title: Lymph node lesion in infectious mononucleosis showing geographic necrosis containing cytologically atypically B-cells. A case report.
abstract: Lymph node lesions in infectious mononucleosis (IM) show a marked histological diversity and may occasionally be confused with malignant lymphoma. We report on a rare case of IM showing geographic lymph node necrosis as well as angiocentric lymphoproliferative lesions, and containing numerous centroblasts, immunoblasts and Reed-Sternberg (RS)-like cells. The patient was a 40-year-old Japanese man with signs and symptoms of classical IM. This was later confirmed serologically, but the necrotic area comprised 50% of a cervical lymph node. The large lymphoid cells, including RS-like cells, were CD3-, CD5-, CD15-, CD20+, CD30+, CD45RO-, CD79a+, LMPI+, and EBNA2+. In situ hybridization study also disclosed that these cells were associated with Epstein-Barr virus (EBV). The patient was disease free during a follow-up of 15 years. Although the classical IM syndrome rarely shows a close resemblance to lymphomatoid granulomatosis of the lymph node or to EBV+ B- cell lymphoproliferative disorders associated with an immunodeficient state on histology, it is important for pathologists to be aware of this type of lesion in diagnostic practice.
authors.affiliation: Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, 617-1, Takabayashinishi-cho, Ohta 373-8550, Japan. mkojima@gunma-cc.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Kojima
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Itoh
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yamane
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyawaki
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Masawa
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D001402:B-Lymphocytes / Q000378:metabolism / Q000473:pathology* / Q000821:virology; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007244:Infectious Mononucleosis / Q000378:metabolism / Q000473:pathology*; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology* / Q000821:virology; D008230:Lymphomatoid Granulomatosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis
chemical_list: D015703:Antigens, CD