Pulmonary manifestations of AIDS-related lymphomas
- Michael Ieong, MD
Michael Ieong, MD
- Assistant Professor of Medicine
- Boston University School of Medicine
- Timothy P Cooley, MD
Timothy P Cooley, MD
- Associate Professor of Medicine
- Boston University School of Medicine
- Section Editors
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
- Arnold S Freedman, MD
Arnold S Freedman, MD
- Section Editor — Lymphoproliferative Disorders
- Professor of Medicine
- Harvard Medical School
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
Human immunodeficiency virus (HIV) infection is associated with an increased incidence of lymphoma. The majority of AIDS-related lymphomas are aggressive, non-Hodgkin lymphoma (NHL) of B cell origin; nearly 60 percent are diffuse large B cell lymphoma and 40 percent Burkitt lymphoma . Most patients show widespread rather than nodal disease, frequently involving the central nervous system (CNS), gastrointestinal tract, lungs, bone marrow, and mucocutaneous tissues. Rare cases of primary pulmonary NHL have been reported [2-4]. NHL in an HIV-infected patient is an AIDS-defining condition.
Hodgkin lymphoma is also more frequent among HIV-infected patients relative to the general population, but overall is less common than NHL, less likely to affect the lungs, and not an AIDS-defining condition [5-9].
Primary effusion lymphoma (PEL) is a rare aggressive tumor seen in HIV infected patients, in association with Kaposi sarcoma-associated herpesvirus (KSHV)/human herpesvirus 8. It has a predisposition to arise in body cavities, such as the pleural space.
The clinical manifestations, diagnosis, and approach to treatment of HIV-associated NHL lymphoma presenting in the chest will be reviewed here. The extra-pulmonary AIDS-related lymphomas, non-AIDS-defining lymphoma, PEL, and Castleman's disease are discussed separately. (See "AIDS-related lymphomas: Epidemiology, risk factors, and pathobiology" and "AIDS-related lymphomas: Primary effusion lymphoma" and "Multicentric Castleman's disease" and "HIV infection and malignancy: Management considerations", section on 'Hodgkin lymphoma'.)
Early in the human immunodeficiency virus (HIV) epidemic, non-Hodgkin lymphoma (NHL) occurred in 2 to 5 percent of HIV-infected patients [10,11]. After the introduction of potent antiretroviral therapy (ART) in the mid-1990s, the incidence of NHL in HIV-infected people peaked around 10 percent but has subsequently dropped to approximately 5 percent . (See "AIDS-related lymphomas: Epidemiology, risk factors, and pathobiology", section on 'Epidemiology'.)
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- PATHOLOGICAL FEATURES
- CLINICAL MANIFESTATIONS
- Laboratory testing
- Pleural fluid analysis
- DIAGNOSIS OF PULMONARY PARENCHYMAL LYMPHOMA
- Transthoracic needle biopsy
- Lung biopsy
- DIAGNOSIS OF MEDIASTINAL LYMPHOMA
- DIAGNOSIS OF PLEURAL LYMPHOMA
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS