Spontaneous Conventional Osteosarcoma Transformation of a Chondroblastoma: A Case Report and Literature Review

Sir,

Narhari et al. discussed the spontaneous conventional osteosarcoma transformation of a chondroblastoma in a 29-year-old Malaysian patient.¹ I presume that the following point might further explain that rare transformation. It is obvious that HIV-positive individuals have increased propensity to have tumors. This has been attributed to different factors, including immunosuppression, co-infection with oncogenic viruses, and life prolongation secondary to the use of antiretroviral therapy.² In fact, among these individuals, co-infection with oncogenic viruses including Epstein–Barr virus, human herpes virus-8, and human papilloma virus could cause significant cancer-related morbidity and mortality. It has been suggested that these viruses interact with HIV in unique ways that predispose HIV-infected individuals to malignant diseases.³ I presume that HIV could play a pivotal role in triggering the transformation of one tumor to another through yet unrecognized cellular and molecular mechanisms. In-depth researches are needed to verify that postulation. To my knowledge, HIV infection is an important health threat in Malaysia. The available data pointed out that HIV incidence per 1000 population (adults 15–49 years) was reported to be 0.30 (0.25–0.36).⁴ I presume that the underlying HIV infection ought to be considered in the studied patient and, hence, CD4 count and viral overload estimations were solicited to be contemplated. If these measurements were done and they showed positive HIV status, the case in question could be truly considered a novel case report. This is because osteosarcoma transformation of a chondroblastoma in HIV-positive patient has never been reported in the literature so far.

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