title: An unusual case of Epstein-Barr virus-positive large B-cell lymphoma lacking various B-cell markers.
abstract: BACKGROUND
  Epstein-Barr virus (EBV) is associated with B-cell lymphoma in various conditions, such as immunodeficiency and chronic inflammation. We report an unusual case of EBV-positive diffuse large B-cell lymphoma (DLBCL) lacking the expression of many B-cell markers.
  
  
  METHODS
  An 83-year-old man presented with a submandibular tumor. Histology of a lymph node biopsy specimen revealed diffuse proliferation of centroblast- or immunoblast-like lymphoid cells with plasmacytic differentiation. Scattered Hodgkin/Reed-Sternberg-like cells were also visible. A routine immunohistochemistry antibody panel revealed that the tumor cells were negative for B-cell and T-cell markers (i.e., CD3, CD19, CD20, CD38, CD45RO, CD79a, CD138, and Pax-5), but were positive for CD30 and MUM-1, not defining the lineage of tumor cells. The final diagnosis of EBV-positive DLBCL was confirmed based on the expression of B-cell-specific transcription factors (Oct-2 and BOB.1), PCR-based identification of monoclonal rearrangement of the immunoglobulin genes, and the presence of EBV-encoded small RNAs in the tumor cells (identified using in situ hybridization).
  
  
  CONCLUSIONS
  The downregulation of broad band of B-cell markers in the present case with EBV-positive DLBCL posed a diagnostic dilemma, as the possible diagnoses included differentiation from anaplastic large cell lymphoma and CD20-negative B-cell lymphomas. Results of immunohistochemical panel including B-cell-specific transcription factors and gene rearrangement analyses critically support the correct diagnosis.
authors.affiliation: Department of Pathology, Kansai Rosai Hospital, 3-1-69 Inabaso, 660-8511, Amagasaki, Hyogo, Japan. nakatukashinichi@kansaih.johas.go.jp.
authors.forename: Shin-Ichi
authors.identifier: http://orcid.org/0000-0002-0055-8149
authors.initials: SI
authors.lastname: Nakatsuka
authors.affiliation: Department of Pathology, Amagasaki Central Hospital, 1-12-1 Shioe, 661-0976, Amagasaki, Hyogo, Japan.
authors.forename: Chikao
authors.initials: C
authors.lastname: Yutani
authors.affiliation: Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, 565-0871, Suita, Osaka, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Kurashige
authors.affiliation: Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, 565-0871, Suita, Osaka, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Kohara
authors.affiliation: Department of Pathology, Kansai Rosai Hospital, 3-1-69 Inabaso, 660-8511, Amagasaki, Hyogo, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Nagano
authors.affiliation: Department of Pathology, Kansai Rosai Hospital, 3-1-69 Inabaso, 660-8511, Amagasaki, Hyogo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Internal Medicine, Amagasaki Central Hospital, 1-12-1 Shioe, 661-0976, Amagasaki, Hyogo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takatsuka
authors.affiliation: Department of Internal Medicine, Amagasaki Central Hospital, 1-12-1 Shioe, 661-0976, Amagasaki, Hyogo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Ifuku
authors.affiliation: Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, 565-0871, Suita, Osaka, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Morii
mesh_terms: D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D020869:Gene Expression Profiling / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D016403:Lymphoma, Large B-Cell, Diffuse / Q000378:metabolism / Q000473:pathology* / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction
chemical_list: D014408:Biomarkers, Tumor
keywords: BOB.1; Downregulation; Epstein-Barr virus; Gene rearrangement study; Lineage specific marker; Malignant lymphoma; Oct-2