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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.

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hiv associated malignancies

HIV ASSOCIATED MALIGNANCIES

Dr. G. VENKATESAN

Asst. Surgeon

GHTM, Tambaram

opportunistic malignacies
OPPORTUNISTIC MALIGNACIES
  • Kaposi sarcoma
  • Lymphoma of Brain
    • Primary
    • Secondary
  • NHL
  • HL
  • Burkitt Lymphoma
  • Cervical dysplasia / Ca
  • Anal dysplasia / Sq cell Ca
key points
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
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?
slide5
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
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
slide8
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
DIAGNOSIS
  • Made on Clinical suspicion and confirmed by HPE
  • Should be differentiated from bacillary angiomatosis
treatment
TREATMENT
  • Single lesions – RT
  • Multiple – Vincristine, Bleomycin, Doxorubicin
  • Regress with HAART
iymphoma
IYMPHOMA
  • Primary CNS lymphoma
  • NHL
  • HL
  • Burkitt lymphoma
primary cns 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

slide14
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
SYSTEMIC LYMPOMA
  • Non Hodgin L
  • Hodgin L
  • Burkitt L
non hodgin lyphoma
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
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
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
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
slide20
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
slide22
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
slide23
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
treatment24
Treatment
  • Surgery
    • Conization
    • Hysterectomy
    • BSO
    • Radical H
    • Pelvic exenteration
    • Cryosurgery
    • Laser surgery
    • Loop electrosurgical excision procedure (LEEP)
slide25
Cont. . .
  • RT – Brachy therapy

- Intracavitary radiation (Cobalt, Caesium, selectron)

  • Chemo – Cisplatin, Ifosfamide(70% response)