title: Epstein-Barr virus-positive diffuse large B-cell lymphoma in elderly patients is rare in Western populations.
abstract: In the currently published World Health Organization-Classification, the new entity of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly was introduced largely based on findings from East-Asian populations. Little is known about its frequency or characteristics in the West, especially in European populations. Using a tissue microarray approach, we identified 8 out of 258 diffuse large B-cell lymphoma cases fulfilling the World Health Organization criteria of an Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly, suggesting an incidence of 3.1% in a European population. The median patient age was 65 years. The highest diagnostic sensitivity was only achieved by EBER in situ hybridization. No correlation between Epstein-Barr virus status and outcome was noted except in latency type 3 lymphomas, which had a very poor survival. Sixty-seven percent of Epstein-Barr virus-positive cases showed the presence of necrosis and 50% expressed the activation marker CD30. However, no morphological or immunohistochemical features reliably distinguished all Epstein-Barr virus-positive diffuse large B-cell lymphoma cases. Thus, to identify these Epstein-Barr virus-positive diffuse large B-cell lymphoma in the elderly, EBER in situ hybridization of all de novo diffuse large B-cell lymphoma cases of patients older than 50 years should be considered. In summary, Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly is rare in Europeans older than 50 years. It can only be diagnosed by EBER-ISH, and its precise prognostic role is unclear. Whether routine testing of all diffuse large B-cell lymphoma patients older than 50 years can be recommended depends essentially on its clinical relevance. Future studies are needed to address this question.
authors.affiliation: Institute of Pathology, University Hospital, University of Basel, 4031 Basel, Switzerland.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Hoeller
authors.forename: Alexandar
authors.initials: A
authors.lastname: Tzankov
authors.forename: Stefano A
authors.initials: SA
authors.lastname: Pileri
authors.forename: Philip
authors.initials: P
authors.lastname: Went
authors.forename: Stephan
authors.initials: S
authors.lastname: Dirnhofer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D015994:Incidence; D053208:Kaplan-Meier Estimate; D017730:Ki-1 Antigen; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology / Q000821:virology; D018579:Patient Selection; D011379:Prognosis; D012367:RNA, Viral; D046888:Tissue Array Analysis; D044465:White People
chemical_list: D017730:Ki-1 Antigen; D012367:RNA, Viral