Atypical hyperplasia of the marginal zone of B follicles in a polymorphic Epstein-Barr virus-associated lymphoproliferative disorder occurring in an adolescent with human immunodeficiency virus infection.
Epstein-Barr virus (EBV)-associated lymphoid proliferations that are similar to post-transplantation lymphoproliferative disorders may occasionally occur in the setting of human immunodeficiency virus (HIV) infection. Herein, we describe such a lesion involving the adenoids in a HIV-seropositive adolescent who acquired immunity against EBV during childhood. On microscopic examination, the marginal zone of B follicles and the interfollicular area were enlarged due to the accumulation of small or intermediate-sized lymphocytes, immunoblasts, epithelioid histiocytes, and plasma cells. A few atypical immunoblasts resembling Reed-Sternberg cells were also present. Most of the cells seen in these expanded regions belonged to the B-cell lineage and displayed a phenotype consistent with that of postgerminal center B cells. No clonal rearrangement of the genes coding for the heavy chain of the immunoglobulin could be demonstrated by polymerase chain reaction analysis. In-situ hybridization studies revealed the presence of EBV early RNA in a significant number of these cells, which suggests the participation of this virus in the pathogenesis of such a B-cell proliferation. The clinical course was benign; no progression or recurrence could be seen more than 24 months after the diagnosis. This atypical lymphoproliferative disorder is probably related to polyclonal reactivation of a latent EBV infection due to a local or systemic immune imbalance induced by HIV replication. Recognition of this reactive condition is important to prevent overtreatment.
Dargent
Jean-Louis
JL
Department of Pathology, Institut de Pathologie et de Génétique, Belgium. jldargent@hotmail.com
Haller
Annick
A
Durdurez
Jean-Pierre
JP
Gennotte
Anne Françoise
AF
D000234:Adenoids / Q000276:immunology / Q000473:pathology*; D000293:Adolescent; D015703:Antigens, CD; D001402:B-Lymphocytes / Q000473:pathology*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000276:immunology / Q000473:pathology*; D005260:Female; D018858:Germinal Center / Q000276:immunology / Q000473:pathology*; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D017403:In Situ Hybridization; D008232:Lymphoproliferative Disorders / Q000276:immunology / Q000473:pathology / Q000821:virology*; D016133:Polymerase Chain Reaction; D016539:Reed-Sternberg Cells / Q000473:pathology
D015703:Antigens, CD