title: Geographic variation in the prevalence of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly: a comparative analysis of a Mexican and a German population.
abstract: Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma of the elderly was included as a provisional entity in the 2008 WHO lymphoma classification. Most reports of this disease come from Asia and little is known about it in other regions of the world, including Latin America. Therefore, in this study, 305 diffuse large B-cell lymphomas in patients above 50 years were analyzed, 136 from Mexico and 169 from Germany. EBV was detected by Epstein-Barr early RNA (EBER) in situ hybridization. Only cases with EBER+ in the majority of tumor cells were regarded as EBV+ diffuse large B-cell lymphoma. The prevalence of EBV+ diffuse large B-cell lymphoma in Mexican patients was found to be 7% (9 of 136), whereas only 2% (4 of 169) of the German cases were positive. The median age at diagnosis was 66 years in the Mexican cohort, as opposed to 77 years in the German group. The site of presentation was in both groups predominantly nodal in nine cases (70%) and extranodal in four cases (30%). Of the 13 EBV+ cases, 10 (77%) were classified as polymorphic and 3 (23%) as monomorphic type. The polymorphic cases showed a non-germinal center B-cell immunophenotype (CD10- MUM1+). Twelve cases (92%) were LMP1 positive and two (15%) expressed EBNA2. An interesting finding was the high frequency of EBV type B with the LMP1 30 bp deletion found in the Mexican cases (50%). Eight of the 11 evaluable cases were B-cell monoclonal by polymerase chain reaction. In summary, we found a similar prevalence of EBV+ diffuse large B-cell lymphoma of the elderly in a Mexican population compared with what has been reported in Asian countries, and in contrast to the low frequency in Western populations (1-3%). However, compared with the Asian series, the Mexican patients were younger at diagnosis, presented predominantly with nodal disease and rarely expressed EBNA2 protein.
authors.affiliation: Institute of Pathology, Eberhard-Karls-University of Tübingen, Tübingen, Germany.
authors.forename: Annegret
authors.initials: A
authors.lastname: Hofscheier
authors.forename: Ana
authors.initials: A
authors.lastname: Ponciano
authors.forename: Irina
authors.initials: I
authors.lastname: Bonzheim
authors.forename: Patrick
authors.initials: P
authors.lastname: Adam
authors.forename: Carmen
authors.initials: C
authors.lastname: Lome-Maldonado
authors.forename: Teresa
authors.initials: T
authors.lastname: Vela
authors.forename: Evelyn
authors.initials: E
authors.lastname: Cortes
authors.forename: Carlos
authors.initials: C
authors.lastname: Ortiz-Hidalgo
authors.forename: Falko
authors.initials: F
authors.lastname: Fend
authors.forename: Leticia
authors.initials: L
authors.lastname: Quintanilla-Martinez
mesh_terms: D017668:Age of Onset; D000368:Aged; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D019309:Epstein-Barr Virus Nuclear Antigens / Q000032:analysis / Q000096:biosynthesis; D005260:Female; D005858:Germany / Q000453:epidemiology; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D017403:In Situ Hybridization; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014763:Viral Matrix Proteins / Q000032:analysis / Q000096:biosynthesis; D014764:Viral Proteins / Q000032:analysis / Q000096:biosynthesis
chemical_list: C402641:EBNA-2 protein, Human herpesvirus 4; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D019309:Epstein-Barr Virus Nuclear Antigens; D014763:Viral Matrix Proteins; D014764:Viral Proteins