PLASMA-CELL MYELOMA IN PATIENTS WHO ARE HIV-POSITIVE

This report describes the occurrence of plasma cell neoplasia in three young HIV-positive males. Two patients presented with massive ascites . On cytologic examination of the fluid, many immature plasma cells we re noted. Genotyping of fluid demonstrated clonal rearrangement of imm unoglobulin heavy and kappa light chain genes in both cases. Postmorte m examination on one of these revealed neoplastic plasmacellular infil trate in various organs, including the bone marrow. The third case pre sented with a hemorrhagic, rapidly enlarging gingival mass with a hist ologic appearance of an undifferentiated neoplasm. Immunoperoxidase st udies revealed positive staining only for epithelial membrane antigen. On flow cytometry, the neoplastic cells did not mark with leukocyte c ommon antigen or any of the B- or T-cell markers. Cytoplasmic kappa li ght chain restriction, as well as genotypic studies, confirmed the dia gnosis of anaplastic plasmacytoma. In two cases a clonal population wa s detected using a probe to the terminal repeat region of the Epstein- Barr virus. These results suggest that plasma cell malignancy is anoth er AIDS-associated neoplasm. Its occurrence in this group of patients is not only coincidental.