Cancers in general

  • slide 17
  • Prof. Hirschel

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1/17 How to find an association between cancer and HIV?

To find an association between cancer and HIV: compare patient numbers; calculate cancer incidence in HIV-infected population and compare it to the incidence in the general population.

2/17 Influence of HAART?

Comparison of neoplasm, Kaposi's sarcoma; NHL and Hodgkin's lymphoma.

3/17 Beyond KS, Lymphoma, and cervical cancer

Patients who are HIV positive may be exposed to other factors which increase cancer incidence, for instance: smoking; hepatitis B and hepatitis C infection; human papillomavirus.

4/17 Significantly increased incidences of neoplasms in the SHCS

Neoplasms including Kaposi's sarcoma, NHL, Ca anal, Hodgkin's lymphoma, cervix, liver, ORL and lung.

5/17 The Future

The future of lung cancer/age and percentage of smokers in Switzerland; age of HIV+ (drug users) in Geneva.

6/17 Patient B, slide #1

A 32-year-old man from West Africa, with right-sided abdominal pain and nausea, HIV infection with a CD4 count of 427 and a viremia of 70'000; ASAT: 85 U/L; ALAT: 30 U/L; GGT: 143 U/L; Ph alc: 115; Alb: 31 g/L; Bili: 14 micro mol/L; LDH: 703 U/L; alpha feto protein: 29800 ng/ml; HCG < 2; HBs ag positive.

7/17 Patient B, slide #2

Diagnosis: Hepatocarcinoma, secondary to hepatitis B. 5/4/2002; 7/1/2003; 22/02/2003

8/17 Patient F, slide #1

atient F: 58 years old, drug addict, HIV positive, admitted for confusion, fever and weight loss in May 2001. CT scan of May 19th 2001: intracerebral polycyclic lesions with a differential diagnosis of toxoplasmosis, lymphoma or abscess...

9/17 Patient F, slide #2

Probable diagnosis: cerebral toxoplasmosis (despite a CD4 count of more than 200); therapeutic trial of sulfadiazine and pyrimethamine; psychiatric problems with agitation and aggression of personnel; transfered to a psychiatric ward, but almost immediately sent back to the general hospital because of cough and fever.

10/17 Patient F, slide #3

Compared to the preceding scan, the three lesions previously seen have increased in size. The most likely diagnosis is lymphoma.

11/17 Patient F, slide #4

May 30th 2001: <br/>-Diffuse pulmonary reticulo-nodular infiltrate: Pneumocystis? <br/>-BAL is done <br/>

12/17 Patient F, slide #5

Bronchoscopy: Complete stenosis of the posterior and apical segments of the right superior lobe; Cytology: Undifferentiated carcinoma (no pneumocystis seen).

13/17 Patient F, slide #6

With the «retrospectro-scope», a mass is seen in the right upper lobe on 19th of May 2001. The patient died on June 6th 2001, from a probable large cell undifferentiated pulmonary carcinoma with cerebral metastases.

14/17 Differential Diagnosis

Cerebral toxoplasmosis and brain metastasis may look similar in CT and NMR scans, as illustrated in the two cases which follow: Patient G was a 45-year-old ex-IV drug user, smoker, HIV positive, with 277 CD4 cells, presenting with seizures. Bronchoscopy revealed undifferentiated carcinoma.

15/17 Patient G

Tumour MRI and X ray.

16/17 Patient H, slide #1

Differential: toxoplasmosis-metastasis. Case H is the mirror image of case G: a 53-year-old smoker and heavy drinker; loses 10 kg, complains of headaches and dysphagia; suspicion of digestive or lung cancer is not confirmed; NMR brain scan (see next slide).

17/17 Case H, slide #2

NMR brain scan showing multiple lesions interpreted as probable metastases of unknown primary; brain biopsy: toxoplasma abscess; HIV test: positive, 56 CD4 cells.

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