Pulmonary Non-Hodgkin’s Lymphoma in AIDS: Discussion

11 Jan

Pulmonary Non-Hodgkin’s Lymphoma in AIDS: DiscussionIn 1982, the first case of non-Hodgkins lymphoma in a patient at risk for AIDS was reported. In the original Centers for Disease Control (CDC) surveillance definition of AIDS, only primary lymphoma of the central nervous system was considered diagnostic of the syndrome. In 1985, however, the definition was revised to include any high-grade B-cell non-Hodgkins lymphoma in the presence of HIV infection. A recent evaluation of the incidence of non-Hodgkins lymphoma among never-married men in San Francisco showed a significant increase of lymphoma in census tracts with a high incidence of AIDS. Based on CDC data for the past four years (1985-1988) non-Hodgkins lymphoma has occurred as a primary or secondary diagnosis in approximately 3 percent of AIDS cases (Xen Sdhtos, CDC, personal communication) compared with 6 percent of cases reported in Colorado.

In the United States, most reported cases of HIV-related non-Hodgkins lymphoma have occurred in homosexuals. However, reports from New York City and Italy suggest that non-Hodgkins lymphoma occurs in both homosexuals and intravenous drug users. This is in contrast to AIDS-associated Kaposi’s sarcoma; more than 90 percent of these reported cases have occurred in homosexual and bisexual men.
Several medical centers have reported their experience with non-Hodgkins lymphomas in AIDS patients. These reports have shown clinicopatho-logic features which distinguish these neoplasms in AIDS patients from those occurring in non-AIDS patients. Several consistent observations have emerged. Non-Hodgkins lymphomas associated with HIV infection are generally diffuse, aggressive B-cell lymphomas. Furthermore, the majority of patients have advanced disease (stage III or IV) and there is a high frequency of extranodal involvement. The most common extranodal sites have been bone marrow, central nervous system and gastrointestinal tract. A few reports have documented cardiac lymphoma in AIDS patients.