title: Peripheral T-cell lymphoma complicated by a proliferation of large B cells.
abstract: We studied 14 cases that showed a morphologic appearance of peripheral T-cell lymphoma and contained substantial numbers of CD20+ large B cells. In all but 2 cases, the CD20+ large cells showed a mix of kappa and lambda light chain expression. Two cases showed a focal predominance of kappa expression. In situ hybridization using the EBER1 probe for detection of Epstein-Barr virus (EBV) RNA was performed on every case. EBV RNA was present in 10 cases. Of 8 cases with EBV RNA stained by immunohistochemistry for the latent membrane protein of EBV, 6 were positive. Double-labeling immunohistochemistry and in situ hybridization confirmed that EBV was present in the large B cells. Polymerase chain reaction (PCR) analysis showed a clonal rearrangement of the T-cell receptor (TCR)-gamma chain gene in 12 of 13 cases tested. One additional case showed a clonal rearrangement of the TCR-beta chain gene by Southern blot hybridization. PCR analysis showed a clonal immunoglobulin gene rearrangement in 5 cases, a suggestion of a clonal rearrangement in 1, an oligoclonal pattern in 4, and a polyclonal pattern in 4. The finding of large B and T cells may result in a misdiagnosis of a reactive process or of T-cell-rich B-cell lymphoma. The presence of EBV in some cases could cause further confusion with the reactive T- and B-immunoblastic proliferation of infectious mononucleosis.
authors.affiliation: Dept of Pathology, Stanford University Medical Center, CA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Higgins
authors.forename: M
authors.initials: M
authors.lastname: van de Rijn
authors.forename: C D
authors.initials: CD
authors.lastname: Jones
authors.forename: J L
authors.initials: JL
authors.lastname: Zehnder
authors.forename: R A
authors.initials: RA
authors.lastname: Warnke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018951:Antigens, CD20 / Q000276:immunology; D015139:Blotting, Southern; D017931:DNA Primers / Q000737:chemistry; D004273:DNA, Neoplasm / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000473:pathology / Q000821:virology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor / Q000235:genetics; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000235:genetics; D007146:Immunoglobulin lambda-Chains / Q000235:genetics; D017403:In Situ Hybridization; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000473:pathology / Q000821:virology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000473:pathology / Q000821:virology; D016411:Lymphoma, T-Cell, Peripheral / Q000150:complications* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis
chemical_list: D018951:Antigens, CD20; D017931:DNA Primers; D004273:DNA, Neoplasm; C099537:Epstein-Barr virus encoded RNA 1; D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D012367:RNA, Viral