PRIMARY EXTRACAVITARY EFFUSION LYMPHOMA DIAGNOSED IN A COLONIC POLYP IN AN HIV+ PATIENT: CASE REPORT AND DIAGNOSTIC CHALLENGES
DOI:
https://doi.org/10.56238/levv17n57-022Keywords:
Primary Effusion Lymphoma, Extracavitary PEL, HIV, HHV-8Abstract
Primary effusion lymphoma is an aggressive lymphoproliferative B-cell neoplasm associated with human herpesvirus type 8 (HHV-8) infection, occurring predominantly in immunosuppressed individuals, especially patients living with HIV. Classically, it manifests as effusion in serous cavities, without the formation of a solid mass. A rare variant, termed extracavitary primary effusion lymphoma, is characterized by presentation as solid masses in extraserosal sites, which represents a significant diagnostic challenge. We report the case of a 34-year-old male patient living with HIV who presented with significant immunosuppression, with a high viral load, CD4 T lymphocyte count at levels indicative of severe immunodeficiency (124 cells/mm³), and a clinical picture characterized by constitutional symptoms, lymphadenomegaly, and skin lesions. During the diagnostic investigation, polypoid lesions were identified in the ascending colon and cecum. Histopathological analysis of polyp biopsies revealed atypical high-grade lymphoid infiltrate with plasmablastic morphology interspersed with colonic glands. Immunohistochemical analysis demonstrated positivity for HHV-8, CD30, CD38, and CD45, associated with the absence of classic B-cell markers, consistent with primary extracavitary effusion lymphoma. The patient underwent reintroduction of antiretroviral therapy and chemotherapy, resulting in sustained remission of the disease for 16 months. This case reinforces the need to consider primary extracavitary effusion lymphoma as a differential diagnosis for aggressive large B-cell lymphomas in immunosuppressed patients, even in the absence of cavitary effusions. The morphological and immunophenotypic overlap with other neoplasms makes the systematic inclusion of HHV-8 testing in the immunohistochemical panel fundamental, enabling accurate diagnosis and positively impacting prognosis.
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