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This article is part of the supplement: Proceedings of the 13th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI)

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HIV/AIDS-related non-Hodgkin’s lymphomas and confounders: preliminary report of the Sub-Saharan Africa Lymphoma Consortium (SSALC)

Leona W Ayers1*, E Akin Abayomi2, Clement Adebamowo3, David K Chumba4, Yawale Iliyasu5, Kikkeri N Naresh6, Joseph R NDung’u7, Yvonne Perner8, Wendy Stevens9 and Lynnette K Tumwine10

Author Affiliations

1 The Ohio State University Department of Pathology, Columbus, OH, USA

2 Stellenbosch University Division of Haematology, Cape Town, South Africa

3 Institute of Human Virology, Abuja, Nigeria; University of Maryland School of Medicine, Baltimore, MD, USA

4 Moi University Department of Human Pathology and Forensic Medicine, Eldoret, Kenya

5 Ahmadu Bello University Teaching Hospital Department of Pathology, Zaria, Nigeria

6 Imperial College Department of Medicine, London, England, United Kingdom

7 University of Nairobi Department of Pathology, Nairobi, Kenya

8 University of the Witwatersrand School of Pathology, Division of Anatomical Pathology, National Health Laboratory Service, Johannesburg, South Africa

9 University of the Witwatersrand School of Pathology, Division of Molecular Medicine and Haematology, National Health Laboratory Service, Johannesburg, South Africa

10 Makerere University Department of Pathology, Kampala, Uganda

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Infectious Agents and Cancer 2012, 7(Suppl 1):P11  doi:10.1186/1750-9378-7-S1-P11


The electronic version of this article is the complete one and can be found online at: http://www.infectagentscancer.com/content/7/S1/P11


Published:19 April 2012

© 2012 Ayers et al; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background

SSALC was established to characterize HIV/AIDS-related lymphoma and the indigenous background of malignant lymphomas (ML) in sub-Saharan Africa. Because WHO classified lymphoma subgroups can vary in prevalence African, Asian or European ancestry, we surveyed lymphoma heterogeneity in geographically diverse East, South and West sub-Saharan populations, particularly for HIV/AIDS associated immunophenotypes.

Methods

A consortium of African pathologists, hematologist/oncologists and oncologic surgeons contributed ML cases and participated in sub-grouping according to WHO classification criteria after appropriate Institutional Review Board (IRB) approvals, Memoranda of Understanding and Material Transfer Agreements were obtained. Paraffin blocks were examined for tissue morphology (H&E), immunophenotype (34 antibodies IHC), EBER, kappa and lambda light chains (CISH) and c-myc and bcl2 translocations (FISH). HIV/AIDS diversity controls were contributed from Europe by consortium and USA by ACSR.

Results

Consortium members contributed 46 - 368 cases each with 1408 total cases to date: 246 diffuse large B-cell lymphoma (DLBCL), 296 Burkitt lymphoma, 163 Hodgkin disease, 69 plasma cell proliferative disorders and 644 others. Aggressive DLBCL, plasmacytoma/plasmablastic lymphoma, KSHV disease and lymphoid hyperplasia will be highlighted.

Conclusions

Sub-Saharan Africa has a variety of ML subgroups; true incidence altered by: 1) Aspiration vs. biopsy for diagnosis; 2) HIV status not communicated to pathologist; 3) known HIV/AIDS patients not biopsied; 4) initial diagnosis by morphology alone, 5) tissue preservation/processing variable.. General observations: HIV/AIDS-related lymphoma is more likely EBER+, has higher cell proliferation rates, and unfavorable immunophenotypes; regions differ in HIV clades with South (clade C) having the most “immunosuppression” associated lymphoma subgroups; East region has more pre-T lymphoblastic lymphomas and West region has more follicular lymphomas. Confounders: infectious lymphadenopathies (EBV+ lymphoproliferations), undifferentiated neuroblastomas, neuroectodermal tumors (PNETs), poorly differentiated, metastatic carcinomas and malignant melanoma (amelanotic).

Acknowledgement

AIDS and Cancer Specimen Resource (ACSR) NCI U01-CA66531-s Sub-Saharan Africa Lymphoma Consortium (SSALC).