1. Expanding the Spectrum of EBV-positive Marginal Zone Lymphomas: A Lesion Associated With Diverse Immunodeficiency Settings.
- Author
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Gong S, Crane GM, McCall CM, Xiao W, Ganapathi KA, Cuka N, Davies-Hill T, Xi L, Raffeld M, Pittaluga S, Duffield AS, and Jaffe ES
- Subjects
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Antiviral Agents therapeutic use, Biomarkers, Tumor genetics, Cell Transformation, Viral, DNA, Viral genetics, Epstein-Barr Virus Infections drug therapy, Female, Gene Rearrangement, Genes, Immunoglobulin Light Chain, Herpesvirus 4, Human drug effects, Herpesvirus 4, Human genetics, Humans, Immunoglobulin G genetics, Immunoglobulin G immunology, Immunoglobulin M genetics, Immunoglobulin M immunology, Immunologic Deficiency Syndromes immunology, Immunosuppressive Agents adverse effects, Lymphoma, B-Cell, Marginal Zone drug therapy, Lymphoma, B-Cell, Marginal Zone genetics, Male, Maryland, Middle Aged, Mutation, Myeloid Differentiation Factor 88 genetics, Prognosis, Risk Factors, Epstein-Barr Virus Infections immunology, Epstein-Barr Virus Infections virology, Herpesvirus 4, Human immunology, Immunocompromised Host, Lymphoma, B-Cell, Marginal Zone immunology, Lymphoma, B-Cell, Marginal Zone virology
- Abstract
Traditionally low-grade B-cell lymphomas have been excluded from the category of monomorphic posttransplant lymphoproliferative disorders. However, recent reports identified Epstein-Barr virus-positive (EBV) extranodal marginal zone lymphomas (MZL), almost exclusively seen in the posttransplant setting. Some reported cases responded to reduced immunosuppression, suggesting that they should be considered as a form of posttransplant lymphoproliferative disorders. We identified 10 cases of EBV MZL, 9 in extranodal sites and 1 presenting in lymph node. Two cases arose following solid organ transplantation, but other settings included iatrogenic immunosuppression for rheumatoid arthritis (2); prior chemotherapy (2); congenital immune deficiency (1); and increased age (3), as the only potential cause of immune dysfunction. There were 4 males and 6 females; age range 18 to 86. The atypical plasmacytoid and/or monocytoid B cells were positive for EBV in all cases, with either latency I or II in all cases tested. Monotypic light chain expression was shown in all with 6 cases positive for IgG, and 2 for IgM, undetermined in 2. Clonal immunoglobulin gene rearrangement was positive in all cases with successful amplification. MYD88 L265P was wild type in the 6 cases tested. We show that EBV MZLs can arise in a variety of clinical settings, and are most often extranodal. Treatment varied, but most patients had clinically indolent disease with response to reduction of immune suppression, or immunochemotherapy.
- Published
- 2018
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