title: Coexistence of age-related EBV-associated follicular hyperplasia and large B-cell EBV+ lymphoma of the elderly. Two distinct features of the same T-cell dysfunction related to senescence?
abstract: Age-related EBV-associated lymphoproliferative disorders form a new clinicopathological group. Until recently, this group was associated with diffuse large B-cell lymphoma (DLBCL), characterised by an aggressive clinical presentation and a poor prognosis. Recent findings in Western Caucasian patients, however, suggest that this entity covers a wide spectrum of diseases, ranging from reactive follicular hyperplasia (HR) to DLBCL. We report the case of an 85-year-old Caucasian man showing lymphadenopathy and numerous hypodense lesions of the liver. Examination of a lymph node revealed follicular hyperplasia with EBV expression confined to germinal centres. The patient was treated with Rituximab and subsequently, the lesions of the liver were explored. They showed extensive necrosis and a polymorphic large B-cell population with strong EBV expression. This is the first report to describe age-related EBV-associated follicular hyperplasia at one site coexisting with DLBCL at another. This case warrants undertaking further investigations each time a diagnosis of age-related EBV-HR is associated with extranodal lesions.
authors.affiliation: Univ. Lille, Institute of Pathology, Centre de Biologie Pathologie, CHU Lille, F-59000 Lille, France. Electronic address: jeanbaptiste.gibier@chru-lille.fr.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Gibier
authors.affiliation: Univ. Lille, Institute of Pathology, Centre de Biologie Pathologie, CHU Lille, F-59000 Lille, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bouchindhomme
authors.affiliation: Univ. Lille, Institute of Pathology, Centre de Biologie Pathologie, CHU Lille, F-59000 Lille, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Dubois
authors.affiliation: Univ. Lille. Department of Hematologic Oncology and Blood Disorders, Hôpital Claude Huriez, CHU Lille, F-59000 Lille, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Hivert
authors.affiliation: Univ. Lille. Institute of Hematology, Centre de Biologie Pathologie, CHU Lille, F-59000 Lille, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Grardel
authors.affiliation: Univ. Lille, Institute of Pathology, Centre de Biologie Pathologie, CHU Lille, F-59000 Lille, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Copin
mesh_terms: D000369:Aged, 80 and over; D020031:Epstein-Barr Virus Infections / Q000473:pathology / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000821:virology; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology*; D000072281:Lymphadenopathy / Q000473:pathology / Q000821:virology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000821:virology*; D008297:Male
keywords: Diffuse large B-cell lymphoma; Elderly; Epstein Barr virus; Reactive hyperplasia