[Non-Hodgkin's lymphomas of the digestive tract and anexal glands in AIDS patients].
BACKGROUND
Non-Hodgkin's lymphoma (NHL) is the second most common neoplasm among patients with AIDS. One of the major clinical characteristics of AIDS-associated NHL is the high frequency of extra-nodal involvement, including the gastrointestinal tract, at initial presentation.


METHODS
From January 1997 to December 2004, 8 cases of NHL of the digestive tract and anexal glands (liver and parotid gland) were observed at the HIV/AIDS division of the Infectious Diseases FJ Muñiz Hospital from Buenos Aires, Argentina. All patients were staged by computed tomography scanning and bone marrow examination, in addition to the endoscopic evaluation.


RESULTS
All patients were males; 4 were heterosexual, 2 homosexual, and 1 were a hemophilic and an intravenous drug abuser. The median age was 42 years and the median CD4 T cell count was 87 cells/uL at the time of the diagnosis of neoplasm. No patient was receiving highly active antiretroviral therapy (HAART) at lymphoma diagnosis. The global incidence of AIDS-associated lymphomas (central nervous system lymphomas, non-Hodgkin lymphomas and Hodgkin lymphoma) during the time of study was 2,9% (54 cases); 17 patients (32%) had diagnosis of systemic NHL; 10 (58,8%) of them were extranodal at the onset of clinical symptoms and 8 (80%) involvement the digestive tract and anexal glands (parotid gland, cavum, esophagus, stomach, duodenum, the right colon in 2 patients and the liver), as primary NHL of high grade and "B" phenotype. All patients presented "B" symptoms at the time of diagnosis. Primary duodenal lymphoma was the only Burkitt lymphoma of this serie and we detected the Epstein-Barr virus genome in the biopsy smears of this tumor and in the hepatic lymphoma. Four patients were treated with systemic chemotherapy with granulocitic growth factor support plus highly active antiretroviral therapy (HAART); 2 of them (cavum and one of the colon) had a prolonged survival with immune reconstitution during 5 and 6 years, respectively, after the diagnosis. The median survival of the patients, which received HAART plus chemotherapy, was 33 months. The median survival of the others patients was 90 days.


CONCLUSIONS
NHL of the gastrointestinal tract is a severe complication of advanced HIV/AIDS disease. Early diagnosis followed by chemotherapy plus HAART are necessary to improve the prognosis and the survival of these patients.
Corti
Marcelo
M
Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina. marcelocorti@fibertel.com.ar
Villafañe Fioti
María F
MF
Lewi
Daniel
D
Schtirbu
Ricardo
R
Narbaitz
Marina
M
de Dios Soler
Marcela
M
D000328:Adult; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D009367:Neoplasm Staging; D010307:Parotid Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis