Over 90% of systemic ARL are high-grade B-cell tumours and within the WHO/REAL classification approximately two-thirds are diffuse large cell lymphomas (20% of which are confined to the central nervous system), whereas one-third are Burkitt's lymphoma (Figures 23.11 and 23.12). The incidence of T-cell lymphoma is also increased but only five- to tenfold. In addition, two uncommon lymphoproliferative disorders that are associated with human herpesvirus 8 are seen in this population: primary effusion lymphoma (PEL) or body-cavity lymphoma and multicentric Castleman's disease. Histologically, PEL is a CD30-(Ki-1)-positive anaplastic large cell lymphoma.
Occasionally, low-grade B-cell lymphomas are reported in HIV patients but there is no epidemiological evidence that these cases have increased in parallel with the AIDS epidemic and no evidence that these patients respond differently to treatment when compared with non-HIV-infected individuals. A few patients with B-cell acute lymphoblastic leukaemia (FAB L3) in HIV disease have been described, and it is likely that these cases represent peripheral blood involvement with Burkitt's lymphoma.
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