Primary effusion lymphoma associated with Human Herpes Virus-8 and Epstein Barr virus in an HIV-infected woman from Kampala, Uganda

A case report

Lynnette K. Tumwine, Rejani Lalitha, Claudio Agostinelli, Simon Luzige, Jackson Orem, Pier Paolo Piccaluga, Lawrence O. Osuwat, Stefano A. Pileri

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction. Primary effusion lymphoma is a recently recognized entity of AIDS related non-Hodgkin lymphomas. Despite Africa being greatly affected by the HIV/AIDS pandemic, an extensive MEDLINE/PubMed search failed to find any report of primary effusion lymphoma in sub-Saharan Africa. To our knowledge this is the first report of primary effusion lymphoma in sub-Saharan Africa. We report the clinical, cytomorphologic and immunohistochemical findings of a patient with primary effusion lymphoma. Case presentation. A 70-year-old newly diagnosed HIV-positive Ugandan African woman presented with a three-month history of cough, fever, weight loss and drenching night sweats. Three weeks prior to admission she developed right sided chest pain and difficulty in breathing. On examination she had bilateral pleural effusions. Haematoxylin and eosin stained cytologic sections of the formalin-fixed paraffin-embedded cell block made from the pleural fluid were processed in the Department of Pathology, Makerere University, College of Health Sciences, Kampala, Uganda. Immunohistochemistry was done at the Institute of Haematology and Oncology "L and A Seragnoli", Bologna University School of Medicine, Bologna, Italy, using alkaline phosphatase anti-alkaline phosphatase method. In situ hybridization was used for detection of Epstein-Barr virus. The tumor cells were CD45+, CD30+, CD38+, HHV-8 LANA-1+; but were negative for CD3-, CD20-, CD19-, and CD79a- and EBV RNA+ on in situ hybridization. CD138 and Ki-67 were not evaluable. Our patient tested HIV positive and her CD4 cell count was 127/L. Conclusions: A definitive diagnosis of primary effusion lymphoma rests on finding a proliferation of large immunoblastic, plasmacytoid and anaplastic cells; HHV-8 in the tumor cells, an immunophenotype that is CD45+, pan B-cell marker negative and lymphocyte activated marker positive. It is essential for clinicians and pathologists to have a high index of suspicion of primary effusion lymphoma when handling HIV positive patients who have effusions without palpable tumor masses. Basic immunohistochemistry is essential for definitive diagnosis.

Original languageEnglish
Article number60
JournalJournal of Medical Case Reports
Volume5
DOIs
Publication statusPublished - 2011

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Primary Effusion Lymphoma
Uganda
Human Herpesvirus 4
HIV
Viruses
Human Herpesvirus 8
Africa South of the Sahara
In Situ Hybridization
Alkaline Phosphatase
AIDS-Related Lymphoma
Immunohistochemistry
Neoplasms
Sweat
Pandemics
Hematology
Pleural Effusion
Hematoxylin
Eosine Yellowish-(YS)
CD4 Lymphocyte Count
Chest Pain

ASJC Scopus subject areas

  • Medicine(all)

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Primary effusion lymphoma associated with Human Herpes Virus-8 and Epstein Barr virus in an HIV-infected woman from Kampala, Uganda : A case report. / Tumwine, Lynnette K.; Lalitha, Rejani; Agostinelli, Claudio; Luzige, Simon; Orem, Jackson; Piccaluga, Pier Paolo; Osuwat, Lawrence O.; Pileri, Stefano A.

In: Journal of Medical Case Reports, Vol. 5, 60, 2011.

Research output: Contribution to journalArticle

Tumwine, Lynnette K. ; Lalitha, Rejani ; Agostinelli, Claudio ; Luzige, Simon ; Orem, Jackson ; Piccaluga, Pier Paolo ; Osuwat, Lawrence O. ; Pileri, Stefano A. / Primary effusion lymphoma associated with Human Herpes Virus-8 and Epstein Barr virus in an HIV-infected woman from Kampala, Uganda : A case report. In: Journal of Medical Case Reports. 2011 ; Vol. 5.
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AU - Lalitha, Rejani

AU - Agostinelli, Claudio

AU - Luzige, Simon

AU - Orem, Jackson

AU - Piccaluga, Pier Paolo

AU - Osuwat, Lawrence O.

AU - Pileri, Stefano A.

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AB - Introduction. Primary effusion lymphoma is a recently recognized entity of AIDS related non-Hodgkin lymphomas. Despite Africa being greatly affected by the HIV/AIDS pandemic, an extensive MEDLINE/PubMed search failed to find any report of primary effusion lymphoma in sub-Saharan Africa. To our knowledge this is the first report of primary effusion lymphoma in sub-Saharan Africa. We report the clinical, cytomorphologic and immunohistochemical findings of a patient with primary effusion lymphoma. Case presentation. A 70-year-old newly diagnosed HIV-positive Ugandan African woman presented with a three-month history of cough, fever, weight loss and drenching night sweats. Three weeks prior to admission she developed right sided chest pain and difficulty in breathing. On examination she had bilateral pleural effusions. Haematoxylin and eosin stained cytologic sections of the formalin-fixed paraffin-embedded cell block made from the pleural fluid were processed in the Department of Pathology, Makerere University, College of Health Sciences, Kampala, Uganda. Immunohistochemistry was done at the Institute of Haematology and Oncology "L and A Seragnoli", Bologna University School of Medicine, Bologna, Italy, using alkaline phosphatase anti-alkaline phosphatase method. In situ hybridization was used for detection of Epstein-Barr virus. The tumor cells were CD45+, CD30+, CD38+, HHV-8 LANA-1+; but were negative for CD3-, CD20-, CD19-, and CD79a- and EBV RNA+ on in situ hybridization. CD138 and Ki-67 were not evaluable. Our patient tested HIV positive and her CD4 cell count was 127/L. Conclusions: A definitive diagnosis of primary effusion lymphoma rests on finding a proliferation of large immunoblastic, plasmacytoid and anaplastic cells; HHV-8 in the tumor cells, an immunophenotype that is CD45+, pan B-cell marker negative and lymphocyte activated marker positive. It is essential for clinicians and pathologists to have a high index of suspicion of primary effusion lymphoma when handling HIV positive patients who have effusions without palpable tumor masses. Basic immunohistochemistry is essential for definitive diagnosis.

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