Human herpesvirus 8 in primary effusion lymphoma in an HIV-seronegative male. A case report.
BACKGROUND
AIDS-related body cavity-based lymphoma, or primary effusion lymphoma (PEL), is a distinct clinicopathologic entity that occurs predominantly in immunosuppressed patients infected with human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus. Although it rarely occurs in human immunodeficiency virus (HIV)-negative patients, we report such a case here.


METHODS
A 74-year-old male, who was HIV and Epstein-Barr virus (EBV) negative, was admitted to the hospital with dyspnea and chest pain. Chest radiography and computed tomography showed right pleural effusion. Cytologic analysis of the pleural effusion revealed a high grade lymphoma with round nuclei, prominent nucleoli and abundant cytoplasm. Polymerase chain reaction performed on the pleural effusion was positive for HHV-8 and negative for EBV. On molecular studies, the immunoglobulin heavy and kappa light chains were rearranged. Flow cytometry revealed a hyperploid fraction with DNA index of 1.29 expressing CD30. Immunostaining for HHV-8 from a cell block was positive. Electron microscopy revealed lymphomalike cells, many in various stages of apoptosis, with large nucleoli and clusters of viruslike particles in the nucleoplasm.


CONCLUSIONS
A firm diagnosis of PEL can be established by the examination of cells from the lymphomatous effusion by a combination of cytology, molecular genetics, phenotypic features, immunostaining and electron microscopy. To our knowledge, this is the first case in which immunostaining for anti-HHV-8 monoclonal antibodies was used to support the diagnosis.
Munichor
Mariana
M
Department of Pathology, Rambam Medical Center, Electron Microscopy Unit, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Cohen
Hector
H
Sarid
Ronit
R
Manov
Irena
I
Iancu
Theodore C
TC
D000368:Aged; D000911:Antibodies, Monoclonal / Q000378:metabolism; D017209:Apoptosis; D001399:Azure Stains; D005434:Flow Cytometry; D018023:HIV Seronegativity; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification* / Q000648:ultrastructure; D006801:Humans; D016130:Immunophenotyping; D017730:Ki-1 Antigen / Q000378:metabolism; D017493:Leukocyte Common Antigens / Q000378:metabolism; D016393:Lymphoma, B-Cell / Q000150:complications / Q000473:pathology* / Q000821:virology*; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism; D016066:Pleural Effusion, Malignant / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D016133:Polymerase Chain Reaction; D011509:Proteoglycans / Q000378:metabolism; D012514:Sarcoma, Kaposi / Q000473:pathology*; D053667:Syndecans; D014057:Tomography, X-Ray Computed; D014965:X-Rays
D000911:Antibodies, Monoclonal; D001399:Azure Stains; D017730:Ki-1 Antigen; D008562:Membrane Glycoproteins; D011509:Proteoglycans; D053667:Syndecans; D017493:Leukocyte Common Antigens