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Clinical Challenge
August 2017

An HIV-Positive Child With a Gingival Mass

Author Affiliations
  • 1Department of Otorhinolaryngology, Louisiana State University Health Science Center, New Orleans
  • 2Children’s Hospital of New Orleans, New Orleans, Louisiana
  • 3Department of Otolaryngology–Head & Neck Surgery, Louisiana State University, New Orleans
JAMA Otolaryngol Head Neck Surg. 2017;143(8):833-834. doi:10.1001/jamaoto.2016.4497

A preadolescent girl presented with a 1-week history of left-sided facial swelling. She had presented 3 months prior with neurologic and vision changes and was diagnosed as having varicella zoster encephalitis and cytomegalovirus retinitis. Further testing led to a diagnosis of HIV/AIDS, and at that time she was started on highly active antiretroviral therapy (HAART) therapy as well as bactrim prophylaxis. Physical examination revealed left-sided facial fullness and a left-sided violaceous, vascular-appearing lesion involving the left maxillary gingiva (Figure, A). The patient was afebrile, her white blood cell count was 3300/μL, and her CD4 count was 210 μg/mL. Magnetic resonance imaging (MRI) of the face revealed a poorly enhancing mass arising from the left maxilla and extending into the left maxillary sinus (Figure, B). An incisional biopsy was undertaken, during which excessive bleeding was encountered. Histologic analysis and immunophenotype of the specimen showed a dual population of lymphoma cells with plasmablasts having large vesicular nuclei and centrally located eosinophilic nucleoli and “plasmacytic” cells with comparatively smaller darker nuclei and smaller scanty nucleoli (Figure, C). Immunohistochemical expression was strongly positive for CD138 (Figure, D) and Epstein-Barr virus–encoded small nuclear RNA (EBV-EBER), and the Ki-67 index (marker of mitotic division) was greater than 90%, negative for CD45, CD20, HHV-8, TdT, CD34, PAX5, CD3, CD99, ALK-1, and CD30. Flow cytometry was noncontributory.

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