Epstein–Barr virus-related reactive lymphoproliferative disorders in middle-aged or elderly patients presenting with atypical features. A clinicopathological study of six cases

Kojima, Masaru; Kashimura, Masamichi; Itoh, Hideaki; Noro, Akira; Akikusa, Bunshiro; Iijima, Misa; Shimizu, Kazuo; Masawa, Nobuhide; Nakamura, Shigeo

doi:10.1016/j.prp.2007.05.002

Cited by 32 publications

(34 citation statements)

References 11 publications

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“…4,5 Only a few reports detailed clinical, histological and immunohistological findings of IM ineldery have been published in the literature. [6][7][8] The histomorphological findings IM in elderly patients appear similar to those of typical IM in younger patients. 7,8 However, clinical presentations of IM elderly are quite distinct from the clinical findings of IM in younger patients, including absence of atypical lymphocytosis of the peripheral blood.…”

supporting

confidence: 61%

“…[6][7][8] The histomorphological findings IM in elderly patients appear similar to those of typical IM in younger patients. 7,8 However, clinical presentations of IM elderly are quite distinct from the clinical findings of IM in younger patients, including absence of atypical lymphocytosis of the peripheral blood. [6][7][8] Indeed, this patient underwent lymph node biopsy to rule out malignant lymphoma.…”

supporting

confidence: 61%

“…7,8 However, clinical presentations of IM elderly are quite distinct from the clinical findings of IM in younger patients, including absence of atypical lymphocytosis of the peripheral blood. [6][7][8] Indeed, this patient underwent lymph node biopsy to rule out malignant lymphoma. Histologically, the lymph node lesion contained numerous plasma cells, cells with plasma cell differentiation and B-immunoblasts and suspected atypical lymphoproliferative disorder.…”

mentioning

confidence: 99%

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Lymph Node Lesion of Acute Infectious Mononucleosis in the Elderly : A Case Report

Kojima

Suzuki

Shimizu

et al. 2011

J Clin Exp Hematopathol

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supporting

confidence: 61%

supporting

confidence: 61%

mentioning

confidence: 99%

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Lymph Node Lesion of Acute Infectious Mononucleosis in the Elderly : A Case Report

Kojima

Suzuki

Shimizu

et al. 2011

J Clin Exp Hematopathol

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“…EBVpositive DLBCL of the elderly is still considered a provisional entity that requires a more precise definition and distinction from other EBV-related disorders, including reactive lesions, EBVpositive classic Hodgkin lymphoma, and the recently described mucocutaneous ulcer. [47][48][49] The term EBV-positive DLBCL of the elderly emphasizes the tendency of these lesions to present at advanced age, although there is no sharp age limit, and similar lesions may be found in younger persons. To date, reports of these tumors in Western countries are limited.…”

Section: Diffuse Large B-cell Lymphomasmentioning

confidence: 99%

The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications

Campo

Swerdlow

Harris

et al. 2011

Blood

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The World Health Organization classification of lymphoid neoplasms updated in 2008 represents a worldwide consensus on the diagnosis of these tumors and is based on the recognition of distinct diseases, using a multidisciplinary approach. The updated classification refined the definitions of well-recognized diseases, identified new entities and variants, and incorporated emerging concepts in the understanding of lymphoid neoplasms. However, some questions were unresolved, such as the extent to which specific genetic or molecular alterations define certain tumors, and the status of provisional entities, categories for which the World Health Organization working groups felt there was insufficient evidence to recognize as distinct diseases at this time. In addition, since its publication, new findings and ideas have been generated. This review summarizes the scientific rationale for the classification, emphasizing changes that have had an effect on practice guidelines. The authors address the criteria and significance of early or precursor lesions and the identification of certain lymphoid neoplasms largely associated with particular age groups, such as children and the elderly. The issue of borderline categories having overlapping features with large B-cell lymphomas, as well as several provisional entities, is reviewed. These new observations chart a course for future research in the field. (Blood. 2011

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“…The group of EBV þ diffuse large B-cell lymphomas includes a recently defined subtype known as diffuse large B-cell lymphoma of the elderly, in which immunological deterioration is additionally associated with the aging process. [27][28][29][30][31][32][33][34][35] The polymorphous subtype of diffuse large B-cell lymphoma of the elderly, in particular, is additionally associated with a polymorphous background consisting of a broad range of B-cell maturation and mixture of reactive elements, including small lymphocytes, plasma cells and histiocytes, similar to that seen in acute EBV infection. These cases can also be associated with large areas of geographic necrosis and ReedSternberg-like cells.…”

Section: A Louissaint Jr Et Almentioning

confidence: 99%

Infectious mononucleosis mimicking lymphoma: distinguishing morphological and immunophenotypic features

et al. 2012

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The diagnosis of infectious mononucleosis (acute Epstein-Barr virus (EBV) infection) is usually made on the basis of clinical and laboratory findings. However, an atypical clinical presentation occasionally results in a lymph node or tonsillar biopsy. The morphological features of EBV-infected lymphoid tissue can easily mimic lymphoma. Furthermore, the immunophenotype of the immunoblasts has not been well characterized. To assess the morphological spectrum of acute EBV infection and the utility of immunohistochemistry in diagnosing difficult cases that resemble lymphoma, we reviewed 18 cases of acute EBV infection submitted in consultation to our institution with an initial diagnosis of/or suspicion for lymphoma. Patients included nine male and nine female individuals with a median age of 18 years (range 9-69). Biopsies were obtained from lymph nodes (3/18) or Waldeyer's ring (15/18). Infectious mononucleosis was confirmed by monospot or serological assays in 72% of cases (13/18). All cases featured architectural distortion by a polymorphous infiltrate with an immunoblastic proliferation, sometimes forming sheets. Reed-Sternberg-like cells were present in 8/18 (44%) of the cases. Infiltrates were often accompanied by necrosis (10/18) and mucosal ulceration (6/15). The majority of immunoblasts in all cases were CD20 þ B cells with a post-germinal center immunophenotype (strongly positive for MUM1/IRF4 (18/18), CD10À (18/18 negative) and BCL-6À (16/18 negative; 2/18 faint BCL-6 expression in o10% of immunoblasts)). Immunoblasts showed variable weak expression of BCL-2 and polyclonal expression of j and k immunoglobulin light chains in 81% cases. ReedSternberg-like cells in 8/8 cases were CD30 þ , CD15À, BOB.1 þ and OCT-2 þ . In conclusion, an atypical lymphoid infiltrate with numerous MUM1 þ , CD10À, BCL-6À immunoblasts should raise the suspicion of a reactive process, such as infectious mononucleosis, and warrants additional consideration before a diagnosis of lymphoma is made.

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Epstein–Barr virus-related reactive lymphoproliferative disorders in middle-aged or elderly patients presenting with atypical features. A clinicopathological study of six cases

Cited by 32 publications

References 11 publications

Lymph Node Lesion of Acute Infectious Mononucleosis in the Elderly : A Case Report

Lymph Node Lesion of Acute Infectious Mononucleosis in the Elderly : A Case Report

The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications

Infectious mononucleosis mimicking lymphoma: distinguishing morphological and immunophenotypic features

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