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Diagnosis of HIV-related malignancies in resource-constrained settings of sub-Saharan Africa, a cautionary tale for non-Hodgkin’s lymphoma

Infectious Agents and Cancer20105 (Suppl 1) :A19

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  • Histopathology Diagnosis
  • Medical Setting
  • Cautionary Tale
  • Pathology Archive
  • Clinical Treatment Trial


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).


There was a small but consistent population of other tumors that reduced the accuracy of both the clinical and histopathology diagnosis of NHLs including those given in Table 1.
Table 1

Confounding tumor look-alikes.


Subtype examples/confounding factors

Presentation or clinical classification

Fungal infections

African histoplasmosis

Kaposi’s sarcoma


Entomophthoromycosis – Basidiobolus ranarum



HIV-1 lymphadenopathy, follicular hyperplasia


Viral lymphadenopathy

EBV lymphadenopathy or lymphoproliferative disorders



HHV-8 lymphoblastic lymphoma

Burkitt lymphoma


Castleman’s disease

Atypical hyperplasia

Pediatric small round cell tumors

Undifferentiated neuroblastoma

Burkitt lymphoma


Primitive neuroectodermal tumors (PNET)

Burkitt lymphoma

Hodgkin’s disease

Lymphocyte predominant

Burkitt lymphoma


Poorly differentiated



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

Authors’ Affiliations

Department of Pathology, The Ohio State University, Columbus, OH, USA
Department of Pathology, Makerere University, Kampala, Uganda
AIDS and Cancer Specimen Resource, ACSR, NIH, USA
Sub-Saharan Africa Lymphoma Consortium, SSALC, ACSR, OHAM, USA


© Ayers et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.