Primary bilateral plasmablastic lymphoma of the testis in a human immunodeficiency virus positive man

Abstract

Human immunodeficiency virus (HIV)-related lymphomas are predominantly aggressive B-cells lymphomas. The most prevalent of the HIV-related lymphomas are diffuse large B-cell non-Hodgkin's lymphoma (NHL), which includes primary central nervous system lymphoma, and Burkitt lymphoma, whereas primary effusion lymphoma, plasmablastic lymphoma (PBL), and classic Hodgkin lymphoma are far less frequent. Of these, PBL is relatively uncommon and displays a distinct predilection for presentation in the oral cavity. In this manuscript, we report a primary testicular form of PBL in 44 year-old Border Security HIV positive patient who presented with bilateral testicular swelling of 1-year duration. On cytopathological and subsequent histopathological examination, the diagnosis of bilateral plasmablastic NHL was made. Extensive systemic work-up failed to reveal any disease outside the testes. Immune suppression rather than HIV itself is implicated in the pathogenesis of lymphomas. Herein, we report a case of PBL as AIDS-related malignancy presenting in testes and its correlation with CD4+ count.

Testicular Plasmablastic Lymphoma in an HIV-Negative Patient: A Rare Case Presentation

“…Features such as the absence of renal dysfunction, lytic bone lesions, and bone marrow involvement are suggestive of PBL. 12,13,15 The morphology and phenotype of this case was consistent with PBL; however, lack of any immunosuppression or evidence of EBV infection makes this case was unusual. The main differential diagnosis considered was PCM.…”

A Unique Case of Testicular Plasmablastic Lymphoma in a Patient with Human Immunodeficiency Virus

“…After imaging, his primary source was found to be testicular. Badyal et al described a case of testicular PBL in an HIV patient who presented with bilateral scrotal swelling and no cutaneous nodules [4]. Our case is unique as it is the first case of primary testicular PBL that presented with cutaneous nodules.…”

“…Risk factors for non-Hodgkin's lymphoma in HIV patients include male gender, low CD4 count, high viral load, and increased age [4]. PBL has features of B-cell lymphoma and plasma cell neoplasms.…”

“…Current guidelines are recommending more aggressive therapy than just cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) in these patients. Infusional etoposide, vincristine, doxorubicin, cyclophosphamide, prednisone (EPOCH) and cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M-IVAC) are considered better treatment options [4-5]. Intrathecal prophylaxis is also recommended particularly in patients with HIV due to the high rate of proliferation in PBL [6].…”

“…Median survival in HIV patients was found to be 10 to 15 months and three-year survival was found to be 25%. Patients with HIV who did not receive treatment had a median survival of three months [4]. Antiretroviral therapy is recommended in patients with PBL to prevent further disease progression and has been shown to improve rates of remission when used in combination with chemotherapy [5-6].…”