HIV-associated malignancies Flashcards by Yvonne McFarlane

HIV is associated with what THREE AIDS-defining cancers?

KAPOSI sarcoma
high grade B cell non-Hodgkin LYMPHOMA
invasive CERVICAL cancer

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What virus causes Kaposi sarcoma?

Kaposi sarcoma herpesvirus or human herpesvirus 8 (HHV8)

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Where in the body does KS typically present?

cutaneous or mucosal lesions

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What proportion of people with KS have visceral disease?

14%

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What THREE factors are included in the KS clinical staging system?

1) TUMOUR related criteria
2) host IMMUNOLOGICAL status
3) presence of SYSTEMIC illness

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What TWO factors confer an improved prognosis in KS?

1) FIRST AIDS illness

2) increasing CD4, improvement with every 100cells

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What TWO factors confer a poorer prognosis in KS?

1) age >50 yrs

2) SYSTEMIC disease

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What blood test gives idea of KS tumour burden and acts as a prognostic indicator?

HHV8 DNA level

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What are the FIVE stages of response criteria for KS?

1) Complete response
2) Clinical complete response
3) Partial response
4) Stable disease
5) Progressive disease

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What is the difference between complete response and clinical complete response in KS criteria?

complete - clinical and histological

clinical - no KS lesions, no histological confirmation

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What is the reduction in KS since HAART introduction?

14% (1980s) to 2% (2000s)

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Which antivirals have been shown to reduce the risk of KS?

GANCICLOVIR

FOSCARNET

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Which common antiviral has NOT been shown to reduce the risk of KS?

ACICLOVIR

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What has been most effective against HHV8 replication - ART or antivirals such as ganciclovir?

ART

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LOCAL therapies for cutaneous KS are now uncommon due to ART - list FIVE?

RADIOTHERAPY
RETINOIDS
VINBLASTINE
CRYOTHERAPY
EXCISION

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What proportion of patients with KS starting ART experience IRIS?

up to 29%

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How is IRIS KS managed?

systemic CHEMOTHERAPY

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When is systemic cytotoxic chemotherapy recommended for KS?

ADVANCED
SYMPTOMATIC
rapidly PROGRESSIVE
Poor prognostic risk index

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Which TWO chemotherapy classes are typically used against KS?

LIPOSOMAL ANTRACYCLINES (doxorubicin)
&
TAXANES (Paclitaxel)

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Which chemotherapy is GOLD STANDARD against KS?

LIPOSOMAL ANTRACYCLINES (doxorubicin)

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What side effects are associated with LIPOSOMAL ANTHRACYCLINE ie doxorubicin?

ALOPECIA
EMESIS
MYELOSUPPRESSION

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When might interferon-A be used for KS?

RARELY
residual KS
reconstituted immune system

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What other targeted therapies may be useful in treatment of KS?

anti-VEGF-A monoclonal antibody (BEVACUZIMAB)
c-kit (IMATINIB)
inhibition of Ras/Raf/MEK/ERK (SELUMETINIB - MEK inhibitor)

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What is RECOMMENDED local therapy for KS?

RADIOTHERAPY
or
INTRALESIONAL VINBLASTINE

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What is SECOND line chemotherapy for KS?

TAXANES (ie paclitaxel)

What are the TWO most common subtypes of Non-Hodgkin lymphoma for PLW HIV?

Diffuse large B cell & Burkitt's lymphoma/leukaemia

At what stage do PLW HIV present with Non-Hodgkin lymphoma?

ADVANCED clinical stage B symptoms EXTRANODAL involvement inc bone marrow

What is the survival for PLW HIV and non-HOdgkin lymphoma?

On ART: near HIV negative population dependent on HISTOLOGICAL type

What BASELINE investigations are required for work up of AIDS-related lymphoma?

BLOOD tests CT BONE MARROW aspirate and trephine

Why is PET scan recommended in AIDS-related lymphoma work up?

Improves STAGING accuracy

When should CSF sampling be done in work up for AIDS-related lymphoma?

``` CNS symptoms or involvement of: PARANASAL sinus BREAST EPIDURAL TESTICULAR ```

Which Non-Hodkin lymphoma subtype has a high risk of CNS involvement?

BURKITTS

What staging classification should be used for AIDS-related lymphoma?

Ann Arbor

Which PLW HIV are more at risk of infection-related mortality during treatment for AIDS-related lymphoma?

CD4 cell count <50

Which parts of the body should be CT scanned for work up for AIDS-related lymphoma?

Neck, chest, abdomen, pelvis

What infections should be screened for in the work up for AIDS-related lymphoma?

Hepatitis B (HBsAg, sAB, cAb) Hepatitis C (HCV Ab) Varicella (VZV IgG) CMV IgG

In addition to renal, liver and bone profile what other biochemistry is required for work up for AIDS-related lymphoma?

``` LDH URATE IMMUNOGLOBULINS PROTEIN ELECTROPHORESIS B2 MICROGLUBULIN CRP ```

Which blood test result is used in prognostic scoring for non-Hodgkin lymphoma?

LDH

Pre-HAART what limited clinical outcomes with chemotherapy for AIDS-related lymphoma?

Risk of opportunistic INFECTION and DEATH (despite lymphoma response)

What TWO factors has led to conventional chemotherapy and doses to be able to be used for PLW HIV with AIDS-related lymphoma?

1) HAART | 2) haematopoietic growth factors (G-CSF)

FIRST LINE treatment for diffuse large B cell lymphoma?

``` CHOP cyclophosphamide doxorubicin vincristine prednisolone ```

What is the potential advantage of EPOCH vs CHOP chemotherapy for diffuse large B cell lymphoma?

Potentially as effective with less toxicity Multi-agent LOW dose PROLONGED exposure

When is radiotherapy indicated for diffuse B cell lymphoma?

stage I or II disease in combination with chemo Not common

What are the BENEFITS of addition of RITUXIMAB to chemotherapy for diffuse B cell lymphoma in PLW HIV?

Improved RESPONSE rate reduced PROGRESSION of lymphoma on treatment reduced DEATH due to lymphoma

What is the RISK of addition of RITUXIMAB to chemotherapy for diffuse B cell lymphoma in PLW HIV?

increase DEATH due to INFECTION | CD4 cell count <50

Is RITUXIMAB recommended for PLW HIV and diffuse B cell lymphoma?

YES

What additional prophylactic measures should be taken if a PLW HIV has CD4 cell count <50 and is being treated with RITUXIMAB as part of diffuse B cell lymphoma chemotherapy?

``` antimicrobial PROPHYLAXIS - cotrimoxazole - fluconazole - aciclovir - azithromycin preemptive G-CSF prompt treatment of opportunistic infection ```

What is the BENEFIT of HAART in treatment of AIDS-related lymphoma?

reduce OPPORTUNISTIC infection superior RESPONSE rate & SURVIVAL

What is the difference in treatment strategy for HIV Burkitts lymphomas vs HIV diffuse B cell lymphoma?

more INTENSIVE | CNS penetration

FIRST LINE treatment for Burkitts lymphoma in PLW HIV?

``` CODox-M/IVAC cyclophosphamide vincristine doxorubicin methotraxate ifosamide etoposide cytarabine ```

What is an ALTERNATIVE treatment for Burkitt's lymphoma in PLW HIV to CODox-M/IVAC?

``` DA-EPOCH dose adjusted etoposide prednisone vincristine cyclophosphamide hydroxydaunorubicin ```

What chemotherapy related toxicity is universal in treatment for Burkitts lymphoma?

NEUTROPENIC fever MUCOSITIS due to intensive regimen

Is RITUXIMAB recommended for PLW HIV and Burkitt's lymphoma?

YES

What is the impact of HIV on risk of CNS involvement with lymphoma?

HIGHER incidence

What is the prognostic implication of SECONDARY CNS lymphoma (ie in context of other systemic lymphoma type)?

VERY POOR prognosis

How can the risk of secondary CNS lymphoma be reduced?

PREVENTIVE treatment as part of FIRST LINE chemotherapy

Which anatomical sites affected by lymphoma increase the risk of CNS relapse?

``` TESTES PARANASAL PARASPINAL EPIDURAL BREAST RENAL TESTICULAR ```

Which lymphoma subtype should include INTRATHECAL CNS chemotherapy in PLW HIV?

BURKITT'S

What adverse event is common when giving chemotherapy for a cancer with high tumour burden, especially so for lymphoma?

TUMOUR LYSIS SYNDROME

Within what time frame does tumour lysis syndrome most commonly occur after chemotherapy for lymphoma?

12-72 hours

What preventative therapy can be used to reduce the effect of tumour lysis syndrome?

HYDRATION anti-URATE (rasburicase or allopurinol) measurement and correction of electrolyte disturbance

For RELAPSED or REFRACTORY AIDS-related lymphoma, what is the treatment?

INTENSIFIED chemotherapy inc PLATINUM & AUTOLOGOUS STEM CELL TRANSPLANT (ASCT)

What might be a typical INTENSIFIED second line treatment of RELAPSED AIDS-related lymphoma?

DHAP dexamethasone high-dose cytarabine cisplatin

When is response to first line treatment usually first assessed for AIDs-related lymphoma?

HALF WAY through treatment

What imaging modality is SUPERIOR when assessing for treatment response at the end of treatment for AIDS-related lymphoma?

PET scan

Which chemotherapy is associated with cardiomyopathy and heart failure and might need follow up in people treated for AIDs-related lymphoma?

ANTHRACYCLINES (doxorubicin)

Which haematological malignancies are associated with chemotherapy for lymphoma?

MYELODYSPLASIA | ACUTE MYELOID LEUKAEMIA

What is the definition of primary CNS lymphoma?

non-hodgkin lymphoma confined to cranio-spinal axis no systemic involvement

What virus is found in CNS cells in HIV-associated primary CNS lymphoma?

EBV

How does primary CNS lymphoma most commonly present on CT scan?

DIFFUSE and MULTIFOCAL supratentorial brain masses

Which parts of the eye can be involved in primary CNS lymphoma?

VITREOUS RETINA OPTIC nerve

What additional work up is recommended for primary CNS lymphoma?

CT Bone marrow biopsy Testicular ultrasound

On identifying brain lesions, in addition to work up for primary CNS lymphoma what initial treatment should be given?

anti-TOXOPLASMOSIS treatment TWO weeks sulfadiazine 1g 4xdaily pyrimethamine 75mg daily

What impact has HAART had on the incidence of primary CNS lymphoma?

REDUCED dramatically

What is the preferred treatment of primary CNS lymphoma for PLW HIV on HAART?

TWO chemotherapy agents METHOTREXATE + cytarabine

When is radiotherapy indicated for primary CNS lymphoma?

if TOXICITY with chemotherapy too high or PALLIATIVE for symptom control

What is primary EFFUSION lymphoma?

``` HIV-associated non-HOdgkin lymphoma SEROUS body cavities - pleural - peritoneum - pericardial NO tumour mass or lymphadenopathy ```

Which virus is primary effusion lymphoma associated with?

HHV8

What is proportion of HIV-related non-Hodgkins lymphoma does primary effusion lymphoma account for?

What is proportion of NON-HIV-related non-Hodgkins lymphoma does primary effusion lymphoma account for?

<1%

Does primary effusion lymphoma affect MEN or WOMEN?

MEN

In addition to HHV8, which other virus MAY play a role in primary EFFUSION lymphoma?

EBV

What is the typical clinical presentation of primary effusion lymphoma?

Dyspnoea (pleural or pericardial involvement) or Abdominal distension (peritoneal involvement)

What immunohistochemistry stain should be performed on the serous fluid to confirm primary EFFUSION lymphoma?

HHV8

What is the FIRST LINE treatment for primary EFFUSION lymphoma?

``` HAART + CHOP cyclophosphamide doxorubicin vincristine prednisolone ```

PLASMABLASTIC lymphoma is a subtype of which lymphoma group?

Diffuse large B cell lymphoma

How many SUBTYPES are there for plasmablastic lymphoma?

THREE

Describe the THREE subtypes of PLASMABLASTIC lymphoma.

ORAL mucosa, monomorphic plasmablasts EXTRAORAL more plasmablastic differentiation associated with CASTLEMANN'S disease

Does PLASMABLASTIC lymphoma affect MEN or WOMEN?

MEN

Which virus is plasmablastic lymphoma associated with?

EBV

What is the UNIQUE presenting feature of PLASMABLASTIC lymphoma?

occurs in ORAL cavity of HIV +ve people

What are the most common EXTRAORAL sites in PLASMABLASTIC lymphoma?

GI tract lymph nodes skin

What is the RECOMMENDED treatment for plasmablastic lymphoma?

``` HAART + CHOP (ie anthracycline containing regimen) cyclophosphamide doxorubicin vincristine prednisolone ```

What is the association between HPV and women with HIV vs women without HIV?

women with HIV more likely to have HPV 16 or 18

What is the association between cervical intraepithelial neoplasia (CIN) and women with HIV vs women without HIV?

women with HIV more likely to have CIN

What is the association between CD4 cell count and incidence of CIN?

lower CD4 cell count - CIN INCREASED | higher CD4 cell count - CIN DECREASED and less progression

What are the risk factors for treatment failure of CIN in women living with HIV?

CD4 cell <200 high viral load no HAART

What imaging modality is used to stage invasive cervical carcinoma?

MRI

What BENEFIT may PET or PET-CT add in the staging of invasive cervical carcinoma?

to identify metastatic lymphadenopathy

What effect does HIV have on invasive cervical cancer compared with women without HIV?

occurs at a YOUNGER age

In addition to annual cervical cytology what additional screening investigation is recommended for women living with HIV?

initial COLPOSCOPY at time of diagnosis

What is the incidence of anal cancer in PLW HIV vs general population?

40 times HIGHER

Which specific patient group demographic of PLW HIV has the highest risk of ANAL cancer?

MSM

What is the association with HAART and incidence of anal cancer in PLW HIV?

INCREASED

Why has anal cancer incidence increased since HAART was introduced?

longer SURVIVAL of PLW HIV | progression of HPV to anal dysplasia to invasive anal cancer

What are the clinical features of anal cancer?

Rectal BLEEDING PAIN INCONTINENCE (if sphincter involved)

What imaging is required to stage ANAL cancer?

``` CT chest, abdomen, pelvis + MRI pelvis (to assess lymph nodes and local extension) ```

What potential BENEFIT might PET imaging offer in initial work up of ANAL cancer?

greater ACCURACY in identifying inguinal lymph nodes

Tumour grading of ANAL cancer is based on what size intervals?

<2cm (T1) 2-5cm (T2) >5cm (T3) local invasion (T4)

FIRST LINE treatment - ANAL cancer?

``` concurrent CHEMORADIOTHERAPY 5fluorouracil (5FU) + mitomycinC + Radiotherapy ```

What is the potential role of intensity-modulated radiation therapy in treatment of ANAL cancer?

HIGH dose radiation | less TOXICITY

What is the benefit of HAART in addition to chemoradiotherapy for anal cancer?

less TOXICITY of chemoradiotherapy | improved SURVIVAL

When is surgical resection indicated in treatment of ANAL cancer?

SALVAGE therapy for residual disease or local recurrence

What surgical intervention is indicated for SALVAGE therapy for ANAL cancer?

``` Abdominoperineal excision of rectum and anal canal + colostomy with reconstructive pedicle flap ```

In patients with anal intraepithelial neoplasia (AIN) what follow up is recommended?

surveillance by HIGH RESOLUTION ANOSCOPY

How much more common is Hodgkins lymphoma in PLW HIV vs the general population?

10 to 20 fold INCREASE

At what stage of disease are PLW HIV more likely to present with Hodgkins lymphoma?

ADVANCED EXTRANODAL involvement esp BONE MARROW B symptoms poor PERFORMANCE status

What investigation is mandatory as part of the work up for Hodgkin lymphoma in PLW HIV but not HIV negative people?

BONE MARROW biopsy

Why is bone marrow biopsy mandatory as as part of the work up for Hodgkin lymphoma in PLW HIV but not HIV negative people?

HIGHER proportion of bone marrow involvement

At what CD4 cell count is there a HIGHER incidence of Hodgkin lymphoma?

<200cells

What is the treatment decision for HIV-associated Hodgkin lymphoma based on?

STAGE of disease early favourable early unfavourable advanced

What it the recommended treatment for HIV-associated Hodgkin lymphoma?

``` chemotherapy + radiotherapy ABVD doxorubicin bleomycin vinblastine dacarbazine ```

Which ART should be avoided in combination with chemotherapy for Hodgkin lymphoma?

PI/ritonavir boosted

What it the recommended treatment for relapsed or refractory HIV-associated Hodgkin lymphoma?

High-dose SALVAGE chemotherapy + autologous STEM CELL Transplant

Against what organisms is prophylaxis recommended during treatment for HIV-related lymphomas?

PCP MAI Fungal infection

What follow up investigation should be performed after treatment for HIV-associated Hodgkin lymphoma?

FDG-PET + BONE MARROW biopsy (if involved)

What effect does HIV have on the interpretation of PET scan?

INCREASED uptake of FDG if unsuppressed VIRAL LOAD

What long term follow up is required for patients who have had radiotherapy for Hodgkin lymphoma?

Thyroid function tests & Mammography (if female)

What is multi centric Castlemann's disease?

LYMPHOPROLIFERATIVE disease | HHV8

How does multi centric Castlemann's disease classically present?

FEVER ANAEMIA multifocal LYMPHADENOPATHY

How does multi centric Castlemann's disease present differently in PLW HIV vs HIV negative people?

YOUNGER age

What other neoplastic process is associated with multi centric Castlemann's disease?

Kaposi sarcoma

Which virus is multi centric Castlemann's disease associated with?

HHV8

How does the incidence of multi centric Castlemann's disease differ between people of African ancestry and non-AFrican ancestry?

HIGHER incidence 2 to 4 fold

What are the initial baseline investigations for work up of multi centric Castlemann's disease?

CT neck, chest, abdomen, pelvis LYMPH NODE biopsy Immunohistochemistry for HHV8 and IgM lambda HHV8 viral load

What is the characteristic histology of multi centric Castlemann's disease?

'onion skin' appearance interfollicular plasmablasts HHV8

What is the utility of HHV8 viral load testing in the diagnosis of multi centric Castlemann's disease?

LOW viral load may EXCLUDE multi centric Castlemann's disease (<1000copies/ml)

When should a BONE MARROW biopsy be considered in work up for multi centric Castlemann's disease?

if haemophagocytic lymphohistiocytosis (HLH) is suspected

Multi centric Castlemann's disease is potentially fatal, through what mechanism?

organ FAILURE

What malignancy is multi centric Castlemann's disease associated with a higher incidence of?

Non-Hodgkin lymphoma

Why does ART apparently not improve clinical outcomes for multi centric Castlemann's disease?

multi centric Castlemann's disease may 'ESCAPE' immune reconstitution

Multi centric Castlemann's disease is a relapsing and remitting disease, through what mechanism does an 'attack' occur?

CYTOKINE STORM

What blood test can predict a 'relapse' of Multi centric Castlemann's disease?

HHV8 viral load RISE

What is recommended FIRST LINE treatment for multi centric Castlemann's disease?

RITUXIMAB

What is recommended treatment for RELAPSED multi centric Castlemann's disease?

RITUXIMAB

In addition to rituximab what should be added to treatment for aggressive multi centric Castlemann's disease?

``` Chemotherapy CHOP cyclophosphamide doxorubicin vincristine prednisolone ```

What should be measured as clinical monitoring for people with multi centric Castlemann's disease in remission?

HHV8 levels

Which testicular cancer has an increased risk associated with HIV?

SEMINOMA

What is the expected survival rate for people with SEMINOMA and HIV on ART?

similar to HIV negative comparisons

What are the specific baseline investigations for testicular cancer?

``` US testes + HCG + AFP ```

Which TWO tumour markers are required in the work up of testicular cancer?

AFP + HCG

What factors that may be related to HIV can contribute to false-positive AFPs?

HAART or hepatitis related liver disease

What is the differential diagnosis of testicular mass in a PLW HIV?

ORCHITIS | LYMPHOMA

What imaging is required for staging in testicular cancer?

CT chest, abdomen, pelvis

STAGE 1 testicular germ cell cancer - what is the treatment?

``` SURVEILLANCE or Seminoma - CARBOPLATIN or Non-seminoma germ cell tumour - BEP bleomycin etoposide platinum ```

What is the chemotherapy for STAGE 1 SEMINOMAS?

CARBOPLATIN

What is the chemotherapy for STAGE 1 NON-SEMINOMA GERM CELL TUMOUR?

BEP bleomycin etoposide platinum

Surveillance is a suitable option for stage 1 testicular germ cell cancers, in what instance is better to start chemotherapy?

HIGH RISK disease or CHAOTIC lifestyle, unlikely to engage with follow up

What is the treatment for metastatic testicular germ cell cancer?

``` BEP bleomycin etoposide cisplatin (either THREE or FOUR cycles) + HAART ```

What antimicrobial prophylaxis may be required during chemotherapy for metastatic testicular germ cell cancer?

antifungals

What THREE non-AIDS defining malignancies have higher risk associated with HIV?

TESTICULAR GERM CELL NON-SMALL CELL LUNG HEPATOCELLULAR

Which lung cancer type is increased in PLW HIV?

NON-small cell lung cancer

How does the presentation of non-small cell lung cancer in PLW HIV differ to those HIV-negative?

YOUNGER age | ADVANCED disease

Which parts of the body need imaging in work up for non-small cell lung cancer?

``` CT chest abdomen adrenals BONE SCAN ```

What are the treatment options for non-small cell lung cancer?

curative SURGERY CHEMORADIATION TARGET receptor therapy HAART

What is the treatment for METASTATIC non-small cell lung cancer?

ERLOTINIB or GEFITINIB (epidermal growth factor receptor (EGFR) targeting tyrosine kinase inhibitors (TKI)) or CHEMOTHERAPY

If a non-small cell lung cancer expresses EGFR mutations what are the treatment options?

ERLOTINIB or GEFITINIB | epidermal growth factor receptor (EGFR) targeting tyrosine kinase inhibitors (TKI)

What proportion of people in Western countries are co-infected with HIV and hepatitis C?

30%

What impact does HIV infection have on hepatitis C?

increases likelihood of CHRONIC infection ie not clearing it | hastens development of CIRRHOSIS

Through what mechanism might HCC occur without cirrhosis due to hepatitis B infection?

hepatitis B is directly CARCINOGENIC

What association is there between CD4 count and HCC development in hepatitis B and HIV co-infection?

LOWER CD4 count = higher risk of HCC

What impact does HIV infection have on hepatitis B?

accelerates PROGRESSION of hepatitis B infection

Which hepatitis (B or C) is associated with more HCC in co-infection with HIV?

Hepatitis C

What is the investigations or surveillance for HCC?

AFP | US liver

What imaging is required to stage HCC?

CT chest, abdomen, pelvis

What impact does HIV have on HCC patients risk of liver disease?

more likely to have COMPENSATED LIVER DISEASE

For HCC, when is surgical resection an option?

Solitary, or small number of lesions

Is biopsy required if complete resection of HCC is possible?

No (potential to seed)

What are the alternative treatment options to resection for localised HCC disease?

Injection of ETHANOL RADIOFREQUECNY ablation Transarterial CHEMO-EMBOLISATION

What is the criteria for the HCC lesion to be considered for liver transplant?

THREE liver lesions <3cm or ONE liver lesion <5cm

What additional consideration is required when planning liver transplant for a PLW HIV?

potential for drug-drug interaction with | IMMUNOSUPRRESANTS ie tacrolimus

What is sorafenib?

Tyrosine kinase inhibitor

Sorafenib, a tyrosine kinase inhibitor, targets what?

Raf cascade

What target cell therapy is used for HCC treatment?

SORAFENIB (tyrosine kinase inhibitor)

Which adverse events appear more common with people on HAART and sorafenib as treatment for HCC?

DIARRHOEA | HAND-FOOT SYNDROME

How often should a person with HIV and hepatitis B co-infection have HCC surveillance?

6 monthly ultrasound scans

What impact does HIV have on colorectal adenocarcinoma?

YOUNGER age more ADVANCED disease increased prevalence of RIGHT side tumours

What is the most common non-AIDS-defining group of malignancies in PLW HIV?

Skin cancers

What is the increased risk of NON-MELANOMA skin cancer in PLW HIV?

2 to 5 fold risk

Which non-melanoma skin cancer is most common in PLW HIV?

BCC (ratio to SCC 7:1)

What is the increased risk of MELANOMA skin cancer in PLW HIV?

3 times more common

What pre-malignant skin lesions are VERY COMMON in PLW HIV?

Actinic keratosis

What different features may occur for SCC in HIV?

``` no sun exposed sites may affect MOUTH, GENITALS, PERINEUM multifocal aggressive high recurrence rate metastasis ```

What impact does HIV have on the presentation of melanoma?

ATYPICAL presentation 'normal' nave 'benign macules' multiple 'nevoid lesions'

Which skin cancers may remit with HAART?

SCC & BCC

What topical treatment is indicated for BCC?

IMIQUIMOD

What conditions is Merkel cell carcinoma associated with?

Chronic lymphocytic leukaemia (CLL) TRANSPLANTATION IMMUNOSUPPRESSIVE drugs HIV

What cutaneous manifestations of lymphoma may occur in PLW HIV?

PRURITIS Cutaneous T cell lymphoma Subcutaneous panniculitis-like T cell lymphoma Castlemann's disease

What is the increased risk of PENILE CANCER in PLW HIV?

FIVE to SIX times higher

What factors increase the risk of PENILE CANCER in PLW HIV?

``` LICHEN SCLEROSUS UNCIRCUMCISED SMOKING HPV Poor HYGIENE ```

Which cancers appear to be decreased in HIV infection?

PROSTATE | BREAST

What histopathological features are present on biopsy of KS lesion?

SPINDLE cells EXTRAVASATED red cells HHV8 immunoSTAIN

What are the typical histopathological features of Diffuse large B cell lymphoma?

``` PROMINENT nucleoli Pleomorphic nuclei (MANY SHAPES) ```

What are the typical histopathological features of BURKITTS lymphoma?

MONOTONOUS medium sized lymphoid cells scant cytoplasm regular nuclei with MULTIPLE nucleoli

What is the CLASSICAL histopathological feature in HODKIN lymphoma?

Binucleate Reed-Sternberg cell

What is the histopathological feature of Multicentric Castlemann's disease?

'Crop circle' or 'onion skin' of plasma blasts (circular distribution) penetrating sclerotic blood vessel from circle - 'lollypop sign'

HIV-associated malignancies Flashcards

(206 cards)