title: Fatal Epstein-Barr virus-associated lymphoproliferative disorder in childhood.
abstract: OBJECTIVE
  We report five childhood cases of fatal Epstein-Barr virus-associated lymphoproliferative disorder to determine their immunopathologic and immunogenotypic features.
  
  
  METHODS
  Clinicopathologic features are described, using clinical, histologic, immunophenotypic, and genotypic examinations.
  
  
  METHODS
  Autopsy cases were performed at Nagoya and Tsukuba university hospitals, Japan.
  
  
  RESULTS
  Infiltrating lymphocytes, which were positive for the EBV genome by in situ hybridization, were polymorphic and showed polyclonal immunoglobulin staining in all five cases. Two cases, however, showed genetic clonality of EBV termini. In one case, the clonality was observed only in the spleen, and in the other case, clonal rearrangement of the JH gene was also found. The former case showed none of the morphologic features of neoplasia and presented a morphology similar to virus-associated hemophagocytic syndrome. In the latter case, infiltrating lymphoid cells were much less polymorphous, and nodular masses of the lymphoid cells in colon and lung specimens were observed.
  
  
  CONCLUSIONS
  We suggest that some polyclonal EBV-associated lymphoproliferative disorders develop into polymorphic, but genotypically monoclonal, lymphoproliferative disorders.
authors.affiliation: First Department of Pathology, Nagoya University, School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yatabe
authors.forename: N
authors.initials: N
authors.lastname: Mori
authors.forename: K
authors.initials: K
authors.lastname: Oka
authors.forename: T
authors.initials: T
authors.lastname: Iijima
authors.forename: S
authors.initials: S
authors.lastname: Saga
authors.forename: K
authors.initials: K
authors.lastname: Takada
authors.forename: J
authors.initials: J
authors.lastname: Asai
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000097:blood; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology; D015139:Blotting, Southern; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D004268:DNA-Binding Proteins / Q000097:blood; D019309:Epstein-Barr Virus Nuclear Antigens; D017809:Fatal Outcome; D005260:Female; D005838:Genotype; D006566:Herpesviridae Infections; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology; D006801:Humans; D016130:Immunophenotyping; D017403:In Situ Hybridization; D007223:Infant; D007564:Japan; D008099:Liver / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000821:virology*; D008297:Male
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D004279:DNA, Viral; D004268:DNA-Binding Proteins; D019309:Epstein-Barr Virus Nuclear Antigens