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Epstein‐Barr virus (EBV)‐positive diffuse large B‐cell lymphoma arising in patient with a history of EBV‐positive mucocutaneous ulcer and EBV‐positive nodal polymorphous B‐lymphoproliferative disorder
Author(s) -
Daroontum Teerada,
Kohno Kei,
Inaguma Yoko,
Okamoto Akinao,
Okamoto Masataka,
Kimura Yoshihiro,
Nagahama Masato,
Sakakibara Ayako,
Satou Akira,
Nakamura Shigeo
Publication year - 2019
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/pin.12738
Subject(s) - mucocutaneous zone , medicine , lymphoma , lymph node , epstein–barr virus , virus , lymphoproliferative disorders , immunosenescence , diffuse large b cell lymphoma , rituximab , b cell , jc virus , immunology , pathology , antibody , immune system , disease , progressive multifocal leukoencephalopathy
Elderly patients with Epstein‐Barr virus (EBV) infection are at increased risk for developing B‐cell lymphoproliferative disorder (B‐LPD) due to immunosenescence. Here, we describe a case of a 75‐year‐old man who developed an EBV‐positive (EBV+) mucocutaneous ulcer (EBVMCU) in the gingiva with spontaneous regression. Eighteen months after regression, he had a cervical lymph node enlargement that was diagnosed as EBV+ nodal polymorphous B‐LPD, Ann Arbor stage IA. Clinicians decided to observe his clinical course without any treatment. Fourteen months later, the patient developed EBV‐positive diffuse large B‐cell lymphoma (DLBCL), Ann Arbor stage IIA, and received six courses of age‐adjusted dose chemotherapy and achieved a complete remission. No evidence of a clonal relationship was found among these three lesions by standard polymerase chain reaction (PCR) analysis for immunoglobulin heavy chain. However, they all had expression of PD‐L1 in the EBV+ large B‐cells and Hodgkin Reed‐Sternberg‐like cells. This is the first case report of a PD‐L1‐positive (PD‐L1+) EBVMCU and the development of multiple EBV‐driven B‐LPDs in the setting of immunosenescence within a 32‐month period.