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Doi M, Hamada M, Ishizawa K, Fushimi N, Kase Y, Ikezono T, Tamaru JI, Yamada T. Diagnostic utility of cytology in a patient with Epstein-Barr virus-positive mucocutaneous ulcer in palatine tonsils: A case report. Diagn Cytopathol 2024; 52:E154-E158. [PMID: 38533980 DOI: 10.1002/dc.25309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a newly established immunodeficiency-related disease. Herein, we report a case of EBVMCU and focus on its cytological usefulness for diagnosis. An 82-year-old man manifested pharyngalgia, dysphagia, and oral pain. His medical history included rheumatoid arthritis that had been treated with methotrexate. Clinically, peritonsillar abscess was suspected, but since neoplastic lesions, including malignant lymphoma (ML), could not be excluded, a series of cytohistological examination was attempted. Despite some alarming findings (e.g., frequent mitoses), fine-needle aspiration and touch imprint cytology consistently revealed a heterogeneous population of lymphoid and plasmacytoid cells with mild nuclear atypia. The final diagnosis of EBVMCU was established based on the permanent histologic specimen; however, retrospectively, cytology was more representative of the benign nature of the lesion than histology, helping a great deal to differentiate it from ML. Cytology can be a useful tool for the correct diagnosis of EBVMCU.
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Affiliation(s)
- Mieko Doi
- Department of Diagnostic Pathology, Saitama Medical University, Saitama, Japan
| | - Mei Hamada
- Department of Diagnostic Pathology, Saitama Medical University, Saitama, Japan
- Department of Pathology, Saitama Medical University, Saitama, Japan
| | - Keisuke Ishizawa
- Department of Diagnostic Pathology, Saitama Medical University, Saitama, Japan
- Department of Pathology, Saitama Medical University, Saitama, Japan
| | - Naoki Fushimi
- Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yasuhiro Kase
- Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
| | - Tetsuo Ikezono
- Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
| | - Jun-Ichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Taketo Yamada
- Department of Diagnostic Pathology, Saitama Medical University, Saitama, Japan
- Department of Pathology, Saitama Medical University, Saitama, Japan
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Di J, Wei S, Jackson A, Munker R, Kesler MV. Transition From Epstein-Barr Virus (EBV)-Positive Rectal Hodgkin Lymphoma to Diffuse Large B-Cell Lymphoma in the Lung. Cureus 2024; 16:e65013. [PMID: 39165470 PMCID: PMC11333787 DOI: 10.7759/cureus.65013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/22/2024] Open
Abstract
We report a distinctive case of sequential lymphomas in a 72-year-old male, initially diagnosed with Epstein-Barr virus (EBV)-positive rectal classic Hodgkin lymphoma (cHL), followed by the development of diffuse large B cell lymphoma (DLBCL) in the lung. This rare progression underscores the complexity of lymphomas associated with EBV infection and their unpredictable clinical courses. The patient's journey began with symptoms of intractable diarrhea, low appetite, and significant weight loss, leading to the diagnosis of stage 4B cHL, managed initially with brentuximab/doxorubicin, vinblastine, dacarbazine (AVD) chemotherapy. Despite a partial response, surveillance identified a transition to DLBCL, marked by new pulmonary lesions. This case highlights the clinical and diagnostic challenges in managing sequential lymphomas, emphasizing the role of EBV in lymphomagenesis and the potential for clonal evolution from a common precursor cell. The therapeutic approach evolved from targeted chemotherapy to consideration of advanced treatments such as autologous stem cell transplant and chimeric antigen receptor (CAR) T-cell therapy, reflecting the aggressive nature and poor prognosis of the disease. This case contributes to our understanding of the EBV's impact on lymphoma progression and underscores the need for vigilant monitoring and adaptive treatment strategies in similar clinical scenarios.
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Affiliation(s)
- Jing Di
- Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Sainan Wei
- Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Amie Jackson
- Hematology and Oncology, Baptist Health Lexington, Lexington, USA
| | - Reinhold Munker
- Hematology and Oncology, University of Kentucky HealthCare, Lexington, USA
| | - Melissa V Kesler
- Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, USA
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Trecourt A, Donzel M, Fontaine J, Ghesquières H, Jallade L, Antherieu G, Laurent C, Mauduit C, Traverse-Glehen A. Plasticity in Classical Hodgkin Composite Lymphomas: A Systematic Review. Cancers (Basel) 2022; 14:cancers14225695. [PMID: 36428786 PMCID: PMC9688742 DOI: 10.3390/cancers14225695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
The co-occurrence of several lymphomas in a patient defines composite/synchronous lymphoma. A common cellular origin has been reported for both contingents of such entities. In the present review, we aimed to gather the available data on composite lymphomas associating a classical Hodgkin lymphoma (cHL) with another lymphoma, to better understand the plasticity of mature B and T-cells. This review highlights that >70% of patients with a composite lymphoma are ≥55 years old, with a male predominance. The most reported associations are cHL with follicular lymphoma or diffuse large B-cell lymphoma, with over 130 cases reported. The cHL contingent is often of mixed cellularity type, with a more frequent focal/weak CD20 expression (30% to 55.6%) compared to de novo cHL, suggesting a particular pathophysiology. Moreover, Hodgkin cells may express specific markers of the associated lymphoma (e.g., BCL2/BCL6 for follicular lymphoma and Cyclin D1 for mantle cell lymphoma), sometimes combined with common BCL2/BCL6 or CCND1 rearrangements, respectively. In addition, both contingents may share similar IgH/IgK rearrangements and identical pathogenic variants, reinforcing the hypothesis of a common clonal origin. Finally, cHL appears to be endowed with a greater plasticity than previously thought, supporting a common clonal origin and a transdifferentiation process during lymphomagenesis of composite lymphomas.
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Affiliation(s)
- Alexis Trecourt
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon 1, UR 3738—CICLY, 69921 Oullins, France
- Correspondence: ; Tel.: +33-(0)4-7886-1186; Fax: +33-(0)4-7886-5713
| | - Marie Donzel
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
| | - Juliette Fontaine
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Hervé Ghesquières
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
- Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Laurent Jallade
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
- Laboratoire d’Hématologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Gabriel Antherieu
- Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Camille Laurent
- Service de Pathologie, Centre de Recherche en Cancérologie de Toulouse-Purpan, Institut Universitaire du Cancer, Oncopole de Toulouse, 31100 Toulouse, France
| | - Claire Mauduit
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Institut National de la Santé et de la Recherche Médicale, Centre Méditerranéen de Médecine Moléculaire (C3M), Unité 1065, Equipe 10, 06000 Nice, France
| | - Alexsandra Traverse-Glehen
- Service de Pathologie Multi-Site, Site Sud, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
- Faculté de Médecine de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Faculté de Médecine Lyon-Sud, CRCL, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon-1, INSERM U1111, CNRS, UMR5308, ENS Lyon, 69921 Oullins, France
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Sun C, Wang Q, Dong Y, Nong L, Cai Y, Wang L, Sun Y, Wang W, Liu X. Primary Epstein-Barr Virus-Positive Mucocutaneous Ulcer of Esophagus: A Rare Case Report. J Clin Med 2022; 11:jcm11164915. [PMID: 36013154 PMCID: PMC9410325 DOI: 10.3390/jcm11164915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Primary EBV-positive mucocutaneous ulcer (EBVMCU) is a rare and indolent disorder occurring in the oropharynx, skin, and gastrointestinal tract, with remission after removal of the immunosuppressive causes. We present a 69-year-old woman with heartburn, regurgitation of gastric acid, enlarged lymph nodes, and parotid glands. The endoscopic examination showed a circumscribed ulcer in the lower esophagus. A biopsy pathology indicated an esophageal EBV-associated lymphoproliferative disorder and a parotid gland/lymph node indolent B-cell lymphoma. Interestingly, the patient did not undergo any treatment, but the endoscopic ulcer improved significantly after more than 2 months. The last pathology showed EBV negativity, and EBVMCU was considered in combination with clinical and endoscopic manifestations. We followed up with the patient at 6 months, and the symptoms of acid reflux and heartburn had disappeared. Our case demonstrates that EBVMCU may occur in the esophagus with spontaneous regression.
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Affiliation(s)
- Chunping Sun
- Department of Geriatric, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Qingya Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Yujun Dong
- Department of Hematology, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Yunlong Cai
- Department of Gastroenterology, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Lihong Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Yuhua Sun
- Department of Hematology, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Wensheng Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing 100034, China
- Correspondence: (W.W.); (X.L.); Tel.: +86-133-6612-3205 (W.W.); +86-137-0138-6256 (X.L.)
| | - Xinmin Liu
- Department of Geriatric, Peking University First Hospital, Peking University, Beijing 100034, China
- Correspondence: (W.W.); (X.L.); Tel.: +86-133-6612-3205 (W.W.); +86-137-0138-6256 (X.L.)
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Zanelli M, Sanguedolce F, Palicelli A, Zizzo M, Martino G, Caprera C, Fragliasso V, Soriano A, Valle L, Ricci S, Cavazza A, Merli F, Pileri SA, Ascani S. EBV-Driven Lymphoproliferative Disorders and Lymphomas of the Gastrointestinal Tract: A Spectrum of Entities with a Common Denominator (Part 1). Cancers (Basel) 2021; 13:4578. [PMID: 34572803 PMCID: PMC8465149 DOI: 10.3390/cancers13184578] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/21/2022] Open
Abstract
EBV is the most common persistent virus in humans. The interaction of EBV with B lymphocytes, which are considered the virus reservoir, is at the base of the life-long latent infection. Under circumstances of immunosuppression, the balance between virus and host immune system is altered and hence, EBV-associated lymphoid proliferations may originate. These disorders encompass several entities, ranging from self-limited diseases with indolent behavior to aggressive lymphomas. The virus may infect not only B-cells, but even T- and NK-cells. The occurrence of different types of lymphoid disorders depends on both the type of infected cells and the state of host immunity. EBV-driven lymphoproliferative lesions can rarely occur in the gastrointestinal tract and may be missed even by expert pathologists due to both the uncommon site of presentation and the frequent overlapping morphology and immunophenotypic features shared by different entities. The aim of this review is to provide a comprehensive overview of the current knowledge of EBV-associated lymphoproliferative disorders, arising within the gastrointestinal tract. The review is divided in three parts. In this part, the available data on EBV biology, EBV-positive mucocutaneous ulcer, EBV-positive diffuse large B-cell lymphoma, not otherwise specified and classic Hodgkin lymphoma are discussed.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (S.R.); (A.C.)
| | | | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (S.R.); (A.C.)
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (G.M.); (C.C.); (S.A.)
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (G.M.); (C.C.); (S.A.)
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Alessandra Soriano
- Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA;
- Gastroenterology Division, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Luca Valle
- Anatomic Pathology, Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa and Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Stefano Ricci
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (S.R.); (A.C.)
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (S.R.); (A.C.)
| | - Francesco Merli
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Stefano A. Pileri
- Haematopathology Division, European Institute of Oncology-IEO IRCCS Milan, 20141 Milan, Italy;
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (G.M.); (C.C.); (S.A.)
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Ishikawa E, Satou A, Nakamura M, Nakamura S, Fujishiro M. Epstein-Barr Virus Positive B-Cell Lymphoproliferative Disorder of the Gastrointestinal Tract. Cancers (Basel) 2021; 13:3815. [PMID: 34359715 PMCID: PMC8345108 DOI: 10.3390/cancers13153815] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Epstein-Barr virus positive B-cell lymphoproliferative disorder (EBV+ B-LPD) encompasses a broad clinicopathological spectrum and distinct clinical behavior that relatively favors the gastrointestinal (GI) tract. In this review, we provide an update on the clinicopathological features and biological behavior of EBV-positive mucocutaneous ulcer (EBVMCU) and primary EBV+ diffuse large B-cell lymphoma (DLBCL) of the GI tract. EBVMCU is a newly recognized entity but well known as an indolent and self-limited EBV+ B-LPD occurring in various immunodeficiencies. In contrast, EBV+ DLBCL constitutes the largest group of EBV+ B-LPDs and is regarded as an aggressive neoplasm. These two distinct diseases have historically been distinguished in the reappraisal of age-related EBV-associated B-LPDs but are challenging in routine practice regarding their differential diagnostic and therapeutic approaches. An increasing number of reports indicate that they are epidemiologically prevalent beyond western and eastern countries, but their comprehensive analysis is still limited. We also describe the PD-L1 positivity of tumorous large cells and non-malignant immune cells, which is relevant for the prognostic delineation among patients with primary DLBCL of the GI tract with and without EBV on tumor cells.
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Affiliation(s)
- Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (M.N.); (M.F.)
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (M.N.); (M.F.)
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8550, Japan;
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (M.N.); (M.F.)
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Ikeda T, Gion Y, Nishimura Y, Nishimura MF, Yoshino T, Sato Y. Epstein-Barr Virus-Positive Mucocutaneous Ulcer: A Unique and Curious Disease Entity. Int J Mol Sci 2021; 22:ijms22031053. [PMID: 33494358 PMCID: PMC7865427 DOI: 10.3390/ijms22031053] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Epstein–Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) was first described as a lymphoproliferative disorder in 2010. EBVMCU is a unifocal mucosal or cutaneous ulcer that often occurs after local trauma in patients with immunosuppression; the patients generally have a good prognosis. It is histologically characterized by proliferating EBV-positive atypical B cells accompanied by ulcers. On the basis of conventional pathologic criteria, EBVMCU may be misdiagnosed as EBV-positive diffuse large B-cell lymphoma or other lymphomas. However, its prognosis differs from that of EBV-associated lymphomas, in that patients with EBVMCU frequently show spontaneous regression or complete remission without chemotherapy. Therefore, EBVMCU is now recognized as a low-grade malignancy or a pseudo-malignant lesion. Avoiding unnecessary chemotherapy by distinguishing EBVMCU from other EBV-associated lymphomas will reduce the burden and unnecessary harm on patients. On the basis of these facts, EBVMCU was first described as a new clinicopathological entity by the World Health Organization in 2017. In this review, we discuss the clinicopathological characteristics of previously reported EBVMCU cases, while focusing on up-to-date clinical, pathological, and genetic aspects.
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Affiliation(s)
- Tomoka Ikeda
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.I.); (M.F.N.); (T.Y.)
| | - Yuka Gion
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan;
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Hospital, Okayama 700-8558, Japan;
| | - Midori Filiz Nishimura
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.I.); (M.F.N.); (T.Y.)
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.I.); (M.F.N.); (T.Y.)
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.I.); (M.F.N.); (T.Y.)
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan;
- Correspondence: ; Tel.: +81-86-235-7150; Fax: +81-86-235-7156
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