Epstein-Barr Virus–Positive Hodgkin Lymphoma–Like Earlobe Lymphoid Infiltrate: Case Report

Epstein-Barr virus: dermatologic associations and implications: part II. Associated lymphoproliferative disorders and solid tumors

Epstein-Barr virus (EBV) was the first human virus to be associated with oncogenesis. Over the past few decades, cumulative research has revealed that latent EBV infection may be implicated in the pathogenesis of a heterogeneous group of lymphoproliferative disorders and malignancies occurring in both immunocompetent and immunocompromised hosts. Many of these diseases have either primary or secondary cutaneous manifestations. Serologic studies and EBV-encoded RNA in situ hybridization stains have been used to show the association of EBV with disease; while these findings may imply a role, they do not equate with causation. In part II of this continuing medical education review, the salient features of EBV-associated lymphoproliferative disorders and solid tumors are detailed.

[Indolent lymphoma of the ear]

INTRODUCTION

In 2007, Petrella et al. identified a new entity: CD8 T-cell indolent lymphoma of the ear.

CASE REPORT

A 40-year-old man presented a nodular erythematous and violaceous painless lesion on his right ear that had appeared four months earlier. Excision histology revealed a non-epidermotropic T-cell proliferation infiltrating the entire dermis and subcutis but with sparing of a grenz zone. The monotonous infiltrate was positive for CD8, CD3, CD5 and TIA-1, and negative for CD30, CD4, CD56, ALK and EMA. The Mib1 proliferation index was 20%. Lyme serology and PCR for EBV were negative. Additional examinations showed no extracutaneous involvement.

DISCUSSION

CD8+ indolent lymphoma is an entity first described in 2007 and reported in the literature in 15 patients. Lesions are located on the nose or external ear. It comprises a non-epidermotropic proliferation of CD8+ T lymphocytes negative for CD4, CD30, CD56, CD57, granzyme B and perforin. The Mib1 proliferation index is low. This new entity appears neither in the 2005 World Health Organization/European Organization for Research and Treatment of Cancer (WHO/EORTC) classification of cutaneous lymphomas nor in the WHO 2008 Classification of tumours of haematopoietic and lymphoid tissues. Surgical treatment or radiotherapy is sufficient, and unlike aggressive, epidermotropic CD8+ T lymphomas chemotherapy is not required.

Hodgkin's disease presenting as discharging neck sinuses and a mediastinal mass

A 23-year-old Asian lady presented with a hard indurated midline neck swelling of 2 months duration without any upper aerodigestive tract or systemic symptoms of note. Her inflammatory markers were elevated and she was commenced on antibiotics. Ultrasound scan and fine needle aspiration cytology (FNAC) were inconclusive. A CT scan showed an ill-defined soft tissue mass anterior to and not well demarcated from the thyroid, and contiguous with a superior and anterior mediastinal mass. Incisional biopsy revealed necrosis and pockets of purulent material. Microbiology suggested a chronic pyogenic abscess negative for acid fast bacilli. She was treated with antituberculous therapy without resolution. She developed a discharging lateral neck mass with progressive increase of the mediastinal mass. She subsequently required a neck exploration and mediastinoscopy. Repeat mediastinal biopsies confirmed the diagnosis of Hodgkin's disease and no organisms on culture. She was commenced on chemotherapeutic treatment with a satisfactory outcome.