Limits...
Angioimmunoblastic T-Cell Lymphoma Presenting with an Acute Serologic Epstein-Barr Virus Profile.

Beer T, Dorion P - Hematol Rep (2015)

Bottom Line: Lymph node biopsy findings typically include effacement of nodal architecture, polymorphic infiltrate, atypical T-cells (usually CD4+/CD10+/PD1+) and prominent proliferations of high endothelial venules and follicular dendritic cells.However, this classic constellation of pathologic findings is often initially obscured by a prominence of EBV+ B-immunoblasts with or without associated peripherally circulating EBV DNA.Here we document the first reported case of an acute serologic EBV profile (VCA-IgM) in a patient with AITL, and we recommend that clinicians maintain a high index of suspicion for AITL in the appropriate clinical scenario, irrespective of Epstein-Barr related findings.

View Article: PubMed Central - PubMed

Affiliation: Department of General Internal Medicine, Geisinger Medical Center, Danville , PA, USA.

ABSTRACT
Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive peripheral T-cell lymphoma typically characterized by prominent lymphadenopathy and B-symptoms at the time of presentation, polyclonal hypergammaglobulinemia, autoimmune hemolysis and frequent but highly variable involvement of Epstein-Barr virus (EBV). Lymph node biopsy findings typically include effacement of nodal architecture, polymorphic infiltrate, atypical T-cells (usually CD4+/CD10+/PD1+) and prominent proliferations of high endothelial venules and follicular dendritic cells. However, this classic constellation of pathologic findings is often initially obscured by a prominence of EBV+ B-immunoblasts with or without associated peripherally circulating EBV DNA. Here we document the first reported case of an acute serologic EBV profile (VCA-IgM) in a patient with AITL, and we recommend that clinicians maintain a high index of suspicion for AITL in the appropriate clinical scenario, irrespective of Epstein-Barr related findings.

No MeSH data available.


Related in: MedlinePlus

Bone marrow biopsy revealing hypercellular marrow with atypical lymphoid infiltrates (A) and left axillary lymph node biopsy with numerous lymphocytes staining positive for Epstein-Barr virus (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4508553&req=5

fig001: Bone marrow biopsy revealing hypercellular marrow with atypical lymphoid infiltrates (A) and left axillary lymph node biopsy with numerous lymphocytes staining positive for Epstein-Barr virus (B).

Mentions: One week later, the patient returned with fevers, tender palpable splenomegaly and an erythematous rash across his anterior chest. Epstein-Barr virus (EBV) testing was positive for IgG antibodies to viral capsid antigen (VCA-IgG) and Epstein-Barr nuclear antigen (EBNA-IgG), IgM antibodies to viral capsid antigen (VCA-IgM) and plasma EBV DNA to a level of 17,100 IU/mL. He was discharged home with a plan of supportive care for a viral illness. However, the patient returned again, just one week later, with fevers and tender bilateral cervical and axillary lymphadenopathy. EBV testing was again positive for VCA-IgG, EBNA-IgG and VCA-IgM. Antibody to EBV early antigen (EA) was also positive. His EBV viral load had increased to 1,400,000 IU/mL. Additional testing revealed a mixed cryoglobulinemia. He was administered high-dose steroids. EBV viral load was rechecked post-steroids and had decreased to 9000 IU/mL. Bone marrow biopsy revealed a hypercellular marrow with diffuse patches of lymphoid infiltrates composed of dense clusters of EBV+ B-cells. Excisional biopsy of an enlarged right axillary lymph node revealed effacement of the nodal architecture and a mixture of large EBV+ CD20+ immunoblasts, plasma cells and histiocytes (Figure 1). Considered within the context of his EBV serology and viral load, his biopsy findings were felt to be compatible with an EBV-associated lymphoproliferative disorder. A trial of weekly rituximab was initiated.


Angioimmunoblastic T-Cell Lymphoma Presenting with an Acute Serologic Epstein-Barr Virus Profile.

Beer T, Dorion P - Hematol Rep (2015)

Bone marrow biopsy revealing hypercellular marrow with atypical lymphoid infiltrates (A) and left axillary lymph node biopsy with numerous lymphocytes staining positive for Epstein-Barr virus (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508553&req=5

fig001: Bone marrow biopsy revealing hypercellular marrow with atypical lymphoid infiltrates (A) and left axillary lymph node biopsy with numerous lymphocytes staining positive for Epstein-Barr virus (B).
Mentions: One week later, the patient returned with fevers, tender palpable splenomegaly and an erythematous rash across his anterior chest. Epstein-Barr virus (EBV) testing was positive for IgG antibodies to viral capsid antigen (VCA-IgG) and Epstein-Barr nuclear antigen (EBNA-IgG), IgM antibodies to viral capsid antigen (VCA-IgM) and plasma EBV DNA to a level of 17,100 IU/mL. He was discharged home with a plan of supportive care for a viral illness. However, the patient returned again, just one week later, with fevers and tender bilateral cervical and axillary lymphadenopathy. EBV testing was again positive for VCA-IgG, EBNA-IgG and VCA-IgM. Antibody to EBV early antigen (EA) was also positive. His EBV viral load had increased to 1,400,000 IU/mL. Additional testing revealed a mixed cryoglobulinemia. He was administered high-dose steroids. EBV viral load was rechecked post-steroids and had decreased to 9000 IU/mL. Bone marrow biopsy revealed a hypercellular marrow with diffuse patches of lymphoid infiltrates composed of dense clusters of EBV+ B-cells. Excisional biopsy of an enlarged right axillary lymph node revealed effacement of the nodal architecture and a mixture of large EBV+ CD20+ immunoblasts, plasma cells and histiocytes (Figure 1). Considered within the context of his EBV serology and viral load, his biopsy findings were felt to be compatible with an EBV-associated lymphoproliferative disorder. A trial of weekly rituximab was initiated.

Bottom Line: Lymph node biopsy findings typically include effacement of nodal architecture, polymorphic infiltrate, atypical T-cells (usually CD4+/CD10+/PD1+) and prominent proliferations of high endothelial venules and follicular dendritic cells.However, this classic constellation of pathologic findings is often initially obscured by a prominence of EBV+ B-immunoblasts with or without associated peripherally circulating EBV DNA.Here we document the first reported case of an acute serologic EBV profile (VCA-IgM) in a patient with AITL, and we recommend that clinicians maintain a high index of suspicion for AITL in the appropriate clinical scenario, irrespective of Epstein-Barr related findings.

View Article: PubMed Central - PubMed

Affiliation: Department of General Internal Medicine, Geisinger Medical Center, Danville , PA, USA.

ABSTRACT
Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive peripheral T-cell lymphoma typically characterized by prominent lymphadenopathy and B-symptoms at the time of presentation, polyclonal hypergammaglobulinemia, autoimmune hemolysis and frequent but highly variable involvement of Epstein-Barr virus (EBV). Lymph node biopsy findings typically include effacement of nodal architecture, polymorphic infiltrate, atypical T-cells (usually CD4+/CD10+/PD1+) and prominent proliferations of high endothelial venules and follicular dendritic cells. However, this classic constellation of pathologic findings is often initially obscured by a prominence of EBV+ B-immunoblasts with or without associated peripherally circulating EBV DNA. Here we document the first reported case of an acute serologic EBV profile (VCA-IgM) in a patient with AITL, and we recommend that clinicians maintain a high index of suspicion for AITL in the appropriate clinical scenario, irrespective of Epstein-Barr related findings.

No MeSH data available.


Related in: MedlinePlus