title: Early peripheral lymph node involvement of human herpesvirus 8-associated, body cavity-based lymphoma in a human immunodeficiency virus-negative patient.
abstract: Human herpesvirus 8 (HHV-8), or Kaposi sarcoma-associated herpesvirus, is a gamma herpesvirus first detected in a specimen of Kaposi sarcoma from a human immunodeficiency virus (HIV)-positive patient. Human herpesvirus 8 is also found in an unusual clinicopathologic form of body cavity-based B-cell lymphoma, which has been named primary effusion lymphoma (PEL) and occurs primarily in HIV-positive patients. PEL is characterized by the formation of lymphomatous effusions, without obvious lymphadenopathy, tumor masses, or bone marrow involvement. Only a few cases of PEL in HIV-seronegative patients have been reported. We describe a case of an HHV-8-associated lymphoma, with ascites, pleural effusion, and axillary lymphadenopathy in an HIV-negative patient. The patient was a 68-year-old Jewish man of North African extraction, with a previous history of coronary bypass surgery and multiple blood transfusions. The pleural fluid contained large atypical lymphoid cells and was suggestive of lymphoma but could not provide a conclusive diagnosis of PEL. The lymph node contained groups of large anaplastic lymphoid cells. Polymerase chain reaction for HHV-8 performed on the lymph node specimen was positive, establishing the diagnosis of PEL. Polymerase chain reaction for Epstein-Barr virus was negative. Results of a gallium scan were normal. The patient did not respond to combination chemotherapy with cyclophosphamide, doxorubicin, vincristine sulfate, and prednisone and progressively developed, massive intra-abdominal solid tumor formation. To our knowledge, this is the first report of a case of PEL that demonstrates peripheral lymph node involvement at diagnosis and the first report of PEL in an Israeli patient.
authors.affiliation: Department of Oncology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel. ariad@bgumail.bgu.ac.il
authors.forename: S
authors.initials: S
authors.lastname: Ariad
authors.forename: D
authors.initials: D
authors.lastname: Benharroch
authors.forename: L
authors.initials: L
authors.lastname: Lupu
authors.forename: B
authors.initials: B
authors.lastname: Davidovici
authors.forename: N
authors.initials: N
authors.lastname: Dupin
authors.forename: C
authors.initials: C
authors.lastname: Boshoff
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001706:Biopsy; D017809:Fatal Outcome; D018023:HIV Seronegativity; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D017730:Ki-1 Antigen / Q000032:analysis; D008198:Lymph Nodes / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000473:pathology* / Q000821:virology*; D008297:Male; D018396:Mucin-1 / Q000032:analysis; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging / Q000209:etiology; D016133:Polymerase Chain Reaction; D011859:Radiography
chemical_list: D017730:Ki-1 Antigen; D018396:Mucin-1