Shahid Waheed, M.D.
   AIDS Malignancy

Due to patients living longer, 40% of
human immunodeficiency virus disease
patients will develop malignancy.
Malignancies strongly related

 Kaposi’s sarcoma

 Non-Hodgkin’s lymphoma

 Cervical carcinoma
Controversial malignancies
related to AIDS

 Anal carcinoma
 Hodgkin’s disease
 Non-melanomatous skin cancer
 Pediatric leiomyosarcoma
Kaposi’s Sarcoma

 Most common tumor associated with
 human immunodeficiency virus
 Approximately 10% of patients with
 AIDS will develop Kaposi’s sarcoma
Kaposi’s Sarcoma
   Higher in males than females. Male to
   female ratio is 3:1.
   Age: 30-40 years old
   Race: No racial or ethnic differences
   Geography: Kaposi’s sarcoma is more
   prevalent in the United States compared to
   Europe, also higher in Africa.
Kaposi’s Sarcoma
 Etiology and Risk Factors:
   In the U.S. Kaposi’s sarcoma
   predominantly occurs in homosexual men.
   Viruses: In 1994 unique viral DNA
   sequences were identified in tumor tissue
   from the patients with AIDS – Kaposi’s
   sarcoma, which led to identification of a
   new virus called Kaposi’s sarcoma
   associated herpes virus, HHV-8.
Kaposi’s Sarcoma
 Signs and Symptoms
  Kaposi’s sarcoma has a variable range from
  small lesions through marked involvement
  of visceral organs
    Skin lesions
       Kaposi’s sarcoma tumors typically are flat raised
       lesions that progress to plaque-like or nodular
       tumors. They vary in size and shape.
       Most lesions are found on the body surface, but can
       be seen in upper body and head and neck areas.
       They may disappear spontaneously.
Kaposi’s Sarcoma
 Signs and Symptoms
   Dermal and lymphatic infiltration of the tumor can
   result in edema of the extremities, peri-orbital
   areas and genital areas.
   Other places lesions can be found:
     Oral area
     Gastrointestinal tract
     Pulmonary area
Kaposi’s Sarcoma
   Cutaneous Kaposi’s sarcoma is a lesion of
   the dermis and can be diagnosed on
 Staging System
   Staging for classification
Kaposi’s Sarcoma
   Must be individualized
     Patients with widespread disease or life threatening
     organ involvement require chemotherapy treatments.
     For patients with asymptomatic slow growing lesions,
     aggressive treatment is not mandatory.
     Treatment options include:
         Interferon alpha
Non-Hodgkin’s Lymphoma
   All HIV infected groups including:
      Intravenous drug users
      Homosexual men
      Transfusion recipient
      Patients with hemophilia are at risk for nonHodgkin’s
   Gender and Race
      Men are more affected than women and Caucasians
      more than African-Americans
Non-Hodgkin’s Lymphoma
     No specific age distribution
     No particular geographic differences noted
Non-Hodgkin’s Lymphoma
 Etiology and Risk Factors
   It is believed that continuous stimulation of
   B-cell proliferation as a result of HIV,
   Epstein-Barr virus infection, and other
   infections in the setting of T7
   immunodeficiency give rise to
   non-Hodgkin’s lymphoma
Non-Hodgkin’s Lymphoma
 Etiology and Risk Factors
   The common histological type of
   non-Hodgkin’s lymphoma in AIDS
     Small noncleaved lymphomas
     Immunoblastic lymphomas
     Diffuse large cell lymphomas
     Body cavity based lymphoma
Non-Hodgkin’s Lymphoma
 Signs and Symptoms
   B symptoms
   Fever, weight loss, night sweats in about 80% of
   patients with AIDS related non-Hodgkin’s
   Extranodal involvement is more prevalent in
   nonHodgkin’s lymphoma related to AIDS
   CNS lymphoma; patients will present with seizures
   or mental status change
   Primary effusion lymphoma usually with pleural or
   pericardial effusion without an identifiable mass
Non-Hodgkin’s Lymphoma
 Screening and Diagnosis
   CAT scan or MRI of the head, chest,
   abdomen and pelvis, bone marrow
   aspiration and biopsy, liver function
   studies, spinal fluid analysis, and assessing
   spinal fluid for Epstein-Barr virus by PCR
Non-Hogdkin’s Lymphoma
 Prognostic Factors:
   CD4 count less than 20 per cubic mm
   CD4 count less than 200 per cubic mm
   History of opportunistic infections prior to
   Karnofsky’s performance score less than 70
   and Stage 4 disease
Non-Hodkin’s Lymphoma
 Treatment includes:
   Cerebral regimen commonly used CHOP
   includes Cyclophosphamide, Doxorubicin,
   Vincristine, Prednisone and Prednisone
 Treatment options:
   Radiation for CNS lymphoma also used in
   combination with chemotherapy
Cervical Carcinoma in HIV
 First recognized in 1993
   Prevalence is about 6-7% in patients with
   abnormal PAP smear
   HIV positive women have more than
   10-fold increase of abnormal cervical cytology
   Prevalence of invasive cervical carcinoma among
   U.S., Hispanic and black women is lower than in
   white women.
Cervical Carcinoma
Signs and Symptoms
  Post-coital bleeding with foul smelling
  vagial discharge
  Lumosacral pain
  Urinary tract infections
  Obstructive symptoms
Cervical Carcinoma
 Work-up with women of invasive
 carcinoma include:
   Pelvic examination
   CT of the pelvis and abdomen
   Chest x-ray
   Liver function studies
   Pathology for squamous cell carcinoma
   most common most positive cervical
   carcinoma area of the squamous cell type
Cervical Carcinoma

  Radiation treatment
Anal Carcinoma
 Increased risk of anal carcinoma in
 homosexual men
 In San Francisco area, estimated range
 between 25 to 87 cases per 100,000
 compared with 0.7 cases per 100,000 in
 entire male population.
 Etiology and risk facators HPV Type 16 and
 18 associated with involvement of anal
Anal Carcinoma
 Other sexually transmitted diseases and
 sexual practices and history of perianal
 herpes simplex and anal condylomas, or
 practice of anal receptive behavior with
 multiple sexual partners increases risk
 of developing anal cancer.
Anal Carcinoma
  Rectal pain
  Obstructive mass
Anal Carcinoma
   Most common is squamous cell carcinoma
 Anal intraepithelial neoplasia
   Ablative therapy, like cervical in situ neoplasia
 Treatment of squamous cell carcinoma
 invasive includes combination of
 chemotherapy and radiation

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