Immunodeficiencyassociated lymphomas

The lymphomas that develop in the oral cavity of patients with HIV infection are most commonly DLBCL with frequent EBV association (75%) {962,2141}, although EBV-associated T-cell lymphomas have also been reported in this setting {1476,2589}. A distinctive form of DLBCL, plasmablastic lymphoma, has recently been shown to exhibit a predilection for the oral cavity of HIV-positive subjects. It differs from the usual

Fig. 4.49 Immunodeficiency-associated lymphoproliferative disorders. A Post-transplant lymphoproliferative disorder, plasmacytic hyperplasia, involving tonsil. B Plasmablastic lymphoma of the oral cavity in HIV-positive subject. The cells possess slightly eccentrically-located large vesicular nuclei, prominent nucleoli, and amphophilic cytoplasm.

Fig. 4.49 Immunodeficiency-associated lymphoproliferative disorders. A Post-transplant lymphoproliferative disorder, plasmacytic hyperplasia, involving tonsil. B Plasmablastic lymphoma of the oral cavity in HIV-positive subject. The cells possess slightly eccentrically-located large vesicular nuclei, prominent nucleoli, and amphophilic cytoplasm.

DLBCL by the plasmablastic morphology frequent lack of expression of CD45 and the pan-B marker CD20, and expression of plasma cell-associated markers (e.g. VS38c and CD138) {576}. EBV is identified in 60% of cases. Histologically, the tumour shows a starry-sky appearance and a high proliferation index. The large tumour cells have eccentric vesicular nuclei, central prominent nucleoli, abundant basophilic cytoplasm and paranuclear hof. There is no maturation into plasma cells. Post-transplant lymphoproliferative disorder (PTLD) can also affect the oral cavity, and they are frequently associated with EBV (>80%). The 'early' lesions, including plasmacytic hyperplasia and infectious mononucleosis-like PTLD, commonly involve the tonsils of children or younger adults {355,356,2830}. The architecture of the tonsil is preserved, with expansion of the interfollicular areas by small lymphocytes, polyclonal plasma cells, plasmablasts and immunoblasts. Clonal immunoglobulin gene rearrangement is rare {355,2830}. Most lesions regress with reduction in immunosup-pression, but rare cases may progress to polymorphic PTLD {2830}. Polymorphic and monomorphic PTLD can also present in the oral cavity (e.g. tonsil, gingiva, alveolus): the former shows architectural effacement, necrosis, cytologic atypia together with a full range of B-cell maturation, while the latter is indistinguishable from conventional DLBCL, and less commonly Burkitt lymphoma {1301,1926, 2131,2850}. Clonal immunoglobulin gene rearrangement is frequently demonstrated in polymorphic and monomorphic PTLD. Regression after reduction in immunosuppression may still be possible in some cases of polymorphic PTLD, but progression is usually the rule for monomorphic PTLD. (Please refer to 'Post-transplant lymphoproliferative disorders' in 'WHO classification of tumours: Tumours of haematopoietic and lym-phoid tissues' for details).

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