Malignancies

Question 1

What cancer’s are associated with Epstein-Barr virus?

Answer 1

• Hodgkin’s Lymphoma
• Burkitt’s lymphoma (non-Hodgkin’s B cell lymphoma)

Question 2

What infections are associated with Burkitt’s lymphoma?

Answer 2

* EBV (~95% in Africa)
* Malaria

Question 3

How does EBV infection result in lymphoma?

Answer 3

• overgrowth of virally transformed B cells is controlled by specific cytotoxic T-cell responses
• Absence of T-cell responses which (e.g. in human immunodeficiency virus (HIV)-infected people) can result in lymphoma.

Question 4

What’s the presentation of Burkitt’s lymphoma?

Answer 4

• Patients often present with a rapidly growing mass,
• Jaw involvement in children is common
• Endemic BL characteristically presents with an enlarging jaw lesion, periorbital swelling, or genitourinary involvement
• Elevated lactate dehydrogenase (LDH)
• Increased uric acid levels because of the tumor’s rapid doubling time (24-48h!)
• Primary site of sporadic BL is typically the abdomen, but the head and neck may be affected as well.
• Adult patients are more likely to present with constitutional symptoms (i.e., fever, weight loss, night sweats).

Question 5

What infection is implicated in Kaposi’s sarcoma?

Answer 5

Human herpes virus 8

Question 6

What’s the typical presentation of Kaposi’s sarcoma?

Answer 6

Kaposi Sarcoma
* Single or multiple papular or nodular hyperpigmented skin lesions commonly on face, legs, and mouth
* May look like bruises
* Visceral disease can occur without skin involvement

Question 7

What’s the first line treatment for Kaposi’s sarcoma?

Answer 7

• Start ART and most lesions will regress

Visceral disease in resource poor settings requiring chemo
* Doxorubicin
* Bleomycin
* Vincristine