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Primary Gastric Lymphoma in an HIV-Infected Patient

1996; Lippincott Williams & Wilkins; Volume: 13; Issue: 5 Linguagem: Inglês

10.1097/00042560-199612150-00014

2331-6993

Juan Carlos Rodríguez-Sanjuán, Angel Naranjo, S Echevarrı́a, Concepción Álvarez-Cañas,

Chronic Lymphocytic Leukemia Research

To the Editor: Gastric involvement by a non-Hodgkin lymphoma (NHL) is uncommon in an HIV-infected patient (1-3). In most cases, it is secondary to extragastric, often multifocal lymphomas. A primary gastric NHL (PGNHL) is very infrequent in such patients since only a few cases having a well demonstrated gastric origin have been published (2,4-8). We report a new case of PGNHL in a woman with previously unknown HIV infection. A 55-year-old woman with a promicuous sexual partner sought medical help for epigastric pain lasting for a month. She underwent upper endoscopy and a gastric lesion was discovered, suggesting malignancy. Biopsy showed a MALT (mucosa-associated lymphoid tissue) lymphoma, and the patient was sent to our institution. During preoperative assessment, serum anti-HIV antibodies were found (enzyme-linked immunosorbent assay and Western blot). Overall white cell count was 4,200/dl, with 43% lymphocytes (CD4+: 12%, 216 cells/dl; CD8+: 66%; CD4+/CD8+: 0.18%). The p24 antigen was negative. β2-Microglobulin was 4.1 mg/dl. Serologic tests for toxoplasma and syphilis as well as markers for B and C hepatitis viruses were also negative. Staging studies by means of body computed tomography, gallium-67 scintigraphy, and bone marrow biopsy showed the tumor was limited to the stomach, so surgical treatment was chosen. A partial gastrectomy with radical lymphadenectomy was performed with uneventful recovery. Pathological specimen examination demonstrated a MALT lymphoma showing both low and high grade histology [according to Isaacson et al. classification (9)], with presence of Helicobacter pylori. The specimen borders like the 15 dissected adenopathies were not involved by the tumor, although the latter showed type III HIV persistent lymphadenopathy. Post-operative chemotherapy was not given. The patient rejected antiretroviral therapy due to digestive intolerance. She underwent a progressive CD4+ lymphocyte decrease (25/dl 2 years later), having a Cryptosporidium infection, and died of bilateral bacterial pneumonia 26 months after the operation, without any evidence of lymphoma recurrence. PGNHL is a neoplasm uncommonly associated with HIV infection, especially as a disease indicator at AIDS diagnosis. Three percent of AIDS cases in Europe and 2.2% in Spain present with NHL at diagnosis (10), and most of them are extranodal. Gastrointestinal involvement is rare, between 1.4 and 2.9% (1-3), and frequently multifocal or secondary to a systemic lymphoma. Gastric localization is much more uncommon, ranging between 0.2 and 0.8% of NHL in HIV patients (1-3). Only a few cases of lymphomatous gastric involvement (2,4-8) can be considered as truly primary gastric lymphomas (those limited to stomach and perigastric nodes without spleen, liver, bone marrow, or peripheral blood involvement). The patient reported here had not previously had any HIV-associated disease, so PGNHL was the disease indicator at diagnosis. However, we cannot definitely rule out an incidental association, bearing in mind the relatively high incidence of NHL in patients aged over 50. This report has the additional interest of describing a PGNHL associated with H. pylori infection and the finding of both low and high grade histology, as previously described (9). Juan Carlos Rodríguez-Sanjuán; Angel Naranjo Department of General Surgery; Hospital Universitario Marqués de Valdecilla; Santander, Spain Santiago Echevarría Department of Internal Medicine; Hospital Universitario Marqués de Valdecilla; Santander, Spain Concepción Alvarez-Cañas Department of Pathology; Hospital Universitario Marqués de Valdecilla; Santander, Spain