EBV-associated B-cell Lymphoproliferative Disorder Research Articles

CROCIN PROMOTES APOPTOSIS IN HUMAN EBV-TRANSFORMED B-LYMPHOCYTE VIA INTRINSIC PATHWAY

BackgroundAs a major carotenoid in saffron, crocin demonstrates potent anti-cancer impacts. However, its anti-lymphoma effects remain vague, especially in the human EBV-associated B-cell lymphoproliferative disorders. This study examined crocin’s apoptogenic potential and its underlying mechanism in CO 88BV59-1 cell line vs. normal human peripheral blood B cells.MethodsCO 88BV59-1 cells were treated with crocin alone or in combination with vincristine for up to 72 h. The cell viability was examined using a resazurin assay. Flow cytometry using annexin V and propidium iodide labeling was performed to detect apoptotic cells. Also, the expression levels of genes and proteins involved in apoptosis (CASP3, CASP8, CASP9, P53, Bax, and Bcl-2) were respectively determined via real-time PCR and Western blot analysis.ResultsCrocin concentration-dependently reduced cell viability in CO 88BV59-1 cells with no significant toxicity toward normal B cells. Similar to vincristine, crocin significantly increased apoptosis in these cells during 72 h of incubation. Furthermore, the combination of crocin (80 μM) and vincristine (1 μM) enhanced apoptosis in CO 88BV59-1 cells. Therefore, this synergistic effect was detected in human EBV-transformed B-lymphocyte. CASP3, CASP9, P53, and Bax/Bcl-2 ratio expressions were significantly raised in CO 88BV59-1 cells, whereas CASP8 was unaltered. It was proposed that crocin promoted apoptosis in CO 88BV59-1 cells in a time- and concentration-dependent manner via the induction of the intrinsic pathway.ConclusionThe results suggest that crocin may serve as a good alternative/coadjuvant to vincristine in EBV-associated B-cell lymphoproliferative disorders.

Age-related EBV-associated B-cell lymphoproliferative disorders and other EBV + lymphoproliferative diseases: New insights into immune escape and immunodeficiency through staining with anti-PD-L1 antibody clone SP142.

Epstein-Barr virus (EBV) is prevalent among healthy individuals, and is implicated in numerous reactive and neoplastic processes in the immune system. The authors originally identified a series of senile or age-related EBV-associated B-cell lymphoproliferative disorders (LPD) bearing a resemblance to immunodeficiency-associated ones. These LPDs may be associated with immune senescence and are now incorporated into the revised 4th edition of 2017 WHO lymphoma classification as EBV-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS). These EBV+ B-cells often have a Hodgkin/Reed-Sternberg (HRS)-like appearance and are shared beyond the diagnostic categories of mature B-cell neoplasms, mature T-cell neoplasms, classic Hodgkin lymphoma, and immunodeficiency-associated LPD. In addition, peculiar new diseases, such as EBV+ mucocutaneous ulcer and EBV+ DLBCL affecting the young, were recognized. On the other hand, lymphoma classification is now evolving in accord with deeper understanding of the biology of programmed death ligand 1 (PD-L1). Assessing PD-L1 positivity by staining with the anti-PD-L1 monoclonal antibody SP142 provides new insight by discriminating between immune evasion and senescence or immunodeficiency. The aim of the present review is to briefly summarize the diagnostic use of immunostaining with SP142 in malignant lymphomas and/or LPDs that feature tumor and nonmalignant large B-cells harboring EBV.

GRANULOMATOSE LINFOMATOIDE

ABSTRACT
 Lymphomatoid granulomatosis (LYG) is a rare extranodal Epstein-Barr virus (EBV) associated B-cell lymphoproliferative disorder. Most cases occur between the fourth and sixth decades of life and the male-to-female ratio is 2:1. The lung is the most frequently involved organ. Radiographically, pulmonary disease is characterized by multiple variable size nodules. Histologically, the lesions show angiocentricity, are rich in T cells, have large atypical B cells, lymphocytic infiltration of the vascular wall and a variable necrosis. LYG is a distinct entity that can usually be differentiated from other EBV-associated B-cell lymphoproliferative disorders on the basis of the combination of clinical presentation and histology. The authors described the case of a 53-year-old woman who was previously diagnosed with sarcoidosis, histoplasmosis, and later with non-Hodgikin B Lymphoma. The lungs presented diffuse alveolar damage, exsudative phase, and infiltration by lymphomatoid granulomatosis. The patient became unstable and died. Grading of these lesions is important because it dictates the treatment choice.
 Keywords: Lymphomatoid granulomatosis, Epstein-Barr virus, pulmonary nodules.

Age-related EBV-associated B-cell lymphoproliferative disorders of the minor salivary gland: a case report

Background: Age-related EBV-associated B-cell lymphoproliferative disorders (LPDs) have shown a marked propensity to involve extranodal sites. This disease was newly listed in the 2008 WHO classification as EBV-positive diffuse large B-cell lymphoma of the elderly, which is defined as a histologically malignant polymorphic or monomorphic B-cell lymphoproliferation in patients older than 50 years of age without any known immunodeficiency or prior lymphoma. We report a case of a female patient with minor salivary gland enlargement, who was diagnosed with age-related EBV-associated B-cell LPDs.

Lymphomatoid granulomatosis--a single institute experience: pathologic findings and clinical correlations.

Lymphomatoid granulomatosis (LYG) is a rare angiocentric and angiodestructive Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorder. It is hypothesized that these patients have dysregulated immune surveillance of EBV. We reviewed the biopsies of 55 patients with LYG who were referred for a prospective trial at the National Cancer Institute (1995 to 2010) and evaluated the histologic, immunohistochemical, in situ hybridization, and molecular findings of these biopsies in conjunction with clinical information. Grading of the lesions was based on morphologic features and the number of EBV-positive B cells. The median age was 46 years (M:F 2.2:1). Clinically, all patients had lung involvement (100%), with the next most common site being the central nervous system (38%). No patient had nodal or bone marrow disease. All patients had past EBV exposure by serology but with a low median EBV viral load. We reviewed 122 biopsies; the most common site was lung (73%), followed by skin/subcutaneous tissue (17%); other sites included kidney, nasal cavity, gastrointestinal tract, conjunctiva, liver, and adrenal gland. Histologically, the lesions showed angiocentricity, were rich in T cells, had large atypical B cells, and were positive for EBV. Grading was performed predominantly on the lung biopsy at diagnosis; they were distributed as follows: LYG grade 1 (30%), grade 2 (22%), and grade 3 (48%). Necrosis was seen in all grades, with a greater degree in high-grade lesions. Immunoglobulin gene rearrangement studies were performed, and a higher percentage of clonal rearrangements were seen in LYG grade 2 (50%) and grade 3 (69%) as compared with grade 1 (8%). LYG is a distinct entity that can usually be differentiated from other EBV-associated B-cell lymphoproliferative disorders on the basis of the combination of clinical presentation, histology, and EBV studies. Grading of these lesions is important because it dictates the treatment choice.

EBV-driven B-cell lymphoproliferative disorders: from biology, classification and differential diagnosis to clinical management.

Epstein–Barr virus (EBV) is a ubiquitous herpesvirus, affecting >90% of the adult population. EBV targets B-lymphocytes and achieves latent infection in a circular episomal form. Different latency patterns are recognized based on latent gene expression pattern. Latent membrane protein-1 (LMP-1) mimics CD40 and, when self-aggregated, provides a proliferation signal via activating the nuclear factor-kappa B, Janus kinase/signal transducer and activator of transcription, phosphoinositide 3-kinase/Akt (PI3K/Akt) and mitogen-activated protein kinase pathways to promote cellular proliferation. LMP-1 also induces BCL-2 to escape from apoptosis and gives a signal for cell cycle progression by enhancing cyclin-dependent kinase 2 and phosphorylation of retinoblastoma (Rb) protein and by inhibiting p16 and p27. LMP-2A blocks the surface immunoglobulin-mediated lytic cycle reactivation. It also activates the Ras/PI3K/Akt pathway and induces Bcl-xL expression to promote B-cell survival. Recent studies have shown that ebv-microRNAs can provide extra signals for cellular proliferation, cell cycle progression and anti-apoptosis. EBV is well known for association with various types of B-lymphocyte, T-lymphocyte, epithelial cell and mesenchymal cell neoplasms. B-cell lymphoproliferative disorders encompass a broad spectrum of diseases, from benign to malignant. Here we review our current understanding of EBV-induced lymphomagenesis and focus on biology, diagnosis and management of EBV-associated B-cell lymphoproliferative disorders.

Abstract 2014: Gene expression profiling identifies characteristic oncogenetic pathways in age-related Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disorders.

Abstract Age-related EBV-associated B-cell lymphoproliferative disorder (AR-EBVLPD) is newly classified as a subtype of diffuse large cell lymphoma (DLBCL) according to the WHO classification. AR-EBVLPD cases have poor prognosis compared to that of EBV-negative DLBCL patients. Until now, its molecular pathogenesis remains largely unknown. We investigated gene expression profiling to identify molecular genetic characterization of AR-EBVLPD. Total RNA was extracted from fresh-frozen tumor samples of five AR-EBVLPD and eight EBV-negative DLBCL cases. Expression profiling was studied using the Agilent 44K human oligonucleotide microarray. Genes highly expressed in AR-EBVLPD included inflammatory and immune-related genes. Gene set enrichment analysis and gene ontology analysis showed that gene sets of the JAK-STAT and NF-kB pathways were enriched in AR-EBVLPD cases. In vitro analysis showed that high activation of JAK-STAT and NF-kB pathways was induced by EBV infection into DLBCL cell lines. The immunoprecipitation assay confirmed that the NF-kB pathway was activated in EBV-infected cell lines compared to EBV-naïve cell lines. The protein expression level of phosphorylated STAT3 increased in an EBV-infected cell line according to western blot analysis. A total of 61 patients (25 AR-EBVLPD and 36 EBV-negative DLBCL) were analyzed immunohistochemically for pSTAT3. Protein expression of phospho-STAT3 was frequently observed in lymphoma cells of AR-EBVLPD clinical samples using immunohistochemistry [AR-EBVLPD: (80.0%, n=20/25) vs. EBV-negative DLBCL: (38.9%, n=22/36), p=0.001]. These results suggested that STAT3 and NF-kB activation was characteristic of AR-EBVLPD, which may reflect the nature of EBV-positive tumor cells. Targeting these pathways as therapies might improve clinical outcomes of AR-EBVLPD. Citation Format: Harumi Kato, Kazuhito Yamamoto, Kennosuke Karube, Jun Takizawa, Shinobu Tsuzuki, Yasushi Yatabe, Teru Kanda, Miyuki Katayama, Yukiyasu Ozawa, Kenji Ishitsuka, Masataka Okamoto, Tomohiro Kinoshita, Koichi Oshima, Shigeo Nakamura, Yasuo Morishima, Masao Seto. Gene expression profiling identifies characteristic oncogenetic pathways in age-related Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disorders. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2014. doi:10.1158/1538-7445.AM2013-2014

Gene Expression Profiling of Age-Related Epstein-Barr Virus (EBV)-Associated B-Cell Lymphoproliferative Disorder Uncovers Alterations in Immune and Inflammatory Genes: Possible Implications for Pathogenesis,

Abstract 3448Age-related EBV-associated B-cell lymphoproliferative disorder (AR-EBLPD) is classified as a subtype of diffuse large cell lymphoma (DLBCL) according to the WHO classification. However, molecular genetic characterization of AR-EBLPD remains largely unknown. We studied expression profiles of 5 AR-EBLPD and 8 EB-negative DLBCL samples using the Agilent 44K human oligonucleotide microarray. Total RNA was extracted from fresh-frozen tumor samples. Each microarray slide was converted into datasets using the Agilent Micro Array Scanner and Feature extractions. Data was standardized with Z-scores. Differences in mRNA expression levels between two sample groups were calculated using a two-sided t-test. A total of 1973 probes showed a p-value less than 0.05 with less than a 25% false discovery rate (FDR). These probes included 1688 genes. The number of probes showing high expression in AR-EBLPD and EB-negative DLBCL was 804 (693 genes) and 1169 (995 genes), respectively. First, we selected the top 300 differentially expressed genes. Genes highly expressed in AR-EBLPD included IL6, TNFAIP3, HOPX, and SLAMF1. IL6 is known as a gene encoding a cytokine which functions in inflammation and the maturation of B lymphocytes, and TNFAIP3 is known as a negative regulatory gene of the NF-kB pathway. HOPX and SLAMF1 are reported as genes related to lymphocyte function or the immune system (Schwartzberg et al. Nature immunology 2009, Hawiger et al. Nature immunology 2011). For better characterization, we next performed Gene Ontology Analysis using the WEB-based GEne SeT AnaLysis Toolkit and found that categories of external stimulus and inflammatory responses were enriched in AR-EBLPD. The Kyoto Encyclopedia of Genes and Genomes (KEGG)-signaling analyses showed that pathways of the NOD-like receptor (p-value =1.30e-06), JAK-STAT (p-value =9.01e-06), and Toll-like receptor (p-value =0.0002) were characteristic of AR-EBLPD. These results implied that inflammation would be prominent in AR-EBLPD cases. For validation, we next performed Gene Set Enrichment Analysis (GSEA) using all the database of KEGG pathways (186 gene sets). Dominant gene sets in AR-EBLPD included the cytokine-cytokine receptor interaction [Normalized Enrichment Score (NES) =2.66, p-value<0.001], NOD-like receptor pathway (NES =2.26, p-value<0.001), TOLL-like receptor pathway (NES =2.14, p-value<0.001), and JAK-STAT pathway (NES =1.79, p-value<0.001). Since all the pathways were related to the NF-kB pathway, inflammatory responses were suggested to activate the NF-kB pathway or vice versa. For confirmation, we finally performed GSEA using gene sets of the NF-kB pathway, which were obtained from a gene set reported by an NIH group (Puente et al. Nature 2011) and 30 gene sets in the GSEA database, and found that the gene sets of the NF-kB pathway were enriched in AR-EBLPD (Figure 1). Our results suggested that the inflammatory and immune-related genes were enriched in AR-EBLPD and that activation of the genes may be associated with NF-kB activation. Aberrant immune and inflammatory responses could define the clinical presentations of AR-EBLPD cases. [Display omitted] (Figure 1) Gene Set Enrichment Analysis of 5 AR-EBLPD and 8 EB-negative DLBCL samples. The NF-kB signature reported from an NIH group (Puente et al. Nature 2011) was enriched in AR-EBLPD [Normalized Enrichment Score (NES) =2.20, p-value<0.001]. Disclosures:No relevant conflicts of interest to declare.

EBV-associated B-cell lymphoproliferative disorder of the elderly successfully treated with autologous peripheral blood stem cell transplantation and locoregional radiotherapy

EBV-associated B-cell lymphoproliferative disorder of the elderly successfully treated with autologous peripheral blood stem cell transplantation and locoregional radiotherapy

Age-related EBV-associated B-cell lymphoproliferative disorders

Age-related EBV-associated B-cell lymphoproliferative disorders

Age‐related EBV‐associated B‐cell lymphoproliferative disorders: Diagnostic approach to a newly recognized clinicopathological entity

EBV is prevalent among healthy individuals, and is implicated in numerous reactive and neoplastic processes in the immune system. The authors originally identified a series of senile or age-related EBV-associated B-cell lymphoproliferative disorders (LPD) bearing a resemblance to immunodeficiency-associated ones, which may be associated with immune senescence in the elderly and which are now incorporated into the 2008 World Health Organization lymphoma classification as EBV-positive diffuse large B-cell lymphoma (DLBCL) of the elderly. This newly described disease is pathologically characterized by a proliferation of atypical large B cells including Reed-Sternberg-like cells with reactive components, which pose a diagnostic problem for pathologists. Clinically, this disease may present with lymphadenopathy, and is often extranodal, frequently involving the skin, gastrointestinal tract, or lung. Onset is usually after the age of 50; the median patient age is 70-79 years, and incidence continues to increase with age, providing additional support to the nosological term of EBV+ DLBCL of the elderly. These patients have a worse prognosis than those with EBV-negative DLBCL or EBV+ classical Hodgkin lymphoma (CHL). The aim of the present review was to summarize the clinicopathological profile of age-related EBV+ LPD and EBV+ Hodgkin lymphoma to facilitate diagnostic approach.

A case of age-related EBV-associated B-cell lymphoproliferative disorder metachronously showing two distinct morphologic appearances, one of a polymorphic disease resembling classical Hodgkin lymphoma, and the other of a large-cell lymphoma

We report a case of age-related EBV-associated B-cell lymphoproliferative disorder (age-related EBV+ B-cell LPD) metachronously showing two distinct morphologic appearances: one of a polymorphic disease resembling classical Hodgkin lymphoma (CHL), and the other of a large-cell lymphoma. A 71-year-old man was admitted to the St. Marianna University Hospital because of fever and generalized lymphadenopathy. Right axillary lymph node biopsy revealed mixed cellularity classical Hodgkin lymphoma (MCHL). The patient was referred to the Tokyo Medical Center, where he was treated with chemotherapy and obtained CR. One year later, the patient again developed fever and generalized lymphadenopathy. Biopsy of the right cervical mass revealed a diagnosis of diffuse large B-cell lymphoma. The patient was treated with salvage chemotherapies and obtained the second CR. Two years later, the patient developed acute myeloid leukemia (AML). Although CR was achieved with chemotherapy, AML relapsed 5 months later and proved to be refractory. Two and a half years later, the patient developed right cervical lymph node enlargement. The biopsy again revealed diagnosis of MCHL. The patient died 2 months later. On reviewing all of the biopsy specimens, including the findings of immunohistochemistry and in situ hybridization, possibility of CHL was ruled out, because neoplastic giant cells resembling Hodgkin and Reed-Sternberg (HRS) cells were positive for both Oct2 and BOB.1, which has not been reported in CHL. Both HRS-like cells at the time of diagnosis of Hodgkin lymphoma and lymphoma cells at the time of diagnosis of non-Hodgkin lymphoma were positive for CD20 and EBV-encoded small RNAs. This case was finally diagnosed as having age-related EBV+ B-cell LPD. We report the case here as it underscores the difficulty in diagnosing age-related EBV+ B-cell LPDs and also suggests an important role of EBV in the pathogenesis of lymphoid neoplasms.

Age-Related EBV-Associated B-Cell Lymphoproliferative Disorders: Comparison with EBV-Positive Classical Hodgkin Lymphoma in Elderly Patients

Age-related Epstein-Barr virus-associated (EBV+) B-cell lymphoproliferative disorder (LPD) is a disease group of EBV+ large B-cell lymphoma characteristically seen in elderly patients without predisposing immunodeficiency. This disease is now going to be listed in the up-coming WHO classification the 4th version. Age-related EBV+ LPD, especially of a polymorphous subtype, which occupied about one-third of cases, is often featured by a rich infiltration of reactive cells in the background, posing the differential diagnostic issue with classical Hodgkin lymphoma (cHL) associated with EBV. However, the clinicopathological differentiation between these two EBV-positive diseases remains to be elucidated. The aim of this study is to clarify the clinicopathological differences between the polymorphic subtype of age-related EBV+ LPD (n=34) and EBV+ cHL (n=108) of patients of 50 years and more of age. Age-related LPD was more closely associated with the following clinical parameters than cHL: a higher age at onset (71 vs. 63 years), lower male predominance (male:female ratio, 1.4 vs. 3.3), and a higher ratio of involvement of the skin (18% vs. 2%), the gastrointestinal tract (15% vs. 4%) and the lung (12% vs. 2%). Furthermore, age-related LPD was histopathologically characterized by a higher ratio of geographical necrosis, a greater increase (>30%) of cytotoxic T cells in the background lymphocytes, a higher positive rate for CD20 and EBNA2 together with an absence of CD15 expression than EBV+ cHL. As predicted by the clinical profile, age-related LPD had a significantly poorer prognosis than EBV+ cHL (P = 0.0001). This analysis has clearly demonstrated that the polymorphous subtype of age-related LPD constitutes an aggressive group with an immune response distinct from those of EBV+ cHL.

Epstein–Barr virus-associated B-cell lymphoma secondary to FCD-C therapy in patients with peripheral T-cell lymphoma

Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorders occur at an increasing frequency in various hereditary and acquired states of immune dysfunction. In a few cases of T-cell lymphoma, especially in angioimmunoblastic T-cell lymphoma (AILT), EBV-associated B-cell lymphoproliferative disorders have been reported. Here, we present two cases of EBV-associated B-cell lymphoma after treatment of T-cell lymphoma (AILT and peripheral T-cell lymphoma, unspecified, PTCL-NOS) with a regimen containing alemtuzumab and fludarabine. Conventional and immunohistological tissue staining showed the typical features of highly proliferating diffuse large B-cell lymphoma in both cases. The monoclonal B-cell population displayed EBV latency type III. At the time of diagnosis the cellular immune status of both patients was severely compromised with an absolute CD4 T-cell count below <120 microl(-1). Our observation supports the notion that combination of cytotoxic drugs and immunosuppressive antibodies in patients with T-cell lymphoma may severely aggravate the already present immunodeficiency. We suggest to monitor the cellular immune status in combination with the EBV load in high risk patients for early detection-and possibly intervention-of EBV-associated lymphoma.

末梢血中のEpstein-Barr virus (EBV)-DNA増加を伴った加齢性EBV関連B細胞増殖異常症

症例は69歳，男性。発熱，右頸部リンパ節腫脹で発症。CTで縦隔・腹腔内リンパ節腫脹を認めた。右頸部リンパ節生検にて，大型異型細胞とその背景に豊富な小型Tリンパ球やマクロファージを認めた。免疫染色では大型異型細胞はCD20, CD30, EBER陽性を示した。また，血液検査ではEBV-VCA IgGが640倍，EBV-DNAを1.0×104 copies/μg DNA検出しEBVの活性化が示唆された。EBVの潜伏感染様式はlatency IIを示し，細胞性免疫能が低下するような基礎疾患は認めなかったことから加齢性EBV関連B細胞増殖異常症と診断した。Rituximab併用CHOP療法を施行し，寛解を得た。治療前に検出された末梢血中のEBV-DNA量は，化学療法後感度以下となった。加齢性EBV関連B細胞増殖異常症において，末梢血中のEBV-DNA量が疾患の活動性および治療反応性の指標として有用である可能性が示唆された。

Imatinib Mesylate Reduces Rituximab-Induced Tumor Growth Inhibition In Vivo on EBV-Associated Human B-Cell Lymphoma.

We previously reported an increase of tumor growth inhibition following chemotherapy combined with concomitantly administration of imatinib mesylate [Decaudin D, et al. Int J Cancer 2005; 113:849–856; Decaudin D, et al. Anti-Cancer drugs 2006; 17:685–696; Decaudin D, et al. Impact of STI571 on the pharmacokinetics of etoposide and / or ifosfamide in mice. Cancer Res (AACR Annual Meeting) 2006;abstr:5154]. Inversely, combination of imatinib and rituximab was reported in very few cases of patients and remains controversial. In order to explore this particular combination of targeted therapies, we therefore investigated the in vivo impact of rituximab plus imatinib on a B-cell lymphoproliferation. Combination of the tyrosine kinase inhibitor imatinib mesylate (STI571) and the anti-CD20 monoclonal antibody rituximab was evaluated on an EBV-associated B-cell lymphoproliferative disorder xenografted into SCID or Rag2/gc −/− (B-, T-, and NK-) mice. Using SCID mice, we found that STI571 diminished the efficacy of rituximab to inhibit tumor growth in vivo (Figure 1A). Using alymphoid Rag2/gc −/− mice, we showed that the effect of STI571 was not dependent on the presence of NK cells (Figure 1B).In contrast, serum complement administered after STI571 treatment reversed this inhibitory effect. Finally, using non immunodeficient mice, we observed an in vivo decrease of CD4-positive T-cells and mature B-cell lymphocytes after imatinib administration. We found that STI571 decreased the in vivo efficacy of rituximab via serum protein components that could influence complement-dependent cytotoxicity. In contrast, this effect was not dependent on the presence of NK cells. [Display omitted]

Senile EBV‐associated B‐cell lymphoproliferative disorder of indolent clinical phenotype with recurrence as aggressive lymphoma

Senile EBV-associated B-cell lymphoproliferative disorder (LPD) was proposed as a new disease entity in 2003. This condition has a high incidence in elderly people without underlying immunodeficiencies, and is characterized by EBV-positive B-cell proliferation with a polymorphic composition. Histologically, the disease has two subtypes. The polymorphic LPD (PLPD) subtype has a preferable prognosis, whereas the large cell lymphoma (LCL) subtype involves aggressive disease progression. Reported herein is a case of senile EBV-BLPD with indolent clinical features and PLPD subtype in the initial phase that recurred as an aggressive lymphoma 3 years after the initial diagnosis. In the recurrent phase, Southern blotting confirmed monoclonal proliferation of large lymphoid B-cells. In both the initial and recurrent phases, polymerase chain reaction (PCR) yielded a single discrete band of a similar size due to an immunoglobulin heavy-chain gene rearrangement, indicating that the large lymphoid B-cells retained identical monoclonality throughout the histological progression and over the whole clinical course. These results suggest that the PLPD subtype is a histological finding in early phase senile EBV-BLPD and that the LCL subtype reflects the progressive phase of the disease.

Virus epstein-barr et proliférations lymphoïdes B

EBV driven B-cell lymphoid proliferations occur after the dysfunction of the immune control and they appear in primary or acquired immunodeficiencies. In primary immunodeficiencies, combined variable immune deficiency (CVID), X linked lymphoproliferative disorder (XLP), severe combined immune deficiency (SCID) and Wiskott-Aldrich syndrome (WAS) are frequently associaterd with EBV associated B-cell lymphoproliferative disorders or lymphomas. In acquired immunodeficiency after organ or bone marrow transplantation, the occurrence of lymphoid proliferation is one of the most serious complications. They are B-cell, polymorphic or monomorphic and EBV related in almost all cases in early proliferations after the graft. In HIV infection, EBV associated B-cell lymphoma are mostly observed in profound immunosuppressed patients. They are localised in brain or in other extra nodal sites. They are diffuse large B cell lymphoma having the features of immunoblastic subcategory. HIV related Burkitt lymphoma is associated with EBV in 30 to 70 % of cases. The role of EBV in such lymphoma where oncogenic events are predominant remain to be elucidated as well as in the Burkitt lymphoma occurring in immunocompetent patients (children or adults) where EBV is present in about 15 % of non endemic cases.

Association of Lymphomatoid Granulomatosis With Epstein-Barr Viral Infection of B Lymphocytes and Response to Interferon-α2b

Lymphomatoid granulomatosis (LyG) is an angiodestructive lymphoproliferative disorder (LPD) often involving the lungs. Its etiology is uncertain, but a number of previous studies had suggested it is a T-cell LPD associated with Epstein-Barr virus (EBV). Because of the similarity between LYG and nasal angiocentric lymphoma, the term angiocentric immunoproliferative lesion was proposed for both entities. Optimal therapy is unknown, but chemotherapy is often used. We studied four patients with LYG over a 5-year period. Biopsy samples were analyzed by immunohistochemistry, EBV in situ hybridization, and for Ig heavy-chain (IgH) gene rearrangements, Clinically, we assessed EBV serology, lymphocyte subsets, and the efficacy of interferon-alpha2b (IFN-alpha2b), All biopsy samples showed an exuberant T-cell infiltrate with scattered atypical large B cells. Double labeling showed EBV in the B cells but not T cells. Clonal IgH gene rearrangements were detected in 2 of 3 patients studied, 1 of whom had three distinct clones, and light-chain restriction showed two clones in an additional patient. All patients had positive EBV serologies. and markedly abnormal lymphocyte subsets. With IFN, 3 patients are alive and disease free at 36, 43, and 60 months; 1 patient achieved a partial response for 16 months but discontinued therapy and died with lymphoma. These results indicate that LYG is a T-cell-rich EBV-associated B-cell LPD in which the infiltrating T cells are numerous but reactive. IgH gene rearrangements may be polyclonal, monoclonal, or oligoclonal. Its association with immune defects suggests it is related to posttransplant LPD. However, LYG and nasal angiocentric lymphoma are distinct entities and should no longer be included together under the term angiocentric immunoproliferative lesion. IFN is effective therapy and should be studied further.