Diagnosis of HIV-related malignancies in resource-constrained settings of sub-Saharan Africa, a cautionary tale for non-Hodgkin’s lymphoma
© Ayers et al; licensee BioMed Central Ltd. 2010
Published: 11 October 2010
Non-Hodgkin’s lymphoma (NHL) subgroups, immunophenotypes, and genotypes have been defined in developed countries but how that information translates to resource-constrained sub-Saharan Africa medical settings is undocumented. Local published data on NHL subgroups come largely from retrospective clinical biopsy study sets of paraffin-embedded tissues filed in local pathology archives. Relatively poorer representation of the rural and low socioeconomic populations is likely in such data. Prospectively identified NHL subgroups using immunologic and molecular techniques in consecutive presentations of patients would best clarify NHL subgroups and confounding diagnoses.
Materials and methods
Approximately 456 cases of malignant lymphoma (ML) from both the sub-Saharan African Lymphoma Consortium and Mid-region AIDS and Cancer Specimen Resource (ACSR) projects in East Africa were examined for microscopic morphology and 30 monoclonal antibodies for common NHL antigens; Lana-1 for HHV-8 (immunohistochemical, IHC); in situ hybridization (ISH) for EBV-encoded RNA, kappa/lambda light chains (Ventana, Tucson, AZ); and fluorescent in situ hybridization (FISH) c-myc t(8;14) (Abbott/Vysis, Downer’s Grove, IL).
Confounding tumor look-alikes.
Subtype examples/confounding factors
Presentation or clinical classification
Entomophthoromycosis – Basidiobolus ranarum
HIV-1 lymphadenopathy, follicular hyperplasia
EBV lymphadenopathy or lymphoproliferative disorders
HHV-8 lymphoblastic lymphoma
Pediatric small round cell tumors
Primitive neuroectodermal tumors (PNET)
Clinical diagnosis of NHL is complicated by other pathological entities that lead to inaccuracies. Histopathology diagnosis based on hematoxylin and eosin (H&E) stained tissue morphology alone improves accuracy (vs. clinical diagnoses alone) but can provide additional inaccuracies due to tumor look-alikes. Caution is warranted in considering either clinical diagnosis or local histopathology diagnosis in a resource-constrained medical setting as accurate in the conduct of clinical treatment trials or epidemiology studies.
This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.
This article is published under license to BioMed Central Ltd.