An unusual and challenging case of HIV-associated primary CNS Lymphoma with Hodgkin-like morphology and HIV encephalitis

Isaac E. Lloyd, Parker W. Clement, Karen L. Salzman, Randy L. Jensen, Mohamed Salama, Cheryl A. Palmer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

HIV-associated primary CNS lymphomas are well-recognized, almost exclusively EBV-driven neoplasms with poor clinical prognosis. We report a challenging, atypical case of an HIV-associated lymphoproliferative disorder with unusual morphologic features reminiscent of Hodgkin Lymphoma, accompanied by HIV encephalitis. A 52-year-old male presented with acute seizures after seven months of progressive neurocognitive decline that was clinically diagnosed as progressive supranuclear palsy. Clinical work-up revealed HIV infection along with two ring-enhancing lesions in the brain on MRI, and negative CSF EBV testing. Subsequent biopsy showed well-demarcated hypercellular regions in the brain comprised of scattered Reed-Sternberg-like cells in a background of small to medium-sized lymphocytes exhibiting focal angiocentricity and geographic necrosis. The atypical cells were positive for CD20, EBV, and CD79a, and negative for CD45, GFAP, CD15, CD30, and p24. These cells were admixed with numerous CD68-positive cells. The adjacent brain showed classic features of HIV encephalitis with perivascular, CD68 and p24-positive multinucleated giant cells. This case illustrates several diagnostic pitfalls in the work-up of HIV-associated brain lesions, as well as reporting a unique histomorphology for an HIV-related primary CNS lymphoproliferative disorder.

Original languageEnglish (US)
Article number152
JournalDiagnostic pathology
Volume10
Issue number1
DOIs
StatePublished - Sep 2 2015
Externally publishedYes

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Encephalitis
Hodgkin Disease
HIV
Human Herpesvirus 4
Lymphoproliferative Disorders
Brain
Reed-Sternberg Cells
Progressive Supranuclear Palsy
Giant Cells
HIV Infections
Lymphoma
Seizures
Necrosis
Lymphocytes
Biopsy
Neoplasms

Keywords

  • Encephalitis
  • Human Immunodeficiency Virus (HIV)
  • Primary Central Nervous System Lymphoma (PCNSL)

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Cite this

An unusual and challenging case of HIV-associated primary CNS Lymphoma with Hodgkin-like morphology and HIV encephalitis. / Lloyd, Isaac E.; Clement, Parker W.; Salzman, Karen L.; Jensen, Randy L.; Salama, Mohamed; Palmer, Cheryl A.

In: Diagnostic pathology, Vol. 10, No. 1, 152, 02.09.2015.

Research output: Contribution to journalArticle

Lloyd, Isaac E. ; Clement, Parker W. ; Salzman, Karen L. ; Jensen, Randy L. ; Salama, Mohamed ; Palmer, Cheryl A. / An unusual and challenging case of HIV-associated primary CNS Lymphoma with Hodgkin-like morphology and HIV encephalitis. In: Diagnostic pathology. 2015 ; Vol. 10, No. 1.
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