EBV-positive diffuse large B-cell lymphoma of the elderly with dual genotype and aberrant TIA-1 expression: a case report and review of literature

Abstract

B-cell lymphomas generally do not express T-cell intracellular antigen-1 (TIA-1), a cytotoxic granule-associated protein. We report a case of EBV-positive diffuse large B-cell lymphoma (DLBCL) of the elderly with aberrant expression of TIA-1. The patient was an 84-year-old man with a history of progressively enlarged left parotid mass and mild facial paresis for 2 months. The incisional biopsy revealed sheets of medium to large lymphoma cells with focal angiocentricity and extensive tumor necrosis; only a few scattered small lymphocytes were noted among the lymphoma cells. Immunohistochemistry in formalin-fixed paraffin-embedded tissue demonstrated that the lymphoma cells marked with CD20, CD30, CD45 (focal), CD79a, BCL2 (focal and weak), PAX5, Oct2, BOB.1, IRF4/MUM1, EBV-LMP1, and TIA-1, but they did not mark with CD3, CD4, CD5, CD7, CD8, CD10, CD15, CD23, CD56, CD57, CD138, kappa and lambda immunoglobulin light chains, BCL6, βF1, granzyme B, or perforin. The aberrant TIA-1 expression was then confirmed by two different autostainers. EBV-encoded RNA (EBER) in situ hybridization was positive in the lymphoma cells. Gel electrophoresis for immunoglobulin heavy chain (IgH) and T-cell receptor (TCR) gene rearrangements revealed no definite clonal band, but fluorescence capillary electrophoresis demonstrated positive results for both IgH and TCR genes. Finally, we concluded this case as an EBV-positive DLBCL of the elderly with dual genotype (rearrangements of both IgH and TCR genes) and aberrant TIA-1 protein expression.