Anorectal Epstein-Barr virus infection mimicking Hodgkin lymphoma in an immunocompetent man.
Anorectal Hodgkin lymphoma (HL) is rare, mainly described in human immunodeficiency virus (HIV) patients with exceptional cases reported in immunocompetents. We report the case of a middle age HIV male, presenting with intestinal occlusion. Rectosigmoidoscopy showed multiple anorectal nodular and ulceronecrotic masses. The biopsy specimens revealed a diffuse polymorphous inflammatory infiltrate in the lamina propria, associated with CD30, CD20, CD3, CD15, and ALK1 scattered large Hodgkin and/or Reed Sternberg -like cells stained by LMP1 antibody and EBER. A diagnosis of EBV-associated atypical lymphoproliferative disease mimicking HL was made. These lesions remained stable for 2 years without treatment then disappeared leaving a mucosal scar. A later control biopsy showed a condylomatous lesion, without lymphoid lesion, suggesting a sexually acquired infection. Eight years later, the complete resolution of the lesion without any treatment is a strong argument against a malignant lymphoid process and raises doubts as to the reality of isolated anorectal HL in immunocompetent participants.
Vasiliu
Viorel
V
Departments of Pathology, Necker-Enfants Malades Hospital and Paris-Descartes University, Paris, France.
Suarez
Felipe
F
Canioni
Danielle
D
Hermine
Olivier
O
Varet
Bruno
B
Brousse
Nicole
N
D001004:Anus Diseases / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D001706:Biopsy; D004279:DNA, Viral / Q000302:isolation & purification; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D004854:Herpesvirus 4, Human / Q000235:genetics; D006689:Hodgkin Disease / Q000175:diagnosis*; D006801:Humans; D007121:Immunocompetence; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D008297:Male; D012002:Rectal Diseases / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D012075:Remission, Spontaneous; D015229:Sexually Transmitted Diseases, Viral / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D012812:Sigmoidoscopy; D013997:Time Factors
D004279:DNA, Viral