Extraoral plasmablastic lymphomas in a high human immunodeficiency virus endemic area

• DOI: 10.1111/his.13964
• Publication Date: 2019-07-30T18:54:37Z
• Authors: Shabnum Meer; Yvonne Perner; Ewen D McAlpine; Pascale Willem
• Keywords: Adult; Male; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Adolescent; HIV; HIV Infections; Middle Aged; Immunophenotyping; 3. Good health; Cohort Studies; Proto-Oncogene Proteins c-myc; South Africa; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Biomarkers, Tumor; Plasmablastic Lymphoma; Humans; Female; Child; In Situ Hybridization, Fluorescence; Retrospective Studies

AimsPlasmablastic lymphoma (PBL) occurs mainly in immunocompromised individuals, usually secondary to human immunodeficiency virus (HIV) infection. It classically occurs intraorally, but has been described in extraoral locations. The aim of this study was to define the immunophenotype and Epstein–Barr virus (EBV) status in a large single‐centre cohort of extraoral PBL (EPBL) in South Africa, a high‐prevalence HIV setting.Methods and resultsThis retrospective study of 45 EPBLs included patients' age, gender, race, HIV status, and site. Cases were reviewed histologically, and classified morphologically as pure plasmablastic or plasmablastic with plasmacytic differentiation, and assessed immunohistochemically with antibodies against CD45, CD20, CD79a, PAX5, CD138, MUM1/IRF4, BLIMP1, VS38c, Ki67, bcl‐6, CD10, cyclin D1, and human herpesvirus‐8, by the use of standard automated procedures. EBV was assessed by the use of chromogenic in‐situ hybridisation. Tumours were assessed with a fluorescence in‐situ hybridisation (FISH) MYC break‐apart probe. Twenty‐seven PBLs showed pure plasmablastic morphology, and 18 showed plasmacytic differentiation. The male/female ratio was 1.5:1. The anus was the favoured extraoral site (31.1%), followed by lymph nodes (15.6%). All 29 patients with known HIV status were HIV‐positive. The immunohistochemical profile recapitulated that reported for oral PBLs and EPBLs in HIV‐positive and HIV‐negative patients. EBV was positive in 92.5% of PBLs. FISH analysis showed MYC rearrangement in 48% of cases.ConclusionThis study showed a strong association of EPBLs with HIV and EBV infection, similarly to the previously described oral PBL. The strong EBV association together with other clinicopathological parameters and an immunohistochemical profile that includes CD45, CD20, MUM1/IRF4, CD138 and Ki67 may be used in distinguishing PBL from diffuse large B‐cell lymphoma and plasma cell myeloma.