Epstein-Barr virus-positive pleural effusion: Clinical features, cytomorphologic characteristics, and flow cytometric immunophenotyping.
OBJECTIVE
The etiology of pleural effusions (PEs) varies, and a percentage of PEs remains unexplained despite an intensive workup. One previous study documented a high prevalence of Epstein-Barr virus (EBV)-DNA in unselected and unexplained PEs. Our aim is to characterize the clinical and cytomorphologic features of EBV-associated PEs, which have not been described.


METHODS
A database search was performed for PEs with EBV-DNA identified in the fluid by real-time quantitative polymerase chain reaction. The corresponding fluid cytology and chemistry were reviewed, and the patients' demographic data and clinical features were recorded.


RESULTS
A total of 20 cases of EBV-DNA-positive PE were found. All patients had a history of lung transplantation. Most of the PE EBV loads were relatively low. Cytologically, polymorphous lymphocytosis was present in more than 70% of PEs. Scattered lymphocytic mitosis and apoptosis were seen in some cases. Mesothelial cells varied in number, and some cases showed reactive atypia. The lymphocytes were predominantly T cells with the CD4/CD8 ratio varying from 10:1 to 3:20.


CONCLUSIONS
EBV infection/reactivation can account for certain proportions of "idiopathic" PEs. Polymorphous lymphocytosis is the most common cytologic feature, but atypical features (in both lymphocytes and mesothelial cells) can be seen.
From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX. takei327@aol.com.
Hidehiro
H
Takei
From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX.
Dina
D
Mody
D000368:Aged; D004279:DNA, Viral / Q000032:analysis*; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005434:Flow Cytometry; D004854:Herpesvirus 4, Human; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000473:pathology* / Q000821:virology*; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014763:Viral Matrix Proteins / Q000032:analysis
D004279:DNA, Viral; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D014763:Viral Matrix Proteins
Epstein-Barr virus; Pleural effusion; Real-time quantitative PCR