title: A case of age-related Epstein-Barr virus (EBV)-associated B cell lymphoproliferative disorder, so-called polymorphous subtype, of the mandible, with a review of the literature.
abstract: Epstein-Barr virus (EBV) is known to be associated with the development of lymphomas in immunocompromised patients. Recently, age-related immune impairment has been recognized as a predisposing factor in the development of EBV-driven lymphoproliferative disorders (LPDs) in elderly patients without any known immunodeficiency or prior lymphoma. In approximately 70% of reported cases, the affected sites have been extranodal, such as the skin, lung, tonsil and stomach. However, age-related EBV-associated B cell (EBV + B cell) LPD is extremely rare in the oral cavity. Here we report a 71-year-old Japanese man who developed an EBV + B cell LPD resembling classical Hodgkin lymphoma (CHL)--so-called polymorphous subtype-of the mandible. Histopathologically, infiltration of large atypical lymphoid cells including Hodgkin or Reed-Sternberg-like cells into granulation tissue with marked necrosis was found in the mandibular bone. Immunohistochemical analysis revealed that the large atypical Hodgkin or Reed-Sternberg-like cells were CD3-, CD15-, CD20+, CD30+ and Epstein-Barr virus (EBV)-latent infection membrane protein-1 (LMP-1)+. In situ hybridization (ISH) demonstrated EBV-encoded small RNA (EBER) + in numerous Hodgkin or Reed-Sternberg-like cells. EBNA-2 was detected by polymerase chain reaction (PCR) using an extract from the formalin-fixed, paraffin-embedded specimen. To our knowledge, this is the first reported case of the polymorphous subtype of age-related EBV + B cell LPD affecting the mandible.
authors.affiliation: Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan. k-kikuchi@dent.meikai.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Fukunaga
authors.forename: Harumi
authors.initials: H
authors.lastname: Inoue
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Masaru
authors.initials: M
authors.lastname: Kojima
authors.forename: Fumio
authors.initials: F
authors.lastname: Ide
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kusama
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D001402:B-Lymphocytes / Q000473:pathology* / Q000821:virology; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000473:pathology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006689:Hodgkin Disease / Q000175:diagnosis; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000473:pathology* / Q000821:virology; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology* / Q000821:virology