Detection of Epstein–Barr virus in inflammatory pseudotumour of the spleen: a case report

Mance, Marko; Romić, Ivan; Majerović, Mate

doi:10.1007/s00508-015-0807-6

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…Splenic EBV-associated IPTs that do not stain for FDC markers form a more heterogeneous phenotypic subgroup. [1][2][3]7,[18][19][20][21][22][23] The spindle cells in this subgroup show expression of vimentin, SMA (Figure 1, E), and/or CD68, suggesting fibroblastic, myofibroblastic, or histiocytic differentiation. In 1 reported case, there was positivity for SMA and keratin, which could suggest an FBRC origin.…”

Section: Histopathologymentioning

confidence: 99%

“…Mycobacterial spindle cell pseudotumor is a rare localized lesion that can occur in the spleen in patients who are immunocompromised, particularly following solid organ transplant and in those with AIDS. 21,23 This lesion may be caused by tuberculous and nontuberculous Mycobacterium. Morphologically, it is composed of proliferating CD68 þ spindle cells staining strongly for acid-fast bacilli.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Fifteen well-documented cases have been reported in the spleen. [1][2][3]7,[18][19][20][21][22][23] The phenotype of the spindle cells in splenic EBV-associated IPT not expressing FDC markers is heterogeneous and controversial. Lesions with a presumed fibroblastic, 1 myofibroblastic (''splenic inflammatory myofibroblastic tumor''), 1,2,20,21 fibroblastic reticular cell (FBRC), 17 or ''fibrohistiocytic'' phenotype have been reported.…”

mentioning

confidence: 99%

“…Lesions with a presumed fibroblastic, 1 myofibroblastic (''splenic inflammatory myofibroblastic tumor''), 1,2,20,21 fibroblastic reticular cell (FBRC), 17 or ''fibrohistiocytic'' phenotype have been reported. 2,3,18,19,23 However, given a close relationship between fibroblasts, myofibroblasts, FBRCs, and FDCs with regard to their origin, differentiation, and transformation, 3,9,17,24 it may well be possible that IPT-like FDC tumors and FDC markernegative EBV-associated IPTs represent phenotypic subgroups of the same entity.…”

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confidence: 99%

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Splenic Epstein-Barr Virus–Associated Inflammatory Pseudotumor

Baeten¹,

Dorpe

2017

Archives of Pathology &Amp; Laboratory Medicine

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Splenic inflammatory pseudotumor (IPT) is an uncommon lesion with an inflammatory morphologic aspect that often poses a diagnostic challenge. The etiology of IPT can be infectious, autoimmune, reactive, or neoplastic. Splenic Epstein-Barr virus (EBV)-associated IPTs form a subset of splenic IPTs in which there is a spindle cell component infected by EBV. The best characterized and most frequent subgroup of splenic EBV-associated IPT is IPT-like follicular dendritic cell tumor. This review also focusses on EBV-associated splenic IPTs without follicular dendritic cell marker expression. These lesions are less well characterized, making the differential diagnosis with other splenic lesions even more difficult. Recently, increased numbers of immunoglobulin G4-positive plasma cells and the presence of numerous granulomas have been reported in EBV-associated IPTs, and this can add to the difficulties in recognizing the neoplastic nature of these lesions. Herein, we also review the epidemiology, clinical features, histologic morphology, immunohistochemistry, electron microscopy, and pathogenesis of EBV-associated IPTs.

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Section: Histopathologymentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Splenic Epstein-Barr Virus–Associated Inflammatory Pseudotumor

Baeten¹,

Dorpe

2017

Archives of Pathology &Amp; Laboratory Medicine

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Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia

et al. 2017

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Follicular dendritic cell (FDC) tumor is an uncommon neoplasm. It generally presents as a slow-growing, painless mass, without systemic symptoms. Histological features usually include low grade spindle cell proliferation. This tumor occurs primarily in lymph nodes, especially cervical and axillary, however, involvement of extranodal sites such as the tonsils, spleen, liver, and gastrointestinal tract has been reported. Inflammatory pseudotumor-like follicular dendritic cell tumor (IPT-like FDCT) is a rare, distinctive histological subtype of this low-grade malignant neoplasm, with consistent Epstein-Barr virus (EBV) association. The differential diagnosis with other fibro-inflammatory tumor proliferations, as inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT), may be challenging. In the present article, two cases of IPT-like FDCT of the spleen are presented, with a broad overview of the literature: one 77-year-old male and one 70-year-old female. A large immunohistochemical panel should be used for diagnosis, as no single specific and totally sensitive markers are available, including markers for CD21, CD23, CD35, CNA42, and clusterin. Individual cases may express one or more of these markers, so that all of them should be investigated. In situ hybridization for EBV is constantly positive. Immunostaining for ALK should be negative, as it is present in roughly half of the cases of IMT. This panel should be used in combination of clinical, laboratory, and topographic evidences. Importantly, inclusion of this lesion as a possible option in clinical and pathological investigation represents the basis for a correct diagnosis.

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Inflammatory Pseudotumor of the Spleen in a Patient with Idiopathic Thrombocytopenic Purpura

et al. 2018

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Inflammatory pseudotumor tumors (IPTs) of the spleen are uncommon lesions of uncertain pathogenesis. A definitive clinical diagnosis is challenging because radiological, as well as gross pathologic features may suggest a lymphoma, an inflammatory myofibroblastic tumor (IMT), or an IPT-like follicular dendritic cell tumor (IPT-FDC). Herein, we report a case of an IPT of the spleen in a 48-year-old woman who presented with idiopathic thrombocytopenic purpura (ITP) symptoms. The results of abdominal ultrasonography revealed the presence of a splenic mass that continued to enlarge after the recovery from ITP, leading to the suspicion of lymphoma. A splenectomy was performed for diagnostic and curative purposes. The lesion was a non-encapsulated yellowish mass (largest diameter: 4,4 cm). The presence of spindle cells expressing smooth muscle actin, vimentin, and focal CD68 admixed with polymorphous lymphoid infiltrate supported the IPT diagnosis. The negative expression of CD21, CD23, CD35, and ALK excluded inflammatory myofibroblastic and follicular dendritic cell tumors. Any evidence of the recurrence of either ITP or IPTs was not noted 60 months after the operation. The present case and the review revealed that splenic IPT tends to occur in middle-aged females and diagnosis is challenging due to the absence of specific symptoms or the characteristic hematological or radiological findings. Surgery is the most frequently performed treatment. Although multiple factors have been suggested in the etiology and pathogenesis, previous bleeding may also play a role in the presence of IPTs in patients with ITP. The rare occurrence of splenic IPT and the lack of diagnostic clinical signs and symptoms do not exclude their consideration in the differential diagnosis of spleen tumors, especially in patients with imaging features that cannot rule out malignancy.

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Detection of Epstein–Barr virus in inflammatory pseudotumour of the spleen: a case report

Abstract: Although very difficult to diagnose at initial presentation, it is very important for the physician to be aware of the importance of a careful diagnosis since IPT of the spleen are rare and considered to be tumours with an intermediate malignant potential.

Cited by 3 publications

References 18 publications

Splenic Epstein-Barr Virus–Associated Inflammatory Pseudotumor

Splenic Epstein-Barr Virus–Associated Inflammatory Pseudotumor

Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia

Inflammatory Pseudotumor of the Spleen in a Patient with Idiopathic Thrombocytopenic Purpura

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