title: Acute EBV masquerading as peripheral T-cell lymphoma.
abstract: Histological features of Epstein-Barr virus (EBV) can rarely mimic lymphoma. A 25-year-old presented with a spontaneous splenic rupture following a short illness. Histopathology assessment of the splenic and marrow tissue was highly suggestive of peripheral T-cell lymphoma not-otherwise-specified (PTCL-NOS). T-cell receptor (TCR) PCR clonality studies revealed a monoclonal T-cell population expressing for both TCRβ and γ, strongly suggestive of a T-cell clonal disease. EBV IgM was positive and IgG negative. EBV PCR was positive (7.02 ×10(4)/mL). Despite the strong suggestion of PTCL-NOS from histopathology and clonality studies, the decision was made to observe the patient and not start multiagent chemotherapy. The patient remained well, with no signs of PTCL and subsequently seroconverted to IgG+ EBV. We highlight the potential pitfall of acute EBV masquerading as PTCL and show the critical role of the multidisciplinary integration of histopathological, serology, molecular and clinical features to avoid misdiagnosis.
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Xiao-Yin
authors.initials: XY
authors.lastname: Zhang
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Graham P
authors.initials: GP
authors.lastname: Collins
authors.affiliation: Department of Cellular Pathology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Soilleux
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Toby Andrew
authors.initials: TA
authors.lastname: Eyre
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000097:blood; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000175:diagnosis*; D008297:Male; D017464:Receptors, Complement 3d / Q000097:blood
chemical_list: D000911:Antibodies, Monoclonal; D017464:Receptors, Complement 3d
references.citation: Cancer. 1971 May;27(5):1029-40
references.pmid: 4103338
references.citation: Mod Pathol. 2012 Aug;25(8):1149-59
references.pmid: 22627742
references.citation: Intern Med. 2013;52(17):1971-5
references.pmid: 23994994
references.citation: Int J Clin Exp Pathol. 2013;6(1):105-9
references.pmid: 23236550
references.citation: J Immunol. 2000 Nov 1;165(9):4831-41
references.pmid: 11046006
references.citation: J Virol. 2015 Feb;89(4):2301-12
references.pmid: 25505080
references.citation: J Exp Med. 1996 Nov 1;184(5):1815-24
references.pmid: 8920869
references.citation: Pathol Res Pract. 2004;200(1):47-51
references.pmid: 15157050
references.citation: Am J Surg Pathol. 1987 Feb;11(2):122-32
references.pmid: 3812872
references.citation: APMIS. 2001 Jun;109(6):419-27
references.pmid: 11506473
references.citation: Med Oncol. 1996 Dec;13(4):207-13
references.pmid: 9152971
references.citation: Int J Clin Exp Pathol. 2014 Apr 15;7(5):2430-7
references.pmid: 24966953