EBV reactivation in older person
Author: Girish Venkataraman, MD, MBBS; Yanxia Cathy Li, MD; Shiraz Fidai, MD; Kevin Schmidt Tanager, MD, 10/25/2018
Category: Lymph Node and Spleen: Reactive/infectious > Infectious processes > EBV-related reactive lymphoid proliferations > EBV reactivation
Published Date: 10/25/2018
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This is a sixty-three year old female with asymmetric tonsillar enlargement. She has no fevers, chills or difficulty swallowing. There are no B. symptoms. Further clinical examination does not reveal any lymphadenopathy. CBC indicates normal study.
The findings below are consistent with EBV-reactivation in an older person.
Learning points:
EBV-related lymphoproliferative processes can show a wide morphologic spectrum ranging from reactive follicular hyperplasia to patchy polymorphous lymphoid infiltrates and overt monomorphic large B-cells.
The current case does not show any sheets of monomorphic large B-cells and hence does not warrant the diagnosis of EBV+ diffuse large B-cell lymphoma, not otherwise specified (WHO 2016).[1] In the absence of any PET evidence of systemic component, these are managed conservatively as EBV reactivation.
REF:
1. Dojcinov SD, Venkataraman G, Pittaluga S, Wlodarska I, Schrager JA, Raffeld M, Hills RK, Jaffe ES. Age-related EBV-associated lymphoproliferative disorders in the Western population: a spectrum of reactive lymphoid hyperplasia and lymphoma. Blood. 2011 May 5;117(18):4726-35.
2: Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19;127(20):2375-90.
H&E images
Sections from the tonsil shows unremarkable surface epithelium with underlying lymphoid tissue demonstrating destruction of architecture with prominent interfollicular expansion by large clusters and sheets of reactive histiocytes with intervening areas demonstrating plasma cells and occasional immunoblasts. The follicular structures are otherwise morphologically compatible with reactive secondary follicles.
CD20 and CD3 stains
Numerous CD20+ B-cells with only occasional large forms are seen besides numerous reactive paracortical T-cells.
CD5
There is weak CD5 coexpression in the mantle zone B-cells while numerous backgound T-cells are noted in CD5. Rarely normal mantle zone B-cells may express CD5 although this phenomenon has been described more often in Castleman disease.
CD4 and CD8
There is preponderance of CD8 T cells over CD4 T-cells. CD4 stain also marks the background histiocytes. There is often expansion of CD8 T-cells in cases of EBV reactivation due to expansion of EBV-specific cytotoxic CD8 T-cells.
EBER
Numerous varying-sized EBV positive cells are seen in the interfollicular regions on the EBV-ISH.
