EBV-positive Reactive Hyperplasia Progressed into EBV-positive Diffuse Large B-cell Lymphoma of the Elderly over a 6-year Period

Abstract

A 70-year-old woman with lymphadenopathy was admitted to hospital in 2008. Lymph node biopsy showed reactive lymphoid hyperplasia (RH) with monoclonal proliferation of Epstein-Barr virus (EBV). Her lymphadenopathy regressed without treatment. In 2014, the patient presented with nasal obstruction because of a left nasal mass. She was diagnosed with EBV-positive diffuse large B-cell lymphoma (DLBCL) of the elderly based on the examination of a biopsy specimen of the mass. The IgH rearrangement in the specimens from the 2008 and the 2014 revealed that they were genetically identical. This is the first report of RH progressing to DLBCL, and suggests that EBV-positive B-cells in RH lymph nodes predict the evolution to DLBCL.

Ebv-Related Lymphoproliferative Diseases: A Review in Light of New Classifications

“…Beyond EBV, IM-like infections can result from human cytomegalovirus, adenovirus, or other pathogens. 15 acute EBV infection is frequently asymptomatic or mild in children under the age of 5 years, while 25-75% of adolescents and adults develop overt IM following Infection. 11 Within weeks of EBV infection, signs and symptoms of IM appear.…”

“…Tonsils and cervical lymph nodes display hyperplasia, featuring a mix of normal-appearing lymphocytes, activated lymphocytes, plasma cells, and Reed-Sternberg-like cells. 15 Notably, many of these normal-appearing and activated B cells, along with a small fraction of the tissue's T and NK cells, are EBV+, with the virus predominantly being in the lytic phase rather than latent. 1 Mild IM cases are often overlooked or diagnosed based on clinical and routine laboratory findings.…”

EBV-Positive Lymphoproliferations of B- T- and NK-Cell Derivation in Non-Immunocompromised Hosts

“…These include IM-like paracortical hyperplasia and follicular hyperplasia with EBV+ germinal centres. Recently, both have been found preceding or concomitant with EBV+ DLBCL [ 39 , 40 , 41 ]. It is yet unclear if these represent precursors to the development of EBV+ DLBCL or, more likely, an early reflection of an immunosuppressed state suggesting a role of immune response in controlling germinal centre transit of EBV infected cells [ 18 ].…”

Avaliação da prevalência de infecção por Epstein-Barr vírus na hiperplasia de tonsilas palatinas através da imunoexpressão do marcador LMP-1.

“…Resultados: A amostra foi composta por 120 lâminas, sendo 66 (55%) de pacientes do sexo masculino. O tamanho médio tonsilar foi 6,0 cm2 (1,5-14,0) e a idade média 6,5 anos (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Ao todo, 72 pacientes (60%) tiveram positividade para o vírus, a maioria meninos (51%) e pré-escolares (51,4%).…”

“…6 Primary infection in children is often asymptomatic and tends to remain latent in memory B cells. 7 During EBV's latent infections, the expression of viral genes that encode nuclear antigens (EBN A-1, 2, 3A, 3B, 3C and LP), latent membrane proteins (LMP-1, LMP-2A and LMP 2B), RNA molecules (EBER-1 and 2), and others can occur. 8 From that state, EBV may be associated with malignant conditions, such as Hodgkin's or Non-Hodgkin's lymphoma, gastric and oropharyngeal carcinomas.…”