PMID- 23782909
OWN - NLM
STAT- MEDLINE
DCOM- 20140708
LR  - 20220309
IS  - 1746-1596 (Electronic)
IS  - 1746-1596 (Linking)
VI  - 8
DP  - 2013 Jun 19
TI  - Acute EBV infection masquerading as "In-situ Follicular Lymphoma": a pitfall in 
      the differential diagnosis of this entity.
PG  - 100
LID - 10.1186/1746-1596-8-100 [doi]
AB  - We present the case of a 30 year-old man who was referred for evaluation of 
      diffuse lymphadenopathy. Six weeks prior, he noticed darkening of his urine 
      associated with pale stools, nausea and an eventual 30 lb weight loss within a 
      month. The initial laboratory findings showed elevation of the liver enzymes. A 
      CT scan showed mesenteric and periaortic lymphadenopathy with the largest lymph 
      node measuring 2.8 cm. Other laboratory results were otherwise unremarkable 
      (including a normal LDH) with the exception of positive serum antibodies against 
      Epstein-Barr virus (EBV) associated antigens (IgM+ and IgG+). An excisional 
      biopsy of 4 of the small neck lymph nodes showed a normal architecture with 
      prominent follicles and an intact capsule. But, by immunohistochemistry two of 
      the follicles showed aberrant coexpression of BCL-2, in addition to CD10 and 
      BCL-6. In-situ hybridization for early Epstein-Barr virus mRNA (EBER) and 
      immunohistochemistry for latent membrane protein-1 (LMP-1) stained both scattered 
      positive cells, as well as BCL-2 positive B-cells. Although an original diagnosis 
      of in-situ follicular lymphoma was favored at an outside facility, additional 
      interphase fluorescence in situ hybridization (FISH) studies for 
      t(14;18);(IGH-BCL2) rearrangement (performed on the BCL-2 + follicles 
      microdissected from the tissue block; Abott probe dual colour fusion) and 
      molecular studies (IGH gene rearrangement by PCR, also performed on the 
      microdissected follicles) were negative. Serologic studies (positive EBV 
      antibodies) and immunostains in conjunction with the molecular studies confirmed 
      the reactive nature of the changes. Our case also shows direct immunopathogenic 
      evidence of BCL-2 expression among the EBV-infected cells, which has to our 
      knowledge not been previously documented in vivo. A diagnosis of EBV infection 
      should, therefore, be considered when confronted with BCL-2 expression in 
      germinal centers, particularly in younger individuals, as the diagnosis of FLIS 
      may lead to extensive and invasive haematologic work-ups. VIRTUAL SLIDES: The 
      virtual slide(s) for this article can be found here: 
      http://www.diagnosticpathology.diagnomx.eu/vs/1323656318940068.
FAU - Gru, Alejandro A
AU  - Gru AA
AD  - Department of Pathology and Immunology, Washington University School of Medicine, 
      660 S, Euclid Avenue, Box 8118, St, Louis, MO 63110, USA. jfrater@path.wustl.edu.
FAU - Kreisel, Friederike
AU  - Kreisel F
FAU - Duncavage, Eric
AU  - Duncavage E
FAU - Nguyen, TuDung T
AU  - Nguyen TT
FAU - Hassan, Anjum
AU  - Hassan A
FAU - Frater, John L
AU  - Frater JL
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20130619
PL  - England
TA  - Diagn Pathol
JT  - Diagnostic pathology
JID - 101251558
RN  - 0 (Antibodies, Viral)
RN  - 0 (BCL6 protein, human)
RN  - 0 (Biomarkers, Tumor)
RN  - 0 (DNA-Binding Proteins)
RN  - 0 (Proto-Oncogene Proteins c-bcl-2)
RN  - 0 (Proto-Oncogene Proteins c-bcl-6)
RN  - EC 3.4.24.11 (Neprilysin)
SB  - IM
MH  - Adult
MH  - Antibodies, Viral/blood
MH  - Biomarkers, Tumor/analysis
MH  - Biopsy
MH  - DNA-Binding Proteins/analysis
MH  - Diagnosis, Differential
MH  - Germinal Center/chemistry/immunology/pathology/*virology
MH  - Herpesvirus 4, Human/immunology/*isolation & purification
MH  - Humans
MH  - Immunohistochemistry
MH  - In Situ Hybridization, Fluorescence
MH  - Infectious Mononucleosis/blood/*diagnosis/genetics/immunology/virology
MH  - Lymph Node Excision
MH  - Lymphoma, Follicular/chemistry/*diagnosis/genetics/immunology
MH  - Male
MH  - Neprilysin/analysis
MH  - Polymerase Chain Reaction
MH  - Predictive Value of Tests
MH  - Proto-Oncogene Proteins c-bcl-2/analysis
MH  - Proto-Oncogene Proteins c-bcl-6
PMC - PMC3874606
EDAT- 2013/06/21 06:00
MHDA- 2014/07/09 06:00
PMCR- 2013/06/19
CRDT- 2013/06/21 06:00
PHST- 2013/03/11 00:00 [received]
PHST- 2013/05/06 00:00 [accepted]
PHST- 2013/06/21 06:00 [entrez]
PHST- 2013/06/21 06:00 [pubmed]
PHST- 2014/07/09 06:00 [medline]
PHST- 2013/06/19 00:00 [pmc-release]
AID - 1746-1596-8-100 [pii]
AID - 10.1186/1746-1596-8-100 [doi]
PST - epublish
SO  - Diagn Pathol. 2013 Jun 19;8:100. doi: 10.1186/1746-1596-8-100.