Transcript Document

HIV ASSOCIATED
MALIGNANCIES
Dr. G. VENKATESAN
Asst. Surgeon
GHTM, Tambaram
OPPORTUNISTIC
MALIGNACIES
Kaposi sarcoma
Lymphoma of Brain


Primary
Secondary
NHL
HL
Burkitt Lymphoma
Cervical dysplasia / Ca
Anal dysplasia / Sq cell Ca
KEY POINTS
High index of clinical suscipion.
Physicians must think in terms of not
only the possibility of opportunistic
infections but also malignancies when
diagnosing and treating HIV positive
patients.
As CD4 count - occurrence as well as
aggressiveness of the malignancies
CASE STUDY
A 25 year- old HIV positive male patient
is having difficulty in breathing, coughs
with expectoration and reports having
no appetite.
What preliminary diagnosis would you
make for this patient?
Cont…
You take an x-ray of the patient and
discover a mediastinal mass.

Given this new information, what diagnosis
would you make for this patient?

What other possible diagnoses could you
make?
KAPOSI’S SARCOMA (KS)
Multicentric Neoplasm consisting of
over growth of venular capillary
endothelium
Can occur as potentially occult lesions
Unusual and rare before AIDS
Most common in North America and
Europe (HOMOSEXUALS)
Closely linked with Human Herpesvirus
HHV8
Cont…
Most common site – skin, Lymph nodes





Others – Mouth, Hard palate,Tip of nose, Penis,
lower legs
GIT, Liver, spleen, Lungs.
Never involves Brain.
Colourful lesions – Red, Violet, Brown, Black
Well circumscribed, flat / raised.
1
CD4 Count X
Aggressiveness
DIAGNOSIS
Made on Clinical suspicion and
confirmed by HPE
Should be differentiated from bacillary
angiomatosis
TREATMENT
Single lesions – RT
Multiple – Vincristine, Bleomycin,
Doxorubicin
Regress with HAART
IYMPHOMA
Primary CNS lymphoma
NHL
HL
Burkitt lymphoma
PRIMARY CNS LYMPHOMA
2nd most common SOL in HIV
Strong association with EBV
CD4 < 50
Difficult to diagnose with imaging
Presentation – focal seizures, Resistant
fever

Lesions – more often solitary
- Deep in white matter
Cont. . .
Confirmed by biopsy

PCR assay of CSF for EBV DNA (90%)
DD – Toxo, Bact. Abscess,
Cryptococcoma, Tuberculoma, Nocardia
RT – difficult to treat.
SYSTEMIC LYMPOMA
Non Hodgin L
Hodgin L
Burkitt L
NON HODGIN LYPHOMA
B Lymphocytes – 80%
T Lymphocytes – 20%
Tend to occur largely at Extranodal sites –
most in CNS, Bone marrow, GIT, Liver, Lungs
Confirmation by HPE
Treatment – Chemotheraphy, Radiotheraphy
HODGIN LYMPHOMA
5 fold
in HIV
More of mixed cellularity / lymphocyte
depleted subtypes
Not in CDC definition of AIDS
Present in advanced stage of AIDS
BURKITT LYMPHOMA
Small non-cleaved cell lymphoma
Most in 10-19 years (young)
C-myc translocation from Ch 8 to Ch
14/22
EBV Positive
Chemotherapy
CERVICAL DYSPLASIA/ Ca
Common cancer in women – 80% of all GYN
cancers
Type 2 HSV
HPV – 16, 18, 31, 33
High risk factors






Multiple partners or monogamous women whose
partner have multiple partners.
Early age at first sexual intercourse
Family size
Heavy smoking
OCP > 8 years
Lower socioeconomic status
Cont…
Erosion, Endocervicitis, Ectropion – not
precursors of CA
Reserve cells beneath columnar EPI at
SC jn – from metaplastic cells (becomes
mature cells)
Metaplasia

Columnar
Squamous
Epidermidization
 Some M cells become atypical
 Atypical metaplasia – precursor of
dysplasia
Cont…
Dysplasia – altered / disorderly
arrangement of cells.
CIN I – Mild
 CIN II – MOD
 CIN III – Sev. - CA in situ

Abnormal vaginal bleeding, discharge,
postcoital bleeding, lower abd – pain
O/E – red, friable, exophytic lesion or
ulcer, bleeds on touch
INV
Screening - Papanicolaou smear – standard
single most effective screening test
Colposcopy
Cericography
Cone – BX
Punch BX
Large loop excision of transformation zone
(LLETZ)
Other investigations
Treatment
Surgery
Conization
 Hysterectomy
 BSO
 Radical H
 Pelvic exenteration
 Cryosurgery
 Laser surgery
 Loop electrosurgical excision procedure
(LEEP)

Cont. . .
RT – Brachy therapy
- Intracavitary radiation (Cobalt,
Caesium, selectron)
Chemo – Cisplatin, Ifosfamide(70%
response)