A Lymphoma Almost Overlooked

A 50-year-old female with a prolonged history of untreated human immunodeficiency virus (HIV) presented with a large vaginal mass. During workup, the mass was found to be vaginal squamous cell carcinoma. Imaging suggested stage IV disease, but a biopsy of liver lesions demonstrated synchronous diffuse large B-cell lymphoma. Her treatment course was notable for complete remission of her lymphoma with lymphoma-directed chemotherapy and complete clinical response of her squamous cell carcinoma to lymphoma-directed therapy. She tolerated intensive chemotherapy despite her HIV but eventually died due to infectious complications during surgery to address a vaginal fistula. The case is demonstrative of several important diagnostic and therapeutic principles in the management of HIV-associated malignancies. Thorough consideration and testing must be performed to ensure accurate staging, as synchronous malignancies and infections can distort standard clinical testing. Further, standard chemotherapeutic regimens often must be tailored and specially sequenced when dealing with severely immunocompromised patients with multiple synchronous processes.