|Year : 2014 | Volume
| Issue : 1 | Page : 57-58
NON-AIDS defining malignancies: Is transitional cell carcinoma bladder one of them?
Francis Katumalla Sridhar, Kim J Mammen
Department of Urology, Christian Medical College, Ludhiana, Punjab, India
|Date of Web Publication||11-Feb-2014|
Francis Katumalla Sridhar
Department of Urology, Christian Medical College, Ludhiana 141 008, Punjab
Source of Support: None, Conflict of Interest: None
AIDS-related malignancies have been a major cause of death among HIV-infected patients, and possibly other NON-AIDS defining malignancies may become an increasingly frequent problem. The development of any cancer in the setting of HIV-induced immunodeficiency can create significant difficulties in the care of such patients, who frequently develop intercurrent illnesses and tolerate anti-neoplastic therapies poorly. Is transitional cell carcinoma of the urinary bladder one of them?
Keywords: Bladder cancer, HIV, NON-acquired malignancies
|How to cite this article:|
Sridhar FK, Mammen KJ. NON-AIDS defining malignancies: Is transitional cell carcinoma bladder one of them?. CHRISMED J Health Res 2014;1:57-8
|How to cite this URL:|
Sridhar FK, Mammen KJ. NON-AIDS defining malignancies: Is transitional cell carcinoma bladder one of them?. CHRISMED J Health Res [serial online] 2014 [cited 2020 Feb 24];1:57-8. Available from: http://www.cjhr.org/text.asp?2014/1/1/57/126800
| Introduction|| |
The risk of malignancies is increased among individuals who are infected with human immunodeficiency virus (HIV), and nearly 40% of all patients with acquired immunodeficiency syndrome (AIDS) develop cancer during the course of their disease.  Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical tumors are the common AIDS defining malignancies.  There is an increasing awareness of NON-AIDS defining malignancies occurring in HIV-seropositive patients Prostate cancers, testicular tumors, Hodgkin's lymphoma lung cancers, squamous and basal cell carcinoma of skin, anal cancers, penile cancers are few of them.  Impaired immune surveillance, abnormal gene mutations are few of the causes for these malignancies.  Urothelial malignancies are known to occur in post-organ transplant patients - reasons being the same. We are reporting a case of transitional cell carcinoma of the urinary bladder in a HIV-seropositive patient. Can it be one of the NON-AIDS defining malignancy?
| Case Report|| |
A 54-year-old gentle man, not a known case of diabetes mellitus or essential hypertension presented with gradually worsening painless hematuria for two months. He does not consume any tobacco products and occasionally consumes alcohol. He was diagnosed to be HIV positive for two years and is irregularly on Highly Active Anti Retroviral Therapy (HAART). He was on indinavir, lamivudine and zidovudine and was not compliant with the regime. CD4 counts were less than 200 cells/mm 3 . Intravenous urogram revealed a space occupying lesion on the left lateral wall of the urinary bladder with left hydronephrosis. Cystoscopy found a wide based fronded papillary tumor on the left lateral wall and left half of the trigone. Transurethral resection of bladder tumor (TURBT) was done and the histopathology was reported as high grade muscle invasive urothelial carcinoma. Management options were discussed and external beam radiotherapy (EBRT), 60 Grey units in 30 fractions over 6 weeks was given. Patient expired 8 weeks post EBRT due to malignant pleural effusion/respiratory failure.
| Discussion|| |
Malignant tumors currently rank among the leading cause of mortality and morbidity in patients infected with HIV. The pathogenesis of neoplasias in HIV is undoubtedly complex. High prevalence of cancer risk factors, such as smoking, alcohol consumption, human papilloma virus (HPV) infection and HCV infection  and abnormal CD4:CD8 ratio  among HIV-infected people are few of the many causes. Post-HAART era showed a decline in the AIDS-defining malignancies, and an increase in the NON-AIDS defining malignancies.  The role of immunosuppression in the development of NON-AIDS defining malignancies has been proven. Patel et al., found that the risk of developing colorectal cancer, a NON-AIDS defining malignancy, was significantly increased when the CD4 cell counts were low.
Post-solid organ transplant recipients are known to develop malignancies due to immunosuppressive status - Urothelial tumors are one of those.  Pathogenesis of neoplasias being the same in both HIV and post-solid organ transplant patients [Figure 1], it can be hypothesized that the urothelial carcinoma of urinary bladder developed in a immunosuppressed HIV-seropositive patient can be one of the NON-AIDS defining malignancies.
|Figure 1: Pathogenesis of neoplasias in HIV and post-organ transplant recipients|
Click here to view
| References|| |
|1.||Levine AM. AIDS-related malignancies: The emerging epidemic. J Natl Cancer Inst 1993;85:1382-97. |
|2.||1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992;41:1-19. |
|3.||Sahiels MS, Cole RS, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 2009;52:611-22. |
|4.||Grulich AE, Van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: A meta-analysis. Lancet 2007;370:59-67. |
|5.||Silverberg MJ, Chao C, Leyden WA, Xu L, Tang B, Horberg MA, et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS 2009;23:2337-45. |
|6.||Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, et al. Adult and Adolescent Spectrum Of Disease Project And HIV Outpatient Study Investigators. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003. Ann Intern Med 2008;148:728-36. |
|7.||Burgia A, Brodine S, Wegner S, Milazzo M, Wallace MR, Spooner K, et al. Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer 2005;104:1505-11. |
|8.||Kamal MM, Soliman SM, Shokeir AA, Abol-Enein H, Ghoneim MA. Bladder carcinoma among live-donor renal transplant recipients: A single centre experience and a review of literature. BJU Int 2008;101:30-5. |