title: Epstein-Barr virus-positive follicular lymphoma.
abstract: Epstein-Barr virus (EBV) -associated follicular lymphoma is only rarely reported. Herein, we report the largest series analyzing prevalence and clinicopathologic characteristics of EBV-associated follicular lymphoma occurring in unselected cases. Out of 382 analyzed cases, 10 EBV-positive follicular lymphomas were identified (prevalence=2.6%, 95% confidence interval 1.3-4.0%). All EBV-positive follicular lymphomas showed EBV-encoded small RNA-positive lymphoma cells present in a follicular distribution. Of these, eight also had tissue available for testing of expression of latent membrane protein 1 (LMP1), out of which six (75%) were positive. There was a significant association with grades 3A-3B follicular lymphoma (P<0.0001) and CD30 expression (P=0.0002). EBV-positive follicular lymphomas were otherwise morphologically and immunophenotypically indistinguishable from EBV-negative cases of similar grade. Nine of the EBV-positive follicular lymphomas occurred in patients with no known history of immunosuppression, while one patient had a history of hydroxychloroquine administration for Sjögren's syndrome. The mean age in the EBV-positive and -negative follicular lymphomas was 56 (range 31-83 years) and 49 years (range 25-92 years), respectively, with no statistically significant difference. Seven of the patients with EBV-positive follicular lymphoma had additional biopsies from different time points available for review, all of which showed progression of disease in the form of progression of tumor grade. Five of these progressed to diffuse large B-cell lymphoma, one of which had tissue available for testing and was EBV-positive. Our findings suggest that EBV infection may have a role in lymphomagenesis and/or disease progression in a subset of follicular lymphomas, thereby expanding the spectrum of recognized EBV-associated B-cell lymphomas.
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mackrides
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: German
authors.initials: G
authors.lastname: Campuzano-Zuluaga
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Yvan
authors.identifier: 0000-0001-9485-5541
authors.initials: Y
authors.lastname: Maque-Acosta
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Moul
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Nouf
authors.initials: N
authors.lastname: Hijazi
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Francis Offiong
authors.initials: FO
authors.lastname: Ikpatt
authors.affiliation: Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Levy
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center. University of Miami, Miami, FL and GRECC, Miami VAHS, FL, USA.
authors.forename: Ramiro E
authors.initials: RE
authors.lastname: Verdun
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Kranthi
authors.initials: K
authors.lastname: Kunkalla
authors.affiliation: Department of Pathology, Stanford University, Stanford, CA, USA.
authors.forename: Yasodha
authors.initials: Y
authors.lastname: Natkunam
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Izidore S
authors.initials: IS
authors.lastname: Lossos
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.|Division of Hematology-Oncology, Department of Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vega
authors.affiliation: Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami and Sylvester Comprehensive Cancer Center, Miami, FL, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D008224:Lymphoma, Follicular / Q000473:pathology / Q000821:virology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged