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HIV ASSOCIATED MALIGNANCIES

HIV ASSOCIATED MALIGNANCIES. Dr. G. VENKATESAN Asst. Surgeon GHTM, Tambaram. OPPORTUNISTIC MALIGNACIES. Kaposi sarcoma Lymphoma of Brain Primary Secondary NHL HL Burkitt Lymphoma Cervical dysplasia / Ca Anal dysplasia / Sq cell Ca. KEY POINTS. High index of clinical suscipion.

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HIV ASSOCIATED MALIGNANCIES

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  1. HIV ASSOCIATED MALIGNANCIES Dr. G. VENKATESAN Asst. Surgeon GHTM, Tambaram

  2. OPPORTUNISTIC MALIGNACIES • Kaposi sarcoma • Lymphoma of Brain • Primary • Secondary • NHL • HL • Burkitt Lymphoma • Cervical dysplasia / Ca • Anal dysplasia / Sq cell Ca

  3. KEY POINTS • High index of clinical suscipion. • Physicians must think in terms of not only the possibility of opportunistic infections but also malignancies when diagnosing and treating HIV positive patients. • As CD4 count - occurrence as well as aggressiveness of the malignancies

  4. CASE STUDY • A 25 year- old HIV positive male patient is having difficulty in breathing, coughs with expectoration and reports having no appetite. • What preliminary diagnosis would you make for this patient?

  5. Cont… • You take an x-ray of the patient and discover a mediastinal mass. • Given this new information, what diagnosis would you make for this patient? • What other possible diagnoses could you make?

  6. KAPOSI’S SARCOMA (KS) • Multicentric Neoplasm consisting of over growth of venular capillary endothelium • Can occur as potentially occult lesions • Unusual and rare before AIDS • Most common in North America and Europe (HOMOSEXUALS) • Closely linked with Human Herpesvirus HHV8

  7. Cont… • Most common site – skin, Lymph nodes • Others – Mouth, Hard palate,Tip of nose, Penis, lower legs • GIT, Liver, spleen, Lungs. • Never involves Brain. • Colourful lesions – Red, Violet, Brown, Black • Well circumscribed, flat / raised. 1 • CD4 Count X Aggressiveness

  8. DIAGNOSIS • Made on Clinical suspicion and confirmed by HPE • Should be differentiated from bacillary angiomatosis

  9. TREATMENT • Single lesions – RT • Multiple – Vincristine, Bleomycin, Doxorubicin • Regress with HAART

  10. IYMPHOMA • Primary CNS lymphoma • NHL • HL • Burkitt lymphoma

  11. PRIMARY CNS LYMPHOMA • 2nd most common SOL in HIV • Strong association with EBV • CD4 < 50 • Difficult to diagnose with imaging • Presentation – focal seizures, Resistant fever • Lesions – more often solitary - Deep in white matter

  12. Cont. . . • Confirmed by biopsy • PCR assay of CSF for EBV DNA (90%) • DD – Toxo, Bact. Abscess, Cryptococcoma, Tuberculoma, Nocardia • RT – difficult to treat.

  13. SYSTEMIC LYMPOMA • Non Hodgin L • Hodgin L • Burkitt L

  14. NON HODGIN LYPHOMA • B Lymphocytes – 80% T Lymphocytes – 20% • Tend to occur largely at Extranodal sites – most in CNS, Bone marrow, GIT, Liver, Lungs • Confirmation by HPE • Treatment – Chemotheraphy, Radiotheraphy

  15. HODGIN LYMPHOMA • 5 fold in HIV • More of mixed cellularity / lymphocyte depleted subtypes • Not in CDC definition of AIDS • Present in advanced stage of AIDS

  16. BURKITT LYMPHOMA • Small non-cleaved cell lymphoma • Most in 10-19 years (young) • C-myc translocation from Ch 8 to Ch 14/22 • EBV Positive • Chemotherapy

  17. CERVICAL DYSPLASIA/ Ca • Common cancer in women – 80% of all GYN cancers • Type 2 HSV HPV – 16, 18, 31, 33 • High risk factors • Multiple partners or monogamous women whose partner have multiple partners. • Early age at first sexual intercourse • Family size • Heavy smoking • OCP > 8 years • Lower socioeconomic status

  18. Cont… • Erosion, Endocervicitis, Ectropion – not precursors of CA • Reserve cells beneath columnar EPI at SC jn – from metaplastic cells (becomes mature cells) Metaplasia • Columnar Squamous Epidermidization • Some M cells become atypical • Atypical metaplasia – precursor of dysplasia

  19. Cont… • Dysplasia – altered / disorderly arrangement of cells. • CIN I – Mild • CIN II – MOD • CIN III – Sev. - CA in situ • Abnormal vaginal bleeding, discharge, postcoital bleeding, lower abd – pain • O/E – red, friable, exophytic lesion or ulcer, bleeds on touch

  20. INV • Screening - Papanicolaou smear – standard single most effective screening test • Colposcopy • Cericography • Cone – BX • Punch BX • Large loop excision of transformation zone (LLETZ) • Other investigations

  21. Treatment • Surgery • Conization • Hysterectomy • BSO • Radical H • Pelvic exenteration • Cryosurgery • Laser surgery • Loop electrosurgical excision procedure (LEEP)

  22. Cont. . . • RT – Brachy therapy - Intracavitary radiation (Cobalt, Caesium, selectron) • Chemo – Cisplatin, Ifosfamide(70% response)

  23. Thank you

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