Small Bowel Perforation Caused by Epstein-Barr Virus-Associated B Cell Lymphoma in a Patient with Angioimmunoblastic T-Cell Lymphoma

Takahashi, Tsutomu; Maruyama, Riruke; Mishima, Satoko; Inoue, Masayasu; Kawakami, Keisuke; Onishi, Chie; Miyake, Toru; Tanaka, Junko; Nabika, Toru; Ishikura, Hiroto

doi:10.3960/jslrt.50.59

Cited by 16 publications

(16 citation statements)

References 16 publications

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“…Whether or not specific mechanism involved in the sequential development of EBV-associated B-cell lymphoma in AITL derived from non-EBV-infected cells should be investigated further. Seven cases have been reported that the secondary B-cell lymphoma develop in extranodal organs, including skin, bone marrow, duodenal bulbous, lung, ileum and soft tissue [4,7-12], and only two cases as well as ours presented skin involvement by secondary B-cell lymphoma [4,8]. The present case is the first report on cutaneous sequential development of EBV-associated DLBCL from AITL in Chinese patients.…”

Section: Case Presentationmentioning

confidence: 51%

Secondary cutaneous Epstein-Barr virus-associated diffuse large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma: a case report and review of literature

et al. 2012

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Only a few cases of extranodal Epstein-Barr virus (EBV)-associated B-cell lymphomas arising from patients with angioimmunoblastic T-cell lymphoma (AITL) have been described. We report a case of AITL of which secondary cutaneous EBV-associated diffuse large B-cell lymphoma (DLBCL) developed after the initial diagnosis of AITL. A 65-year-old Chinese male patient was diagnosed as AITL based on typical histological and immunohistochemical characteristics in biopsy of the enlarged right inguinal lymph nodes. The patient initially received 6 cycles of chemotherapy with CHOP regimen (cyclophosphamide, vincristine, adriamycin, prednisone), but his symptoms did not disappear. Nineteen months after initial diagnosis of AITL, the patient was hospitalized again because of multiple plaques and nodules on the skin. The skin biopsy was performed, but this time the tumor was composed of large, polymorphous population of lymphocytes with CD20 and CD79a positive on immunohistochemical staining. The tumor cells were strong positive for EBER by in situ hybridization. The findings of skin biopsy were compatible with EBV-associated DLBCL. CHOP-R chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab) was then administered, resulting in partial response of the disease with pancytopenia and suppression of cellular immunity. To our knowledge, this is the first case of cutaneous EBV-associated DLBCL originated from AITL in Chinese pepole. We suggest the patients with AITL should perform lymph node and skin biopsies regularly in the course of the disease to detect the progression of secondary lymphomas.Virtual slidesThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1197421158639299

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Section: Case Presentationmentioning

confidence: 51%

Secondary cutaneous Epstein-Barr virus-associated diffuse large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma: a case report and review of literature

et al. 2012

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“…To our knowledge, only 21 cases of AITL with histologic progression to EBV-associated B cell lymphoma, involving nodal (13/21) and extranodal (8/21) sites, have been described in English literature [14–22, 24]. Reported extranodal sites of involvement include skin (three cases) [18–20], bone marrow (two cases) [14, 15], ileum (one case) [21], soft tissue (one case)[24], and lung (one case) [22]. The present case is the first report of CNS involvement as extranodal manifestation of EBV-associated B cell lymphoma following a diagnosis of AITL.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, even though the neoplastic T cells are EBV-negative, high-grade histologic progression, when occurring in rare occasions, is usually to a B cell lymphoma that is usually EBV-positive [14]. Reported sites of involvement include lymph node [14–17], skin [18–20], bone marrow [14, 15], small intestine [21], and lung [22]. To our knowledge, central nervous system (CNS) involvement by an EBV-positive B cell lymphoma following a diagnosis of AITL has not been previously documented in literature.…”

Section: Introductionmentioning

confidence: 99%

Cerebellar EBV-associated diffuse large B cell lymphoma following angioimmunoblastic T cell lymphoma

et al. 2015

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Epstein-Barr virus (EBV)-associated B cell lymphoproliferative disorders may be seen in patients with angioimmunoblastic T cell lymphoma (AITL). Although both nodal and extranodal sites of involvement have been described, central nervous system involvement by B cell lymphoma following AITL has not previously been documented. We report a first example of such unusual presentation, in which an 80-year-old man developed diffuse large B cell lymphoma (DLBCL) in the cerebellum 4 months after the initial diagnosis of AITL. EBV-encoded RNAs were detected in the DLBCL, suggesting that EBV played a pivotal role in the pathogenesis of high-grade histologic progression of AITL. The patient survived less than 9 months after his initial diagnosis of AITL. We believe that this case expands the spectrum of extranodal manifestation of EBV-positive B cell lymphoma associated with AITL and illustrates the importance of recognition of this association when encountering unusual central nervous system lesions in patients with known AITL.

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“…This possibility is supported by previous reports, which documented expansion of EBV-negative B-cell clones in AITL 3,5,6 as well as development of EBV-positive B-cell lymphomas in some cases in which the original AILT lacked detectable EBV-positive cells. 1,39 …”

Section: Discussionmentioning

confidence: 99%

Peripheral T-cell Lymphomas of Follicular T-Helper Cell Derivation With Hodgkin/Reed-Sternberg Cells of B-cell Lineage

Nicolae¹,

Pittaluga²,

Venkataraman

et al. 2013

American Journal of Surgical Pathology

116

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Peripheral T-cell lymphomas (PTCL) are functionally and morphologically complex. EBV-positive B- cells have been reported in angioimmunoblastic T-cell lymphoma (AITL) and other PTCL and may mimic Hodgkin/Reed-Sternberg (HRS) cells, but EBV-negative HRS-like B-cells have not been described. We wished to assess the nature of the PTCL associated with HRS-like cells, and to determine whether EBV-negative HRS-like cells may be seen. We identified 57 PTCL cases reported as containing HRS-like cells. These included 32 AITL, 19 PTCL-NOS, 3 PTCL-NOS, follicular variant, 1 PTCL-NOS, T-zone variant and 2 adult T-cell leukemia/lymphoma (ATLL). All patients were adults, median age, 63, and presented with lymphadenopathy. The male: female ratio was 31:26 (1.2:1). Clonal TRG rearrangement was detected in 46/53 cases. 6/38 cases had a concomitant clonal immunoglobulin gene rearrangement. In 52/57 cases the HRS cells were positive for EBV. Five cases, three classified as AITL and two as PTCL-NOS, follicular variant, contained HRS-like cells negative for EBV. All PTCL with EBV-negative HRS cells had a TFH-immunophenotype. The neoplastic T-cells expressed CD3, CD4, and PD-1, and formed rosettes around the HRS-like cells. The HRS-like cells were positive for CD20 (variable intensity), PAX5, CD30 and CD15 (4/5). We conclude that both EBV positive and EBV negative HRS-like B-cells may occur in the background of PTCL; caution is needed to avoid misdiagnosis as CHL. The close interaction between the HRS-like cells and the rosetting PD-1-positive T-cells suggests a possible pathogenetic role in this phenomenon, and provides new insights into the abnormal B-cell proliferations that occur in the context of TFH malignancies.

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Small Bowel Perforation Caused by Epstein-Barr Virus-Associated B Cell Lymphoma in a Patient with Angioimmunoblastic T-Cell Lymphoma

Cited by 16 publications

References 16 publications

Secondary cutaneous Epstein-Barr virus-associated diffuse large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma: a case report and review of literature

Secondary cutaneous Epstein-Barr virus-associated diffuse large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma: a case report and review of literature

Cerebellar EBV-associated diffuse large B cell lymphoma following angioimmunoblastic T cell lymphoma

Peripheral T-cell Lymphomas of Follicular T-Helper Cell Derivation With Hodgkin/Reed-Sternberg Cells of B-cell Lineage

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