The spectrum of cutaneous lymphomas in HIV infection - A study of 21 cases

We studied 21 HIV-associated lymphomas with cutaneous presentation to deter mine whether they showed features of primary cutaneous lymphoma arising for tuitously or whether they represented the cutaneous involvement of AIDS sys temic lymphoma. Besides rare mycosis fungoides (n = 3), which shared typica l clinicopathologic lesions, nonepidermotropic large-cell lymphomas (n = 18 ) were predominant. They frequently presented as a solitary nodule or tumor . Seven of the eight large T-cell lymphomas had a CD30-positive (CD30+) phe notype but did not express ALK protein. Overexpression of p53 protein was o bserved in six cases. Although EBV-EBER transcripts were detected in two of them, LMP1 protein was absent. Except for their original prevalence, the f eatures of these T-cell CD30+ cutaneous lymphomas were the same as in immun ocompetent patients. The 10 B-cell cutaneous lymphoma were immunoblastic or centroblastic lymphomas, with a differential expression of BCL-6 and Synde can. Four of them expressed CD30, EBER-EBV transcripts, and LMP1 and p53 pr oteins. This B-cell CD30+ EBV+ phenotype contrasts with cutaneous lymphoma in immunocompetent patients. Human herpesvirus 8 was not involved in lympho magenesis since its sequences were detected in a single patient with Kaposi 's sarcoma and Castleman's disease. These lymphomas occurred in severely im munocompromised patients with a low CD4 count. Death was due to immunodepre ssion rather than to lymphoma spread, suggesting avoiding aggressive immuno suppressive treatment in such patients.