ONC-2. Plasmablastic lymphoma in an immunocompetent elderly patient.

An 82-year-old male patient presented with a progressively enlarging swelling in his right submandibular area and right side of neck of 4 weeks' duration. He had decreased appetite and a 20-pound weight loss over the last few months. He was a cachectic-appearing white man, with a large mass of lymph nodes in the right submandibular and neck area. A large node was also palpable in the right axilla. Lymph node biopsy based on morphologic and immunophenotypic features revealed plasmablastic lymphoma, positive for EBV. This tumor was positive for CD-30, partially positive for EMA but negative for B-cell and T-cell markers (CD 20, CD 79a, CD2, CD3, CD4, CD43 and CD45RO). HHV-8 was negative. He was negative for HIV. Despite completion of six cycles of CHOP regimen, follow-up imaging studies showed widespread residual disease. Patient expired subsequently, less than 1 year since the time of diagnosis. Plasmablastic lymphoma (PBL) of the oral cavity is a B-cell lymphoma that has been recognized in association with acquired immunodeficiency syndrome (AIDS). PBL displays an aggressive clinical course and prognosis is usually poor despite therapy. It is composed of rapidly, growing, large neoplastic cells displaying a marked degree of plasma cell differentiation. PBL was first described in 1997 as a series of 16 patients in the oral cavity of HIV infected people. Most reported cases have been in association with immunodeficiency states in particular HIV infection. One study from Japan described 22 HIV-positive patients with EBV + B-cell lymphoproliferative disorder (median age 75.5). PBL is a distinct disease entity within the spectrum of EBV-associated B-cell lymphoproliferative disorders. Here we have reported an extremely uncommon presentation of a rare tumor--plasmablastic lymphoma in an elderly person without any known immunodeficiency. Advanced age might be considered as one of the predisposing conditions, secondary to decreased immune surveillance.

Arun Kalyanasundaram, MD, Rob Meloy, MD, and Albert Quiery, MD. Geisinger Medical Center, Danville, PA.