CD20-negative large-cell lymphoma with plasmablastic features: a clinically heterogenous spectrum in both HIV-positive and -negative patients.
BACKGROUND
Plasmablastic lymphoma (PBL) has been described as a rapidly progressive and almost invariably fatal CD20- VS38c+ diffuse large-cell lymphoma with plasmablastic features, almost exclusively involving the jaw and oral mucosa in HIV-positive patients.


METHODS
From 2001 to 2003 we evaluated 12 men with PBL, and report the pathology, clinical findings, treatment and outcome. Six of 12 were HIV-positive while among the others, one was post-renal transplant, one had ulcerative colitis and four had no known immunodeficiency.


RESULTS
Tumor growth pattern, in general, showed cohesiveness and a starry-sky pattern; the morphology varied from typical plasmablastic to centroblastic cells. Partial immunophenotypes were (+/total): CD138, 11 of 12 (91.7%); MIB1 10 of 11 (4+, range 75-95%); p63/VS38c, nine of 10 (90%); EBV, eight of 11 (73%); LCA(CD45), two of 12 (16.7%); HHV8/LANA, zero of 10; ALK, zero of seven; and CD20, zero of 12. Three had stage IE and nine stage IV disease. Nine of 12 had an intermediate/high International Prognostic Index or high-risk disease. Computed tomography and positron emission tomography scan in four of 12 revealed extensive bone metastases. Eight of 12 are alive after treatment, with a median follow-up of 11+ months (range 1-24). Of the HIV-positive patients, five of six are alive with a median follow-up of 17 months.


CONCLUSIONS
It appears that PBL are heterogenous in terms of clinical presentation and morphology. The outcome presented here is superior to that originally reported.
Teruya-Feldstein
J
J
Department of Pathology, Memorial Sloan-Kettering Cancer Center, NY 10021, USA. feldstej@mskcc.org
Chiao
E
E
Filippa
D A
DA
Lin
O
O
Comenzo
R
R
Coleman
M
M
Portlock
C
C
Noy
A
A
D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000097:blood*; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016130:Immunophenotyping; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D015996:Survival Rate
D018951:Antigens, CD20