This is a 77 year old man presenting with developed a left side sore throat in early June 2016. Direct laryngoscopy revealed necrotic appearing left base tongue lesion which was biopsied. Of note, the patient received Methotrexate and Remicade since 2014 for rheumatoid arthritis. This was initially referred as a MYC+ BCL2+ "double expressor" large B-cell lymphoma from the outside institution.

Although the morphologic findings are worrisome, the overall clinical context and morphologic findings are in keeping the recently described entity called EBV+ mucocutaneous ulcer.

This entity has been segregated form EBV+ diffuse large B cell lymphoma by the 2016 revised WHO classification of lymphoid neoplasms as new provisional entity due to its self-limited growth potential and response to conservative management. These lesions may present in advanced age or with iatrogenic immunosuppression.(1,2).

Close follow up without treatment resulted in resolution of lesion within weeks in this case.

References
1.          Swerdlow SH et al. The 2016 revision of the WHO Health Organization classification of lymphoid neoplasms. Blood 2016; 127(20):2375-2390.
2.     Dojcinov SD et al. EBV positive mucocutaneous ulcer- a study of 26 cases associated with various sources of immunosuppression. Am J Surg Path 2010; 34; 405-417.