title: Epstein-Barr virus-associated composite lymphoma composed of peripheral T-cell lymphoma and an anaplastic variant of a diffuse large B-cell type of non-Hodgkin's lymphoma and strongly expressing p53 protein.
abstract: We report a case of composite lymphoma consisting of peripheral T-cell lymphoma and an anaplastic variant of diffuse large B-cell lymphoma (DLBCL) and associated with Epstein-Barr virus (EBV) infection and strong p53 expression. A 65-year-old Japanese woman developed fever and generalized lymphadenopathy. A biopsy of the cervical node revealed the morphology of malignant lymphoma with 2 kinds of lymphoma coexisting in 1 lymph node. One lymphoma type consisted of immunoblastic large cells with the T-cell marker phenotype CD3+, CD45RO/UCHL-1+, CD20/L26-, CD79-, CD10-, CD30-, and CD15-; the other type consisted of large cells with abundant cytoplasm and pleomorphic nuclei with the marker phenotype CD79+, CD20/L26+, CD45RO/UCHL-1-, CD3-, CD10-, CD30+, NPM/ALK-, and CD15-. Therefore, the diagnosis was composite lymphoma of peripheral T-cell lymphoma and an anaplastic variant of DLBCL, stage IVB, because the patient had bone marrow involvement with peripheral T-cell lymphoma. The biopsy led to findings of latent type II EBV-associated lymphoma in both the peripheral T-cell lymphoma and the anaplastic variant of DLBCL as the result of positive signals for EBV small RNAs by in situ hybridization, positive immunostaining results for EBV latent membrane protein 1 antibody, and negative immunostaining results for EBV nuclear antigen 2. Immunostaining of the mass with p53 antibody also yielded positive results for both types of lymphoma cells. This case suggests that the immunocompromised state of this patient with EBV-related peripheral T-cell lymphoma allowed the emergence of an EBV-related anaplastic variant of DLBCL and suggests a close relationship between p53 expression and latent EBV infection.
authors.affiliation: Division of Hematology and Immunology, Department of Internal Medicine, Kanazawa Medical University, 1-1, Daigaku, Uchinadamachi, Kahoku-gun, Ishikawa, Prefecture 920-0293, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hirose
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukushima
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Masaki
authors.forename: Kumiko
authors.initials: K
authors.lastname: Shimoyama
authors.forename: Hiromi
authors.initials: H
authors.lastname: Karasawa
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Ogawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Wano
mesh_terms: D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D016130:Immunophenotyping; D008198:Lymph Nodes / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000378:metabolism / Q000821:virology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000378:metabolism / Q000821:virology; D016411:Lymphoma, T-Cell, Peripheral / Q000175:diagnosis* / Q000378:metabolism / Q000821:virology; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000378:metabolism / Q000821:virology; D016159:Tumor Suppressor Protein p53 / Q000032:analysis / Q000096:biosynthesis*
chemical_list: D015703:Antigens, CD; D016159:Tumor Suppressor Protein p53