more effective for the clinical follow-up and the early detection of eventual relapses. 6,12 However, a prompt local biopsy is mandatory to examine the histopathologic picture and to J INT ASSOC PHYSICIANS AIDS CARE 6(4); 2007 study eventual cell transformation, 5,[12][13][14][15] as well as to detect the presence of EBV genoma, 1,6,10,12 as mentioned above. In an immunocompromised host or among HIV-infected patients, the differential diagnosis of nasopharyngeal carcinoma has to take into account a broad spectrum of bacterial, fungal, mycobacterial, and other opportunistic infections, and lymphoma and other malignancies too, 12,16,17 while a concomitant, EBV-associated lymphatic hypertrophy of surrounding tissues may be more frequent just in patients with HIV disease, to mimic a lymphoproliferative disease.…”

“…17 Castleman's syndrome, initially associated with EBV too, includes multicenter proliferative disorders that seem to be more frequently associated with other herpes viruses (ie, HHV-8). 18 In fact, among HIVinfected patients, EBV-associated lymphoproliferative disorders and malignant lymphomas are known to be proportionally more frequent than in the general population, 1,5,[13][14][15] but a diagnosis of AIDS may be posed only when Burkitt lymphoma or primary brain lymphoma are of concern. In about one half of AIDSrelated non-Hodgkin lymphomas, the expression of EBV antigen may be found by a wide range of histopathological studies, thus resembling the situation of African Burkitt lymphoma.…”

“…16 Furthermore, childhood cancers detected in Zambia showed an increase of nasopharyngeal carcinoma compared with a drop of Burkitt lymphoma, when comparing 2 periods preceding and following the HIV epidemic, respectively, all examined before the introduction of HAART. 20 As known, patients with HIV disease are also prone to develop both lymphoid hyperplasia and malignant lymphomas sharing the same location, 5,[13][14][15] and probably to suffer from a worse prognosis compared with that of the general population. 21 Although lymphoid hyperplasia is largely predominant in frequency, 5,13,15 it may usually mimic cancer and make the differential diagnosis more complicated.…”

Nasopharyngeal lymphoid tissue masses in patients with human immunodeficiency virus-1

“…Does hyperplastic nasopharyngeal lymphoid tissue (NPLT) in human immunodeficiency virus-1 (HIV- 1) infection deserve greater attention?…”