Case Of Epstein-Barr Virus Research Articles

A Case of Epstein-Barr Virus (EBV)-Associated Diffuse Large B-cell Lymphoma (DLBCL) of the Pharynx with Initial Symptoms of Sore Throat

A Case of Epstein-Barr Virus (EBV)-Associated Diffuse Large B-cell Lymphoma (DLBCL) of the Pharynx with Initial Symptoms of Sore Throat

Epstein-Barr virus uveitis after intravitreal triamcinolone injection

Purpose: To report a case of Epstein-Barr virus (EBV) uveitis after intravitreal triamcinolone injection.
 Methods: Observational case report.
 Results: A 66-year-old male presented with bilateral intermediate uveitis, left macular branch retinal vein occlusion, and left macular edema 3 months following acute infectious mononucleosis. He received systemic prednisolone, methotrexate, and intravitreal bevacizumab with partial response. Intravitreal triamcinolone was given for recurrent macular edema, which led to the development of severe panuveitis with positive EBV PCR in aqueous humour. This was successfully treated with high-dose systemic valaciclovir and topical prednisolone.
 Conclusion: Non-infectious uveitis may become infectious following intravitreal steroid administration triggering intraocular viral replication. Intraocular fluid should be tested in cases which are suspicious for infection and EBV should be considered a differential diagnosis, particularly if PCR is negative for more common viral etiologies.

3135 A Case of Epstein-Barr Virus (EBV) Mediated Acquired Hemophagocytic Lymphohistiocytosis (HLH) Presenting With Upper GI Bleed (UGIB)

INTRODUCTION: HLH often follows a fatal disease course with inflammation due to uncontrolled proliferation of macrophages causing multi-organ failure. Acquired HLH presents in adults secondary to infection (most commonly CMV or EBV) or malignancy. Several case reports have linked gastrointestinal bleed (GIB) to acquired HLH. We present a case of acquired HLH presenting with UGIB. CASE DESCRIPTION/METHODS: A 34 year old man with a history of chronic active EBV (CAEBV) presented from clinic for treatment of acquired HLH flare. He was diagnosed with HLH secondary to CAEBV infection 1.5 years prior and has been treated with steroids, rituximab, and etoposide with plans for stem cell transplant. Exam was notable for fever 102°F and hepatosplenomegaly. Labs were notable for EBV quant >1 million IU/mL, new CMV quant 7000 IU/mL, elevated ferritin, transaminitis, lactic acidosis, pancytopenia, and labs consistent with DIC (fibrinogen 155 mg/dL, D-dimer 1,082 ng/mL, platelets 41.6 × 103/cmm). He later developed episodes of hematemesis preceded by vomiting, requiring transfer to MICU due to hemodynamic instability. Abdominal ultrasound was without cirrhosis. EGD showed a 5 mm non-bleeding Mallory-Weiss tear (MWT) with stigmata of recent bleeding and clot extending down to GEJ; no intervention was conducted. The following day, he had more episodes of hematemesis. Emergent EGD showed large burden of clots in the esophagus extending to the GEJ; the clots were aspirated until mucosal defect could be visualized, revealing ulcerations with one actively oozing (Figure 1). Three hemostatic clips were placed followed by the application of hemospray with complete cessation of bleeding (Figure 2). DISCUSSION: HLH has been associated with GIB manifesting as diffuse or isolated ulceration anywhere in the GI tract. Here we present a patient with HLH who had a GIB that manifested as hematemesis and was found to have endoscopic evidence of MWT. About 80-90% of MWT heal spontaneously. However, this patient's coagulopathy manifesting as DIC resulting from his HLH prevented spontaneous healing leading to hemorrhagic complications. His GIB required clipping and the addition Hemospray aided in achieving hemostasis and hemodynamic stability. Hemospray's efficacy has been shown in peptic ulcer bleeds and cancer related GIB, however, there is minimal data on its use in acute esophageal bleed making this a unique case. Overall, this case highlights the GI complications of HLH and the importance of endoscopic management in controlling such a bleed.

An uncanny combination: A case of Epstein-Barr virus–associated B-cell lymphoproliferative disorder in the absence of immunosuppression

An uncanny combination: A case of Epstein-Barr virus–associated B-cell lymphoproliferative disorder in the absence of immunosuppression

The importance of repeating a bone marrow examination – A fatal case of epstein-barr virus (EBV) driven haemophagocytic lymphohistiocytosis (HLH) in a 1 year old

The importance of repeating a bone marrow examination – A fatal case of epstein-barr virus (EBV) driven haemophagocytic lymphohistiocytosis (HLH) in a 1 year old

Excellent Therapeutic Results Achieved in Salvage Therapy for Steroid-Refractory Grades III-IV Acute Gvhd with Basiliximab and Etanercept: A Multicenter Prospective Study

Introduction: Standard first-line therapy for the treatment of acute graft-versus-host disease (aGVHD) involves corticosteroids. However, fewer than half of patients have durable complete response. Steroid refractory aGVHD (SR-aGVHD) is associated with increased mortality, and long-term mortality rate remains around 70%. Second-line treatments included antithymoglobulin (ATG), mycophenolate mofetil (MMF), tacrolimus (FK), IL-2R antibodies, alemtuzumab, etanercept, infliximab, sirolimus and others. The overall complete remission (CR) rate from the 28 published retrospective studies that evaluating agents for second-line therapy of SR-aGVHD was 32%, the median survival was only about 6 months and no agent was clearly superior. To date, no consensus has been reached regarding the optimal secondary treatment of SR-aGVHD. Based on the pivotal roles of T cells and inflammatory cascade in aGVHD induction, since 2009 we performed a multicenter prospective study to assess the efficacy and safety of an approach to treat severe (grades III-IV) SR-aGVHD by the combination of basiliximab (anti-IL2-R) and etanercept (anti-TNFα).Methods: We conducted an open-label, non-randomized, phase II study at three centers, Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou), Department of Hematology, Zhejiang Provincial People's Hospital (Hangzhou), and Department of Hematology, Guangzhou General Hospital of Guangzhou Military Command (Guangzhou), between January 2009 and October 2013. Patients fulfilled one of the following criteria were included: (1)when newly diagnosed with grades III-IV aGVHD or overlap syndrome and showed progression after 3 days, or no improvement after at least 7 days of treatment or partial response at 14 days with 2 mg/kg per day prednisolone; or (2) de novo grades I-II aGVHD but eventually evolved into grades III-IV during treatment with prednisolone. Basiliximab was given intravenously at 20mg/d on days 1, 4, 8, 15, 22, 29, 36 (if necessary). Etanercept was given subcutaneously at 25mg per dose twice a week for 4 weeks and then pursued at 25mg once a week for another 4 weeks. During combined therapy all patients received cyclosporine and maintained on therapeutic level. Prednisolone was tapered by 10% of the total dose twice weekly.Results: (1) Forty-one patients with steroid-refractory grades III-IV aGVHD were included. Acute GVHD occurred at a median time of 13 days post-transplantation (range: 5-85). First-line treatment with 2 mg/kg/day steroids was initiated at GVHD diagnosis. Thirty patients (73.2%) were diagnosed as grade II aGVHD but evolved into severe aGVHD during treatment with prednisolone, and 11 patients (26.8%) were severe aGVHD at onset. Median time from diagnosis of aGVHD to study enrollment was 12 days (range 3-49). Fifteen patients (36.6%) presented with overall grade III aGVHD and 63.4% with grade IV. (2) Median number of infusions of basiliximab was 4 (range 2-7) and median number of etanercept was 8 (range 1-11). At day 28 after treatment by the combination therapy of basiliximab and etanercept was initiated, overall response (CR+PR) to second-line treatment was 92.7% with 78% of CR. The incidences of CR per organ was 100%, 80.5% and 85.4% for skin, gut and liver involvement, respectively. Nine of 24 evaluable patients developed chronic GVHD (cGVHD), in which 4 cases were with mild cGVHD and 5 with extensive cGVHD. (3)The cumulative incidence of a invasive pulmonary fungal infection at 12 months post-transplantation was 42.4%. Although twenty-eight patients (69.3%) experienced at least 1 cytomegalovirus (CMV) reactivation, all patients developed CMV-positive antigenemia without CMV disease. One patient developed viral encephalitis by human herpesvirus 6 (HHV6). No case of Epstein-Barr virus (EBV) reactivation was reported. Five-year overall survival (OS) rate after the combination therapy was 55.2% . A total of 17 patients died and causes of death ordered by the number of patients were invasive pulmonary fungal infection, (n=8, 47.1%), relapse (n=4, 23.5%), aGVHD (n=4, 23.5%), and arrhythmia (n=1, 5.9%).Conclusions: Here we developed a novel salvage treatment approach for grades III-IV SR-aGVHD by using the combination of basiliximab and etanercept, which achieved a clinically meaningful response in approximately more than 90% of patients and 55.2% of 5-year OS. DisclosuresNo relevant conflicts of interest to declare.

Long-Term Endoscopic Follow-up in Small Bowel Transplant Recipients: Single-Center Series

BackgroundThe reliability of endoscopic findings after adult intestinal transplantation on short-term follow-up has been shown. The aim of this study was to evaluate in a long-term follow-up the diagnostic value of endoscopies compared with the biopsy value. MethodsWe evaluated 52 endoscopies over a period of 2 years (2 in each patient in 2010 and 1 in each patient in 2011, plus 1 endoscopy for suspected post-transplant lymphoproliferative disease [PTLD]) on 17 recipients transplanted between the years 2000 and 2006 (more than 5 years of follow-up). ResultsAll the 52 endoscopic findings were comparable to biopsy definitive results: only 1 case of mild enteritis and 1 case of Epstein-Barr virus (EBV) chronic infection at biopsy were not diagnosed by endoscopy. One case of rectal PTLD and 1 of EBV-related enteritis were diagnosed by use of both procedures. Specificity was 98%: we did not calculate sensitivity because no episodes of rejection were diagnosed because recipients were stable in long-term follow-up. ConclusionsEndoscopy is a reliable procedure even on a long-term follow-up after intestinal transplantation, allowing a support to biopsy for diagnosis on adult recipients, especially for EBV infections and PTLD surveillance.

Epstein-barr virus-negative post-transplant lymphoproliferative diseases: three distinct cases from a single center.

Three cases of Epstein-Barr virus (EBV)-negative post-transplant lymphoproliferative disease that occurred 6 to 8 years after renal transplantation are reported. The patients respectively had gastric mucosa-associated lymphoid tissue lymphoma, gastric diffuse large B-cell lymphoma, and atypical Burkitt lymphoma. Absence of EBV in the tissue samples was demonstrated by both in situ hybridization for EBV early RNA and polymerase chain reaction for EBV DNA. Patients were treated with reduction in immunosuppression and combined chemotherapy plus an anti-CD20 monoclonal antibody, rituximab. Despite the reduction in immunosuppression, patients had stable renal functions without loss of graft functions. The patient with atypical Burkitt lymphoma had an abnormal karyotype, did not respond to treatment completely, and died due to disease progression. The other patients are still alive and in remission 5 and 3 years after diagnosis, respectively. EBV-negative post-transplant lymphoproliferative diseases are usually late-onset and are reported to have poor prognosis. Thus, reduction in immunosuppression is usually not sufficient for treatment and more aggressive approaches like rituximab with combined chemotherapy are required.

BOB.1-positive Classical Hodgkin's Lymphoma Carries Hypermethylation of Its Promoter as Epigenetic Marker of Gene-silencing Memory.

Analysis of archival formalin-fixed, paraffin-embedded (FFPE) pathological specimens of three case of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) and three cases of classical Hodgkin lymphoma (CHL) revealed that hypermethylation of the BOB.1 gene promoter was exclusively observed in CHL. A discrepancy was observed, however, between the methylation status of the BOB.1 gene promoter and its expression in the EBV-positive mixed cellular CHL (MCCHL). Since MCCHL lacks the typical B-cell phenotype even in the presence of abundant BOB.1 transcription factors, functional activity of BOB.1 may be lost or reduced by a mechanism other than epigenetic gene silencing. When some tumor-suppressor gene products have lost their biological function, impact or significance of derepression of such genes may be little. Therefore, when interpreting immunohistochemical results for diagnostic or research purposes, it must be borne in mind that apparent positive immunostaining can merely be the result of chromatin remodeling and that such transient expression often has little functional significance. Any apparent positive immunohistochemical result needs to be interpreted carefully with the help of the hypermethylation status as a molecular marker of gene silencing memory.

Neurological symptoms in a post-transplant patient: a cautionary tale

Primary central nervous system (CNS) post-transplant lymphoproliferative disorder (PTLD) is a rare complication of organ transplantation affecting about 1 % of transplant recipients [1, 2]. The median time from transplantation to diagnosis ranges from 12.6 months to 52 months [1, 3]. We herein describe an unusual case of Epstein barr virus (EBV) positive primary CNS PTLD, presenting after a very long delay of 12 years after renal transplant. A 50-year-old woman presented with a 12-week history of gradual onset, constant, throbbing generalised headache of moderate intensity. She also reported progressive vertigo, difficulty in walking, nausea and vomiting. She was a nonsmoker and denied use of alcohol or other illicit drugs. Twelve years previously, she had a renal transplant for endstage renal disease secondary to chronic pyelonephritis. Her routine medications included cyclosporin 50 mg twice daily, azathioprine 100 mg once daily and prednisolone 5 mg once daily. Clinical examination demonstrated broken pursuit eye movements, mild appendicular ataxia and right extensor plantar response. She walked with a slightly broadbased ataxic gait. Systemic examination was unremarkable. Laboratory studies including inflammatory markers and autoimmune screen were unremarkable. Magnetic resonance imaging (MRI) of the brain with gadolinium showed scattered nodular enhancing lesions involving bilateral cerebellar hemispheres, splenium of corpus callosum and right peritrigonal white matter (Fig. 1). Cerebrospinal fluid (CSF) analysis revealed a white cell count of 7 (100 % lymphocytes), protein 0.39 g/L and normal glucose. Stains and culture results for bacteria, mycobacteria and fungi were negative. However, CSF polymerase chain reaction for EBV was positive at 1,000 copies/ml; BK and JC virus were negative. Computed tomography scan of chest, abdomen, and pelvis was unremarkable. A biopsy of the posterior fossa lesion showed a polymorphic population of lymphoid cells, in keeping with polymorphic type PTLD (Fig. 2). Azathioprine was discontinued and cyclosporin was initially reduced to 25 mg twice daily. She was also treated with 4 cycles of methotrexate (3000 mg/m on day 1) and cytarabine (1600 mg/m every 12 h on day 2 and 3) at 3 weekly intervals, with complete clinical and radiological response. The dose of cytarabine was reduced by 20 percent from the standard dose (2000 mg/m), given the reduced baseline creatinine clearance rate of 53 mL/min/ 1.73 m. She is currently on prednisolone 5 mg daily and cyclosporin 35 mg twice daily. There has been no recurrence to date over a period of 18 months. She also retains good renal graft function. Post-transplant lymphoproliferative disorders represent a spectrum ranging from EBV-driven infectious mononucleosis type polyclonal proliferations, to EBV positive or S. K. Chhetri R. Dayanandan H. C. A. Emsley (&) Department of Neurology, Royal Preston Hospital, Preston PR2 9HT, UK e-mail: h.emsley@liv.ac.uk; hedley.emsley@manchester.ac.uk

Post‐transplant lymphoproliferative disease of donor origin, following haematopoietic stem cell transplantation in a patient with blastic plasmacytoid dendritic cell neoplasm

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare condition that originates from dendritic cells. We report on the first case of Epstein-Barr virus (EBV)-driven post-transplant lymphoproliferative disorder (PTLD) of donor origin in a BPDC patient post-allogeneic haematopoietic stem cell transplantation (HSCT). Flow cytometry study identified a cell population CD4+/CD56+/CD45RA+/CD123+/TCL1+ suggestive of BPDCN diagnosis, which was confirmed by a lymph node biopsy (cells positive for BCL11a, BDCA-2, CD2AP, CD123, TCL1 and S100). Cytogenetic analysis revealed a complex karyotype: (19 metaphase) 47,XX,t(1;6)(q21;q2?5),-13 + 2mar[11]/47, XX, +21 [3]/46,XX [5]. The patient was started on acute myeloid leukaemia (AML) induction schedule, and subsequently an allogeneic HSCT was performed. On day +36 post-HSCT, bone marrow biopsy/aspirate showed complete morphological remission, and chimerism study showed 100% donor chimera. However, on day +37, the patient was found to have enlarged cervical and supraclavicular lymphoadenopathy, splenomegaly and raised lactic dehydrogenase. EBV-DNA copies in blood were elevated, consistent with a lytic cycle. A lymph node biopsy showed EBV encoded RNA and large atypical B cells (CD45dim-, CD4+/CD56+, monoclonal for k-chain, CD19+/CD20+/CD21+/CD22+/CD38+/CD43+/CD79β-/CD5-/CD10-), consistent with PTLD monomorphic type. Chimerism study showed that PTLD was of donor origin. This case together with the recent literature findings on BPDCN and PTLD are discussed.

A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis. (Pediatr Gastroenterol Hepatol Nutr 2012; 12: 57∼61)

AIDS-Related Pathology

AIDS-Related Pathology

Primary Cutaneous Giant Cell Plasmacytoma in an Organ Transplant Recipient: A Rare Presentation of a Posttransplant Lymphoproliferative Disorder

Posttransplant lymphoproliferative disorder (PTLD) is comprised of a spectrum of lymphoid diseases, ranging from early lesions, such as plasmacytic hyperplasia, to monomorphic neoplasms, including plasmacytoma-like lesions. Although PTLD may involve a variety of organs, primary cutaneous PTLD is rare. We report a unique case of Epstein-Barr virus (EBV)-positive primary cutaneous giant cell plasmacytoma developed 5 years after renal/pancreatic transplant in a 55-year-old male patient. The patient received local radiotherapy without reduction in immunosuppression and responded well. A review of the literature identified additional 49 cases of primary cutaneous B-cell PTLD, including 18 cases of plasmacytoma-like lesions. Primary cutaneous B-cell PTLD usually presents years after transplantation, has male preponderance, tends to occur on extremities, is frequently EBV-associated, and predicts a favorable clinical outcome. Unlike PTLD in general, in which EBV-positive cases usually occur earlier than EBV-negative ones, the longer presentation interval in the cutaneous PTLD seems to be uncorrelated to EBV status. Compared with other subtypes of cutaneous B-cell PTLD, plasmacytoma-like lesions have an increased male preponderance and tendency to present on the extremities. Although the majority of cases have been treated with reduction of immunosuppression, antiviral therapy and/or local radiotherapy, and a few with chemotherapy, the best therapeutic intervention for primary cutaneous B-cell PTLD remains to be further investigated with the analysis of more reported cases and large clinical trials.

Lymphoma and Immunosuppression: A Report of a Case Associated With Efalizumab Therapy

Lymphomas have been associated with immunodeficiency disorders, including those acquired secondary to the use of immunosuppressants for autoimmune disorders and for the prevention of graft rejection. Biologic agents have also been associated with the development of lymphoproliferative disorders. We report the case of Epstein-Barr Virus- negative diffuse large B-cell lymphoma associated with efalizumab, a monoclonal antibody that inhibits T-cell activity. Discontinuation of efalizumab resulted in a partial remission of lymphoma, although administration of chemotherapy was ultimately required. The use of immunomodulators must be tempered with the knowledge of their effect on the immune system and their association with lymphoproliferative disorders.

T cell lymphoproliferative disorders associated with anti-tumor necrosis factor alpha antibody therapy for ulcerative colitis: literature summary

The enhanced risk of development of lymphoproliferative disorders in patients with inflammatory bowel disease has been attributed to immunosuppressive/immunomodulatory therapies. Infliximab is a chimeric monoclonal immunoglobulin G1 antibody directed against tumor necrosis factor alpha (TNF-α) that was approved by the Food and Drug Administration (FDA) in 1998 as an effective therapeutic agent against inflammatory bowel disease. Malignant lymphomas of both B and T cell lineage have been described in patients undergoing therapy involving TNF-α blockade. To date, eight cases of Epstein–Barr virus (EBV)-negative hepatosplenic T cell lymphoma associated with infliximab have been reported to the FDA’s Adverse Event Reporting System, as well as several other T cell lymphoproliferative disorders with aggressive clinical outcomes. We present the histologic, immunophenotypic, and molecular features of a T cell lymphoproliferative disorder involving the axillary lymph node of a 33-year-old male following infliximab treatment for ulcerative colitis. These EBV-negative lymphomas suggest that lymphoproliferative disorders following infliximab treatment for inflammatory bowel disease may involve EBV-independent immune dysregulation. The spectrum of lymphoproliferative disorders associated with infliximab and the potential mechanisms by which they occur are discussed.

Epstein-Barr virus-positive inflammatory pseudotumor of the spleen managed with laparoscopic splenectomy.

We report a case of Epstein-Barr virus (EBV)-positive splenic inflammatory pseudotumor treated by laparoscopic splenectomy. A 66-year-old female without symptoms was found to have a solitary, avascular, solid tumor of the spleen by contrast-enhanced computed tomography. The tumor was compatible with a primary tumor of the spleen. A benign splenic tumor was the most likely diagnosis, but malignant lymphoma could not be ruled out because the serum-soluble interleukin-2 receptor (sIL-2R) level was elevated. Laparoscopic splenectomy was performed to enable a definite diagnosis. Removal of the whole spleen without injury was possible. Possible contamination of the extirpation orifice by cancer cells was carefully prevented by enclosing the spleen in a plastic bag. Histopathological examination showed the tumor to be an EBV-positive inflammatory pseudotumor. To the best of our knowledge, this is only the second report of an EBV-positive splenic inflammatory pseudotumor with an increased serum sIL-2R level. Although EBV-positive inflammatory pseudotumors have been reported to recur, no sign of recurrence has been detected in the present case in the 17months following splenectomy.

EBV Positive Primary Cutaneous CD30+ Large T-Cell Lymphoma in a Heart Transplanted Patient: Case Report

Most post-transplant lymphoproliferative disorders (PTLDs) are of B-cell origin, whereas T-cell lymphomas rarely occur. We detail the clinicopathological features of the first case of Epstein-Barr virus (EBV)-associated primary cutaneous CD30+ anaplastic large cell lymphoma (ALCL) in the setting of heart transplant. A 71-year-old patient, 111 months after transplant, presented with multiple cutaneous lesions on the left thigh; histological and immunohistochemical examinations led to diagnosis of T-cell CD30+ ALCL. In situ hybridization demonstrated the presence of EBV-positive tumour cells. The patient received radiotherapy, but he relapsed at the same cutaneous site with loco-regional nodal spread. Chemotherapy was administered resulting in complete remission; four years later the patient is alive and well. Our findings indicate that primary cutaneous EBV+ CD30+ ALCLs should be included within the T-cell PTLDs spectrum; further studies are required to confirm whether they may be also considered, in transplantation settings, a distinct lymphoma subset with relatively favourable outcome.

Epstein-Barr Virus-Infected Malignant T/NK-Cell Lymphoma in a Patient with Hypersensitivity to Mosquito Bites

We report an autopsy case of Epstein-Barr virus (EBV)-infected malignant lymphoma in a young male who had hypersensitivity to mosquito bites. The autopsy revealed multiple confluent lymphoma lesions in the lungs, and on the right leg irregular-shaped skin ulcers were seen. The left pleural effusion also contained a large number of lymphoma cells. The lymphoma cells were determined as T/NK-cell type cells by immunohistochemistry. EBV DNA was detected most intensively in the lungs and EBV-encoded small RNAs-positive lymphoma cells were also observed in the lungs at a high frequency. EBV latent membrane protein-1 expression and a high Ki-67 labeling indices were noted in the lymphoma cells of the lung lesions. These findings indicate that the development of the malignant lymphoma was associated with the proliferation of EBV-infected lymphoma cells, and the cells that infiltrated the whole the body, especially the lungs, caused the patient's death.

A Case of Epstein-Barr Virus (EBV)-Associated Thymic Carcinoid and Investigation of Existence of EBV-Infected Cells in Thymus and Thymic Tumors

We describe the first case of Epstein-Barr virus (EBV)-associated thymic carcinoid tumor found by in situ hybridization (ISH) on paraffin-embedded sections. ISH revealed that both tumor cells and infiltrated lymphocytes were EBV positive, while a few EBV-infected lymphocytes were detected in 2 of 11 thymuses and 1 of 11 thymomas.