An unusual and challenging case of HIV-associated primary CNS Lymphoma with Hodgkin-like morphology and HIV encephalitis.
HIV-associated primary CNS lymphomas are well-recognized, almost exclusively EBV-driven neoplasms with poor clinical prognosis. We report a challenging, atypical case of an HIV-associated lymphoproliferative disorder with unusual morphologic features reminiscent of Hodgkin Lymphoma, accompanied by HIV encephalitis. A 52-year-old male presented with acute seizures after seven months of progressive neurocognitive decline that was clinically diagnosed as progressive supranuclear palsy. Clinical work-up revealed HIV infection along with two ring-enhancing lesions in the brain on MRI, and negative CSF EBV testing. Subsequent biopsy showed well-demarcated hypercellular regions in the brain comprised of scattered Reed-Sternberg-like cells in a background of small to medium-sized lymphocytes exhibiting focal angiocentricity and geographic necrosis. The atypical cells were positive for CD20, EBV, and CD79a, and negative for CD45, GFAP, CD15, CD30, and p24. These cells were admixed with numerous CD68-positive cells. The adjacent brain showed classic features of HIV encephalitis with perivascular, CD68 and p24-positive multinucleated giant cells. This case illustrates several diagnostic pitfalls in the work-up of HIV-associated brain lesions, as well as reporting a unique histomorphology for an HIV-related primary CNS lymphoproliferative disorder.
Department of Pathology, University of Utah, 15 North Medical Drive East, Suite #1100, Salt Lake City, UT, 84112, USA. isaac.lloyd@hsc.utah.edu.
Isaac E
IE
Lloyd
Department of Pathology, University of Utah, 15 North Medical Drive East, Suite #1100, Salt Lake City, UT, 84112, USA. parker.clement@hsc.utah.edu.
Parker W
PW
Clement
Department of Radiology, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA. karen.salzman@hsc.utah.edu.
Karen L
KL
Salzman
Department of Neurosurgery, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. randy.jensen@hsc.utah.edu.
Randy L
RL
Jensen
Department of Pathology, University of Utah and ARUP Laboratories, ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108-1221, USA. mohamed.salama@path.utah.edu.
Mohamed E
ME
Salama
Department of Pathology, University of Utah, Huntsman Cancer Institute, 1950 Circle of Hope Drive, N3150, Salt Lake City, UT, 84112, USA. cheryl.palmer@path.utah.edu.
Cheryl A
CA
Palmer
D015526:AIDS Dementia Complex / Q000150:complications / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000150:complications; D006801:Humans; D007150:Immunohistochemistry; D016483:Lymphoma, AIDS-Related / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged
D014408:Biomarkers, Tumor