HISTOPATHOLOGIC SPECTRUM OF AIDS-ASSOCIATED LESIONS IN MAHARAJ-NAKORN-CHIANG-MAI-HOSPITAL

The histopathological alterations in various organs and the presence o f AIDS-associated lesions were studied in 86 biopsy and 29 necropsy sp ecimens of AIDS patients. The most common cancer seen in this study we re malignant lymphomas (4% of cases) with development of extensive ext ranodal lymphomatous involvement from the outset. Although a preponder ance of high grade B-cell pathologic subtypes is found in AIDS-associa ted lymphoma, we also report the first case of T-lymphoblastic lymphom a with a picture of acute lymphoblastic leukemia (T-ALL). Tuberculosis (34% of cases) was the most common opportunistic infection presented in tissue sections, and the majority of tissue biopsies revealed poorl y organized granulomas and extensive necrosis with numerous bacilli. P enicilliosis (20% of cases) appeared to be the most common cutaneous l esion with multiple organ involvement. The involved organs showed a pa rtially anergic tissue reaction characterized by poorly formed granulo mas with diffuse infiltrate of fungi-laden macrophages and lymphoid ce ll depletion. This organism has to be distinguished from Histoplasma c apsulatum and other yeast-form fungi. Co-existing cytomegalovirus and P. carinii infections were the pre dominant findings in lung necropsy specimens from pediatric patients who died from AIDS. A major patholog ic feature in this group was diffuse alveolar damage stage II to III w ith heavy loads of organism and extensive lymphoplasmacytic infiltrati on.