T lymphoblastic leukemia/lymphoma and human immunodeficiency virus infection
T lymphoblastic leukemia/lymphoma and human immunodeficiency virus infection
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T淋巴细胞白血病/淋巴瘤与人类免疫缺陷病毒感染
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
B. Alobeid
中科院分区：
文献类型：
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作者：
Kamraan Z. Gill;Shafinaz Hussein;Yuxia Jia;V. Murty;G. Bhagat;B. Alobeid
尊敬的先生，人类免疫缺陷病毒感染 (HIV+) 的个体患某些血液恶性肿瘤的风险很高，例如弥漫性大 B 细胞淋巴瘤和伯基特淋巴瘤。治疗管理的进步提高了艾滋病毒感染者的长期生存率，导致其他肿瘤的发病率增加，而迄今为止，这些肿瘤在该患者群体中被认为是罕见的。尽管如此，T 淋巴细胞白血病/淋巴瘤 (T-ALL/LBL) 在 HIV 感染患者中仍然很少见；此前仅报道过 5 例病例 [1-5]。在此，我们描述了另一例在 HIV 感染情况下发生的 T-ALL/LBL 病例。一名 55 岁男性，有 HIV/AIDS 病史，出现虚弱、发烧、体重减轻、颈部肿块 1 个月。他在就诊前 20 年被诊断出患有艾滋病毒/艾滋病，并且由于多次机会性感染，他的病程变得更加复杂。自最初诊断以来，他一直在接受 HAART 治疗，但据报道他不依从。他最近的 CD4 计数和病毒载量分别为 218/μL（正常范围 393-1489/μL）和 68 个拷贝/mL（通过 PCR 检测，COBAS AmpliPrep/COBAS TaqMan HIV-1 检测试剂盒，2.0 版）。他的体格检查显示发烧（39.5°C）、淋巴结肿大（颏下、颈部和腹股沟）以及躯干和四肢近端由红斑丘疹和色素沉着斑疹组成的皮疹。实验室检查显示血红蛋白浓度为5.1 g/dL（正常范围13.3-16.2 g/dL），白细胞计数为4.0（×10/L，正常范围3.54-9.06），血小板计数为52,000/μL（52×10/L，正常范围165-415×10/L）。 CT 扫描显示淋巴结肿大，涉及颈部、纵隔、肠系膜、腹膜后和腹股沟淋巴结。骨髓活检显示，与年龄相比，骨髓细胞明显增多（90%），整个骨髓空间被广泛的原始细胞浸润所取代（图 1a）。骨髓抽吸物还显示出大量原始细胞，占所有骨髓有核成分的 86%。对抽吸物进行流式细胞分析显示，一群原始细胞表达 CD34、TdT、细胞质 CD3、CD5、CD7、CD33、CD43 和 HLA-DR，但不表达表面 CD3、CD2、CD4、CD8、CD1a、CD117、CD13、CD11c、表面 TCR 或 CD64（图 1b-d）。该免疫表型可诊断 T-ALL。左颈部淋巴结活检显示广泛的副皮质淋巴母细胞浸润，这些母细胞的免疫表型与骨髓中母细胞的免疫表型相似。通过 EBV 编码的 RNA 原位杂交，淋巴母细胞的 EBV 呈阴性。骨髓和淋巴结样本的 G 带核型分析揭示了 t(7;14)(p15;q32) 易位，尽管这种情况很少见，但之前已被描述为与 TK 相关。 Z.吉尔：S.侯赛因：V。 V.穆蒂：G。 Bhagat：B. Alobeid (*) Departments of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, 630 W. 168 St., VC14-229, New York, NY 10032, USA 电子邮件：ba2024@columbia.edu
Dear Sir, Human immunodeficiency virus-infected (HIV+) individuals are at high risk for developing certain hematologic malignancies such as diffuse large B-cell lymphoma and Burkitt lymphoma. Advances in therapeutic management have improved the long-term survival of HIV-infected individuals leading to increases in the incidence of other neoplasms that were hitherto considered rare in this patient population. Nevertheless, T lymphoblastic leukemia/lymphoma (T-ALL/ LBL) remains a rare occurrence in patients with HIV infection; only five cases have been previously reported [1–5]. Here, we describe an additional case of T-ALL/LBL occurring in the setting of HIV infection. A 55-year-old man with a history of HIV/AIDS presented with weakness, fever, weight loss, and a neck mass for 1 month. He was diagnosed with HIV/AIDS 20 years prior to presentation, and his course had been complicated by numerous opportunistic infections. He had been treated with HAART since the time of original diagnosis, but he was reported to be noncompliant. His most recent CD4 count and viral load were 218/μL (normal range 393–1489/μL) and 68 copies/mL (by PCR assay, COBAS AmpliPrep/COBAS TaqMan HIV-1 Test Kit, Version 2.0), respectively. His physical exam was significant for fever (39.5°C), lymphadenopathy (submental, cervical, and inguinal), and skin rash consisting of erythematous papules and hyperpigmented macules on the trunk and proximal extremities. Laboratory studies showed a hemoglobin concentration of 5.1 g/dL (normal range 13.3–16.2 g/dL), a white blood cell count of 4.0 (×10/L, normal range 3.54–9.06), and a platelet count of 52,000/μL (52×10/L, normal range 165–415×10/L). CT scan revealed lymphadenopathy involving the neck, mediastinal, mesenteric, retroperitoneal, and inguinal lymph nodes. A bone marrow biopsy revealed a markedly hypercellular marrow for age (90%), the entire marrow space being replaced by an extensive infiltrate of blasts (Fig. 1a). The marrow aspirate also showed an extensive population of blasts, which accounted for 86% of all marrow nucleated elements. Flow cytometric analysis of the aspirate revealed a population of blasts that expressed CD34, TdT, cytoplasmic CD3, CD5, CD7, CD33, CD43, and HLA-DR and did not express surface CD3, CD2, CD4, CD8, CD1a, CD117, CD13, CD11c, surface TCR, or CD64 (Fig. 1b–d). This immunophenotype was diagnostic of T-ALL. A biopsy of a lymph node from the left neck showed extensive paracortical infiltrates of lymphoblasts, and the immunophenotype of these blasts was similar to that of the blasts in the bone marrow. The lymphoblasts were negative for EBV by EBVencoded RNA in situ hybridization. G band karyotype analysis of the bone marrow and lymph node samples revealed the translocation t(7;14)(p15;q32), which, although rare, has been previously described in association with TK. Z. Gill : S. Hussein :V. V. Murty :G. Bhagat : B. Alobeid (*) Departments of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, 630 W. 168 St., VC14-229, New York, NY 10032, USA e-mail: ba2024@columbia.edu
影响因子：
45.3
作者：
Goldberg, JM;Silverman, LB;Asselin, BL
通讯作者：
Asselin, BL