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Manini N, Davidow K, Conard K, Powell J. Hematopoietic Bone Marrow Transplant to Treat Systemic EBV-positive T-cell Lymphoma of Childhood. J Pediatr Hematol Oncol 2024; 46:e208-e211. [PMID: 38117087 DOI: 10.1097/mph.0000000000002800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
Systemic Epstein-Barr virus-positive T-cell lymphoma of childhood (S-EBV-TCL) is a rare disease for which there is no standard of care. S-EBV-TCL is often associated with hemophagocytic lymphohistiocytosis and is generally thought of on the spectrum of EBV-related disease. For the few reported cases of cure in the literature, hematopoietic stem cell transplant has been required because it is the only treatment that has induced complete remission in patients suffering from EBV-associated T-cell or natural killer cell lymphoproliferative diseases, except hemophagocytic lymphohistiocytosis. Here, we present the case of one patient who was successfully cured with a modified regimen of dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), followed by hematopoietic stem cell transplant using a reduced-intensity conditioning regimen.
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Affiliation(s)
| | - Kimberly Davidow
- Department of Pathology Division of Pediatric Hematology/Oncology, Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital-Delaware, Wilmington, DE
| | - Katrina Conard
- Department of Pediatric Hematology/oncology Pathology, Nemours Children's Hospital-Delaware
| | - Jonathan Powell
- Department of Pathology Division of Pediatric Hematology/Oncology, Nemours Center for Cancer and Blood Disorders, Nemours Children's Hospital-Delaware, Wilmington, DE
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2
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Robbins DJ, Ranheim EA, Kallan JE. Unsuspected systemic Epstein-Barr virus-positive T-cell lymphoma of childhood diagnosed at autopsy in a potential homicide case. J Pathol Transl Med 2022; 57:123-127. [PMID: 36539395 PMCID: PMC10028015 DOI: 10.4132/jptm.2022.10.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Systemic Epstein-Barr virus (EBV)-positive T-cell lymphoma of childhood (SETLC) is a rare, rapidly progressive, and often fatal disease of children and young adults characterized by monoclonal expansion of EBV-positive T cells in tissues or peripheral blood following infection with EBV. Its distinction from other EBV-positive T-cell lymphoproliferative disorders with overlapping features can be difficult, and particular diagnostic features may not be manifest until autopsy examination. We present the case of a 10-year-old boy with significant disability due to remote traumatic brain injury following non-accidental head trauma who died unexpectedly at home. Given the history of physical abuse and the potential for homicide charges, significant medicolegal implications arose with this case. Pathologic investigation ultimately revealed conclusive diagnostic features of SETLC including extensive proliferation of EBV-positive T cells in multiple organs. A natural manner of death was confirmed, thereby excluding delayed homicide related to complications of non-accidental head trauma.
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Affiliation(s)
- Daniel J Robbins
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erik A Ranheim
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jamie E Kallan
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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3
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Geerlinks A, Keis J, Ngan B, Shammas A, Vali R, Hitzler J. Unusual lymphoid malignancy and treatment response in two children with Down syndrome. Pediatr Blood Cancer 2019; 66:e27822. [PMID: 31136091 DOI: 10.1002/pbc.27822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lymphoid malignancies other than acute lymphoblastic leukemia (ALL) are rare in children with Down syndrome (DS). Information about the toxicity of chemotherapy and prognosis is largely derived from the experience of children with DS and ALL or children without DS. PROCEDURE We describe the treatment and outcome of two unusual lymphoid malignancies in children with DS. One patient was diagnosed with Burkitt lymphoma (BL) and the second, after treatment for B precursor ALL, with T-cell EBV-positive proliferative disorder (LPD). RESULTS BL was treated with standard doses of LMB group B therapy subsequently intensified to group C therapy, including high-dose methotrexate (HD-MTX, 3-8 g/m2 ). The patient did not experience excessive toxicity and remains in complete remission 13 months later. Despite presentation with disseminated disease the patient with T-cell EBV-positive LPD after treatment for B precursor ALL responded to dexamethasone and rituximab and remains in complete remission two years later. CONCLUSIONS Upfront reduction of the high treatment intensity, which is associated with excellent survival outcomes in BL, may not be warranted in all children with DS. Response to therapy and prognosis of T-cell EBV-positive LPD in a patient with DS was not predicted by reported experience in the absence of DS.
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Affiliation(s)
- Ashley Geerlinks
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Keis
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Bo Ngan
- Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amer Shammas
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reza Vali
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Johann Hitzler
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Developmental and Stem Cell Biology, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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4
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Ko YH. Epstein-Barr virus-positive T/NK-cell lymphoproliferative diseases in children and adolescents. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2017.00198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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5
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Yoshida M, Osumi T, Imadome KI, Tomizawa D, Kato M, Miyazawa N, Ito R, Nakazawa A, Matsumoto K. Successful treatment of systemic EBV positive T-cell lymphoma of childhood using the SMILE regimen. Pediatr Hematol Oncol 2018; 35:121-124. [PMID: 29648917 DOI: 10.1080/08880018.2018.1459982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Masanori Yoshida
- a Children's Cancer Center , National Center for Child Health and Development (NCCHD) , Tokyo , Japan
| | - Tomoo Osumi
- a Children's Cancer Center , National Center for Child Health and Development (NCCHD) , Tokyo , Japan
| | - Ken-Ichi Imadome
- b Department of Advanced Medicine for Infections , NCCHD , Tokyo , Japan
| | - Daisuke Tomizawa
- a Children's Cancer Center , National Center for Child Health and Development (NCCHD) , Tokyo , Japan
| | - Motohiro Kato
- a Children's Cancer Center , National Center for Child Health and Development (NCCHD) , Tokyo , Japan
| | - Noritaka Miyazawa
- a Children's Cancer Center , National Center for Child Health and Development (NCCHD) , Tokyo , Japan
| | - Reiko Ito
- c General Pediatrics and Interdisciplinary Medicine , NCCHD , Tokyo , Japan
| | | | - Kimikazu Matsumoto
- a Children's Cancer Center , National Center for Child Health and Development (NCCHD) , Tokyo , Japan
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6
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Systemic Epstein-Barr Virus-positive T-Cell Lymphoproliferative Disease of Childhood With Good Response to Steroid Therapy. J Pediatr Hematol Oncol 2017; 39:e497-e500. [PMID: 28697169 DOI: 10.1097/mph.0000000000000909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Systemic Epstein-Barr virus (EBV)-positive T-cell lymphoproliferative disease of childhood is a rare disease and has a very fulminant clinical course with high mortality. A 21-month-old female patient was referred to our hospital with a 1 week history of fever and was subsequently diagnosed with systemic Epstein-Barr virus-positive T-cell lymphoproliferative disease of childhood. After starting treatment with dexamethasone, she showed early defervescence and improvement of laboratory parameters, and has remained disease-free after stopping steroid treatment, although longer follow-up is necessary. Our report underscores the possibility that this disease entity may be heterogenous in terms of prognosis.
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7
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Three Rwandan Children With Massive Splenomegaly and Epstein-Barr Virus-associated Lymphoproliferative Disorders: Case Presentations and the Literature Review. J Pediatr Hematol Oncol 2016; 38:e158-61. [PMID: 27352192 DOI: 10.1097/mph.0000000000000561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This report describes 3 Rwandan children with massive splenomegaly and pancytopenia who underwent splenectomy. Each was diagnosed with Epstein-Barr virus-associated lymphoproliferative disorder (EBV LPD) based on lymphocyte morphology, lymphocyte immunophenotype, and the results of EBV in situ hybridization studies. The differential diagnosis of splenomegaly, with a special emphasis on the sub-Saharan African context, is discussed along with EBV and associated disorders. These cases serve as a call to consider EBV LPD in the differential diagnosis of splenomegaly in children in whom common causes have been ruled out.
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8
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Cytotoxic Molecule-positive Epstein-Barr Virus-associated Peripheral T-cell Lymphoma in a 20-Month-old Child: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2015; 37:e475-80. [PMID: 26056791 DOI: 10.1097/mph.0000000000000368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral T-cell lymphoma (PTCL) is rare in children. Expression of cytotoxic molecules (CM) in nodal PTCL has unique clinicopathologic features, including an Epstein-Barr virus (EBV) association. However, CM+, EBV-associated PTCL is extremely rare in the childhood, with only 1 study having been reported to date, including both pediatric and adult patients. We report a case of CM+ PTCL in a 20-month-old boy with left neck lymphadenopathy as well as multiple visceral lesions. A biopsied lymph node was diffusely infiltrated by atypical lymphoid cells with a CD4/CD8, granzyme B+, perforin+, and TIA-1+ phenotype, and EBV positivity by in situ hybridization. Rearrangements of the TCR γ-chain and β-chain genes were demonstrated by polymerase chain reaction. Ancillary genetic studies detected trisomy 2, trisomy 10, a structurally abnormal 6p, and additional copies of the IRF4 gene. Multiple bone marrow biopsies failed to show any evidence of tumor, histiocytic hyperplasia, or hemophagocytosis. This lesion was therefore diagnosed as "CM+, EBV-associated high-grade peripheral T-cell lymphoma." After 5 cycles of chemotherapy, the patient was in remission 8 months following initial diagnosis. To our knowledge, this represents the youngest child with this rare tumor in the published literature, and showing an unusually favorable initial response to therapy.
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9
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Chen G, Chen L, Qin X, Huang Z, Xie X, Li G, Xu B. Systemic Epstein-Barr virus positive T-cell lymphoproliferative disease of childhood with hemophagocytic syndrome. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:7110-7113. [PMID: 25400806 PMCID: PMC4230111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
Epstein-Barr virus (EBV) associated lymphoproliferative disease (LPD) are commonly derived from B-cells, however, it is becoming more and more apparently that EBV can also infect T-lymphocytes. Systemic EBV positive T-cell LPD of childhood is rare and characterized by an extremely aggressive course and poor prognosis. Here, we report a 22-year-old female of systemic EBV positive TLPD with acute EBV infection and review the clinical features of this disorder. A 22-year-old previously healthy female without immunocompromised status presented with persisting coach and fever resistant to conventional therapies. Physical examination showed hemorrhage and hepatosplenomegaly. Laboratory examinations revealed severe pancytopenia, disseminated intra-vascular coagulopathy (DIC), and anti-EBV-IgM positivity. Peripheral blood smears and bone marrow investigation identified a number of atypical lymphocytes. Flow cytometry (FCM) did not show any significant evidence of leukemia or lymphoma. The lymph node biopsy showed apparent infiltration of lymphocytes, which expressed CD2+, CD3+, CD7+ and TIA1+. There was no CD20+ or CD56+ cells. EBV early RNA (EBER) was positive. Cytogenetic analysis showed a normal karyotype. T-cell receptor (TCR) gene rearrangement revealed a polyclonal pattern. The patient received prednisolone and IVIG therapy with a transient good condition, and then died of multiorgan failure one week after diagnosis.
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Affiliation(s)
- Guoshu Chen
- Department of Hematology, Huizhou Municipal Central Hospital41 Eling Road North, Huizhou 516001, P. R. China
| | - Li Chen
- Department of Hematology, Huizhou Municipal Central Hospital41 Eling Road North, Huizhou 516001, P. R. China
| | - Xiaohua Qin
- Department of Hematology, Huizhou Municipal Central Hospital41 Eling Road North, Huizhou 516001, P. R. China
| | - Zhuoya Huang
- Department of Pathology, Huizhou Municipal Central Hospital41 Eling Road North, Huizhou 516001, P. R. China
| | - Xiaoling Xie
- Department of Hematology, Huizhou Municipal Central Hospital41 Eling Road North, Huizhou 516001, P. R. China
| | - Guowei Li
- Department of Hematology, Huizhou Municipal Central Hospital41 Eling Road North, Huizhou 516001, P. R. China
| | - Bing Xu
- Department of Hematology, Nanfang Hospital, Southern Medical UniversityGuangzhou 510515, P. R. China
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10
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Ameli F, Ghafourian F, Masir N. Systematic Epstein-Barr virus-positive T-cell lymphoproliferative disease presenting as a persistent fever and cough: a case report. J Med Case Rep 2014; 8:288. [PMID: 25163591 PMCID: PMC4150421 DOI: 10.1186/1752-1947-8-288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/12/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Systemic Epstein-Barr virus-positive T-cell lymphoproliferative childhood disease is an extremely rare disorder and classically arises following primary acute or chronic active Epstein-Barr virus infection. It is characterized by clonal proliferation of Epstein-Barr virus-infected T-cells with an activated cytotoxic phenotype. This disease has a rapid clinical course and is more frequent in Asia and South America, with relatively few cases being reported in Western countries. The clinical and pathological features of the disease overlap with other conditions including infectious mononucleosis, chronic active Epstein-Barr virus infection, hemophagocytic lymphohistiocytosis and natural killer cell malignancies. We describe the rare case of systemic Epstein-Barr virus-positive T-cell lymphoproliferative childhood disease in a 16-year-old Malay boy. Case presentation He presented with a six-month history of fever and cough, with pulmonary and mediastinal lymphadenopathy and severe pancytopenia. Medium- to large-sized, CD8+ and Epstein-Barr virus-encoded RNA-positive atypical lymphoid cells were present in the bone marrow aspirate. He subsequently developed fatal virus-associated hemophagocytic syndrome and died due to sepsis and multiorgan failure. Conclusions Although systemic Epstein-Barr virus-positive T-cell lymphoproliferative childhood disease is a disorder which is rarely encountered in clinical practice, our case report underlines the importance of a comprehensive diagnostic approach in the management of this disease. A high level of awareness of the disease throughout the diagnosis process for young patients who present with systemic illness and hemophagocytic syndrome may be of great help for the clinical diagnosis of this disease.
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Affiliation(s)
| | | | - Noraidah Masir
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak 56000, Cheras, Kuala Lumpur, Malaysia.
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11
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Lemaire AS, Daussay D, Bouchindhomme B, Grardel N, Botte A, Copin MC. [Systemic EBV+ T-cell lymphoproliferative disease of childhood]. Ann Pathol 2014; 34:339-43. [PMID: 25132446 DOI: 10.1016/j.annpat.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/18/2013] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
Systemic EBV+ T-cell lymphoproliferative disease of childhood is a recent entity described in the 2008 World Health Organisation tumours of haematopoietic system and lymphoid tissues as a clonal T-cell EBV+ systemic proliferation. It occurs after acute or chronic active EBV infection. We report the case of a caucasian, immunocompetent 12-year-old girl, with no particular history, who presented with hemophagocytic lymphohistiocytosis in the aftermath of an infectious mononucleosis. Main symptoms were multiple organ failure, hepatosplenomegaly and pancytopenia. Histopathology of peripheral lymph node and bone marrow revealed a T-cell, CD8+, EBV+ lymphoproliferation. An elevated viral load was detected in blood by PCR. The patient died within 3 weeks. Since most of the cases have been reported in Asia and South America, few cases still have been described in Europe. Unlike B-cell lymphoproliferation in immunocompromised individuals, T-cell EBV+ lymphoproliferation occurs in immunocompetent patients and seems to be the consequence of a proliferative disorder of EBV-infected T-cells, attributed to a cytotoxic T-cell response deficiency. These T-cell proliferations are more frequently immunoreactive for CD8 than CD4. A key feature of the diagnosis might be EBV viral load.
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Affiliation(s)
- Anne-Sophie Lemaire
- Institut de pathologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | - Dorothée Daussay
- Institut de pathologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Brigitte Bouchindhomme
- Institut de pathologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Nathalie Grardel
- Laboratoire d'hématologie, centre de biologie-pathologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - Astrid Botte
- Service de réanimation pédiatrique, hôpital Jeanne-de-Flandre, CHU de Lille, 54, avenue Eugène-Avinée, 59037 Lille cedex, France; Université Lille-Nord de France, 59000 Lille, France
| | - Marie-Christine Copin
- Institut de pathologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université Lille-Nord de France, 59000 Lille, France
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12
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Smith MC, Cohen DN, Greig B, Yenamandra A, Vnencak-Jones C, Thompson MA, Kim AS. The ambiguous boundary between EBV-related hemophagocytic lymphohistiocytosis and systemic EBV-driven T cell lymphoproliferative disorder. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:5738-5749. [PMID: 25337215 PMCID: PMC4203186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/21/2014] [Indexed: 06/04/2023]
Abstract
Epstein Barr virus (EBV)-related hemophagocytic lymphohistiocytosis (EBV-HLH) is a form of acquired, infection-related HLH which typically represents a fulminant presentation of an acute EBV infection of CD8+ T cells with 30-50% mortality rate. Systemic EBV-positive lymphoproliferative disease of childhood (SE-LPD) is a rare T cell lymphoproliferative disorder predominantly arising in the setting of acute EBV infection, often presenting with HLH. Since both entities have been associated with clonal T cell populations, the discrimination between these diseases is often ambiguous. We report a unique case of a 21 years old female who presented with clinical and laboratory findings of florid HLH in the setting of markedly elevated EBV titers (>1 million) and an aberrant T cell population shown to be clonal by flow cytometry, karyotype, and molecular studies. This case raises the differential of EBV-HLH versus SE-LPD. Review of the literature identified 74 cases of reported EBV-HLH and 21 cases of SE-LPD with associated HLH in 25 studies. Of those cases with available outcome data, 62 of 92 cases (67%) were fatal. Of 60 cases in which molecular clonality was demonstrated, 37 (62%) were fatal, while all 14 cases (100%) demonstrating karyotypic abnormalities were fatal. Given the karyotypic findings in this sentinel case, a diagnosis of SE-LPD was rendered. The overlapping clinical and pathologic findings suggest that EBV-HLH and SE-LPD are a biologic continuum, rather than discrete entities. The most clinically useful marker of mortality was an abnormal karyotype rather than other standards of clonality assessment.
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MESH Headings
- Biopsy
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/genetics
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/pathology
- Epstein-Barr Virus Infections/virology
- Female
- Flow Cytometry
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunohistochemistry
- Karyotyping
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/genetics
- Lymphohistiocytosis, Hemophagocytic/immunology
- Lymphohistiocytosis, Hemophagocytic/pathology
- Lymphohistiocytosis, Hemophagocytic/virology
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/immunology
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/surgery
- Lymphoma, T-Cell/virology
- Peripheral Blood Stem Cell Transplantation
- Predictive Value of Tests
- T-Lymphocytes/immunology
- T-Lymphocytes/virology
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Megan C Smith
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
| | - Daniel N Cohen
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
| | - Bruce Greig
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
| | - Ashwini Yenamandra
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
| | - Cindy Vnencak-Jones
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
| | - Mary Ann Thompson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
| | - Annette S Kim
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center Nashville TN, USA
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Huang W, Lv N, Ying J, Qiu T, Feng X. Clinicopathological characteristics of four cases of EBV positive T-cell lymphoproliferative disorders of childhood in China. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:4991-4999. [PMID: 25197370 PMCID: PMC4152060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 06/02/2014] [Indexed: 06/03/2023]
Abstract
A new category, "EBV positive T-cell lymphoproliferative disorders (LPD) of childhood", was proposed in the 2008 World Health Organization's (WHO) classifications of lymphoma. This series of lymphoproliferative disorders is rare. There are two major types of this series of disorders: systemic EBV positive T-cell LPD of childhood and hydroa vacciniforme-like lymphoma (HVLL). In this study, we describe the distinct features of four cases of EBV positive T-cell LPD of childhood in China. Two were systemic EBV positive T-cell LPD of childhood, one was HVLL and one was chronic active EBV (CAEBV). The main manifestations were lymphadenopathy, fever, hepatosplenomegaly and skin rashes. The structure of the lymph nodes in the patients ranged from preserved to partially or totally destroyed. Small- to medium-sized, atypical T cells had infiltrated the lymph nodes. In HVLL, the neoplastic cells had infiltrated the dermis and subcutaneous region surrounding sweat glands and nerves. All of the cases tested positive for CD8, other T cells, cytotoxic markers and EBV-encoded RNA (EBER) without CD56 expression. Molecular analysis was performed in three cases. All of the three analyses showed a TCRγ rearrangement and one case also had an IGH rearrangement. One of the patients with systemic EBV positive T-cell LPD of childhood experienced rapid evolved and died within five months of onset. CAEBV, systemic EBV-positive T-cell LPD of childhood and HVLL are distinct but overlapping diseases within the category of EBV-positive T-cell LPD of childhood. They constitute a continuous spectrum of EBV-infected associated disorders.
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Affiliation(s)
- Wenting Huang
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, 100021, China
| | - Ning Lv
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, 100021, China
| | - Jianming Ying
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, 100021, China
| | - Tian Qiu
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, 100021, China
| | - Xiaoli Feng
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College Beijing, 100021, China
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