[Grey zone lymphomas: limitations of the classification of aggressive B-cell lymphomas]

EBV-Positive Grey Zone Lymphoma in an HIV Infected Man from Kampala, Uganda: Case Report

AIM

We describe the clinical, histopathological and immunophenotypic characteristics of an HIV-infected adult man on antiretroviral therapy who presented with an EBV-positive grey zone lymphoma.

CASE PRESENTATION

A 56-year-old HIV infected man from Uganda presented with a four month history of progressive abdominal swelling and B-symptoms. He was on highly active antiretroviral therapy (HAART) and cotrimoxazole. He was afebrile (36.9°C), severely wasted (BMI 14.8), and mildly anaemic. On physical examination, he had a 15 by 8 cm mass in the hypogastrium and umbilical region. The total white cell count was 8.3×10³/μL; neutrophils, 5.72×10³/μL; haemoglobin 11.1g/dL, platelets 528×10³/μL, LDH 197 IU/L and CD4 367/μL. Abdominal ultrasound and CT scan showed a tumour involving the mesentery, jejunum and mid ileum. At laparotomy, a biopsy was taken, fixed, processed and stained with Haematoxylin & Eosin (H & E). Histopathology demonstrated large pleomorphic cells admixed with inflammatory smaller cells, Reed-Sternberg-like cell variants and frequent abnormal mitoses. Biomarkers CD20, PAX5, CD30 were positive but ALK negative (immunohistochemistry and strong EBER positivity in situ hybridization. The patient improved on modified CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy.

DISCUSSION

The tumour had features intermediate between mediastinal large B cell lymphoma and classical Hodgkin lymphoma.

CONCLUSION

We present a case of EBV-positive grey zone lymphoma in an HIV-infected man on HAART therapy diagnosed and treated in a resource constrained medical setting. The histological features are unusual and represent a low incidence lymphoma that is recognized by mixed features reminiscent of Hodgkin's lymphoma and mediastinal large B-cell lymphoma.