Letters to the editor
Does HIV infection accelerate malignant transformation of pre-malignant states? U
To the editor: The increased incidence of malignancy in patients infected with the human immunodeficiency virus (HIV-1) is well recognised (1). Non-Hodgkin’s lymphoma, Kaposi’s sarcoma and primary CNS lymphoma account for most tumours reported, and their presence indicates the development of AIDS in HIVinfected individuals. Apart from these, a number of unexpected tumours occurring in HIV-infected patients have been reported (2). We have recently seen the development of neurofibrosarcoma in an HIV antibody-positive patient with cutaneous neurofibromatosis. He was a 28year-old mild haemophiliac with a baseline factor VIII level of 0.08 u/ml. He received non-heated factor VIII concentrate on a number of occasions following trauma. In 1985 he developed thrombocytopenia and was found to have antibodies to HIV-1. He presented in 1988 with posterior left-sided chest pain. Investigation revealed a mass on the posterior chest wall which was surgically resected after correction of his thrombocytopenia with high-dose intravenous immunoglobulin. Histologically this was a neurofibrosarcoma. A course of local radiotherapy was given but 6 months later he developed further chest pain. Multiple pleural and extrapleural lesions were present on a thoracic CT scan. Although at presentation his CD4 count was 380 x 106/1, progression of his disease coincided with a rapid fall in his count to 80 x lo6/]. A second course of palliative radiotherapy produced only partial symptomatic relief. He died a year later with paraplegia, following the development of cord compression from a tumour deposit.
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Neurofibromatosis is a neurocutaneous premalignant condition with neurofibrosarcoma developing in a small number of patients. The incidence of sarcoma in the largest reported series was 3 % (3). It is possible that the malignant transformation in our patient was unrelated to his HIV status. However, we speculate that because of HIV-related reduced cellular immunity his chances of malignant transformation were increased. Validation of such a hypothesis will require extensive epidemiological surveillance. We would be interested to hear if other physicians have seen accelerated malignancies in HIV-infected individuals with pre-malignant conditions.
References LEVINEAM. Non-Hodgkin’s lymphomas and other malignancies in the acquired immune deficiency syndrome. Semin Oncol 1987: 14: 34-39. RAVALLIS, CHABONAB, KHANAA. Gastrointestinal neoplasia in young HIV antibody-positive patients. Am J Clin Pathol 1989: 91: 458-461. D’AGOSTINO AN, SOULEEH, MILLERR H . Sarcomas of the peripheral nerves and somatic soft tissues associated with multiple neurofibromatosis (von Recklinghausen’s disease). Cancer 1963: 16: 1015-1027.
Correspondence: M. Makris, F.E. Preston Department of Haematology, Royal Hallamshire Hospital, Sheffield S10 2JF, U.K.
Does HIV infection accelerate malignant transformation of pre-malignant states? U
To the editor: The increased incidence of malignancy in patients infected with the human immunodeficiency virus (HIV-1) is well recognised (1). Non-Hodgkin’s lymphoma, Kaposi’s sarcoma and primary CNS lymphoma account for most tumours reported, and their presence indicates the development of AIDS in HIVinfected individuals. Apart from these, a number of unexpected tumours occurring in HIV-infected patients have been reported (2). We have recently seen the development of neurofibrosarcoma in an HIV antibody-positive patient with cutaneous neurofibromatosis. He was a 28year-old mild haemophiliac with a baseline factor VIII level of 0.08 u/ml. He received non-heated factor VIII concentrate on a number of occasions following trauma. In 1985 he developed thrombocytopenia and was found to have antibodies to HIV-1. He presented in 1988 with posterior left-sided chest pain. Investigation revealed a mass on the posterior chest wall which was surgically resected after correction of his thrombocytopenia with high-dose intravenous immunoglobulin. Histologically this was a neurofibrosarcoma. A course of local radiotherapy was given but 6 months later he developed further chest pain. Multiple pleural and extrapleural lesions were present on a thoracic CT scan. Although at presentation his CD4 count was 380 x 106/1, progression of his disease coincided with a rapid fall in his count to 80 x lo6/]. A second course of palliative radiotherapy produced only partial symptomatic relief. He died a year later with paraplegia, following the development of cord compression from a tumour deposit.
220
Neurofibromatosis is a neurocutaneous premalignant condition with neurofibrosarcoma developing in a small number of patients. The incidence of sarcoma in the largest reported series was 3 % (3). It is possible that the malignant transformation in our patient was unrelated to his HIV status. However, we speculate that because of HIV-related reduced cellular immunity his chances of malignant transformation were increased. Validation of such a hypothesis will require extensive epidemiological surveillance. We would be interested to hear if other physicians have seen accelerated malignancies in HIV-infected individuals with pre-malignant conditions.
References LEVINEAM. Non-Hodgkin’s lymphomas and other malignancies in the acquired immune deficiency syndrome. Semin Oncol 1987: 14: 34-39. RAVALLIS, CHABONAB, KHANAA. Gastrointestinal neoplasia in young HIV antibody-positive patients. Am J Clin Pathol 1989: 91: 458-461. D’AGOSTINO AN, SOULEEH, MILLERR H . Sarcomas of the peripheral nerves and somatic soft tissues associated with multiple neurofibromatosis (von Recklinghausen’s disease). Cancer 1963: 16: 1015-1027.
Correspondence: M. Makris, F.E. Preston Department of Haematology, Royal Hallamshire Hospital, Sheffield S10 2JF, U.K.
