CUTANEOUS PRESENTATIONS OF LYMPHOMA IN HUMAN-IMMUNODEFICIENCY-VIRUS DISEASE - PREDOMINANCE OF T-CELL LINEAGE

Background and Design: Most non-Hodgkin's lymphomas in patients with human immunodeficiency virus infection are of B-cell lineage. Cutaneous lymphoma in the human immunodeficiency virus disease has not been systematically reviewed. We studied 25 patients with both human immunodeficiency virus infection and cutaneous presentations of lymphoma, using immunohistochemistry and in situ hybridization for Epstein-Barr virus. Results: Two groups of patients were discerned: (1) those with conditions similar to mycosis fungoides or Sezary syndrome with an indolent course (n = 8) and (2) those with nodules or papules, greater immunosuppression, a rapid clinical course, and large cell lymphoma seen on biopsy specimens (n = 17). The epidermotropic lymphomas were of T-cell lineage and CD30(-). Thirteen of the large cell lymphomas were also of the T-cell type, and 71% were CD30(+). Epstein-Barr virus was absent in the epidermotropic lymphomas, but it was present in 73% of the nonepidermotropic cases. Conclusions: Two forms of human immunodeficiency virus-associated cutaneous lymphoma were found: indolent disease resembling mycosis fungoides or Sezary syndrome and large cell lymphomas with a poor prognosis, whose cells often had a CD30(+) T-cell phenotype and harbored the Epstein-Barr virus.