Infectious Mononucleosis and Other Epstein-Barr Virus–Associated Diseases: Part 2

Published on 04/03/2015 by admin

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Chapter 22 Infectious Mononucleosis and Other Epstein-Barr Virus–Associated Diseases

Part 2

Carl Allen, Cliona M. Rooney, Stephen Gottschalk

Figure 22-1 EBV-LATENT GENE EXPRESSION AND IMMUNOGENICITY OF COMMON EBV-ASSOCIATED MALIGNANCIES.

EBNA, Epstein-Barr nuclear antigen; LP, leader protein. For an explanation of symbols, see Fig. 21-1. *Not all lymphomas are latency type III.

EBV-Associated Malignancies

Malignancy	EBV Frequency
Hodgkin disease	≈40%
Non-Hodgkin lymphomas
Burkitt lymphoma	20%-95%
Diffuse large B-cell lymphoma and CD30⁺ Ki-1⁺ anaplastic large cell lymphoma	10%-35%
Lymphomatoid granulomatosis	80%-95%
T-cell-rich B-cell lymphoma	20%
Angioimmunoblastic lymphoma	>80%
T-cell, NK cell, and T/NK-cell lymphomas	30%-90%
Nasopharyngeal carcinoma	>95%
Gastric adenocarcinoma	5%-10%
Pyothorax-associated lymphoma	>95%
Leiomyosarcoma in immunocompromised patients	>95%

Figure 22-2 EXAMPLES OF EBV-POSITIVE LYMPHOID MALIGNANCIES.

Posttransplant lymphoproliferative disorder, Hodgkin lymphoma, and large B-cell lymphoma. PTLD in the duodenum of a 15-month-old (A) with history of liver transplant. The PTLD was classified as a polymorphic type and was EBV-positive (B). Hodgkin lymphoma (C) and EBV-positive Reed-Sternberg cells (D). Large B-cell lymphoma (plasmablastic type) in an HIV-positive patient (E), diffusely EBV-positive (F). Note, all EBV studies are in situ hybridizations for EBV mRNA, EBER.

Figure 22-3 FURTHER EXAMPLES OF EBV-POSITIVE MALIGNANCIES.

Burkitt lymphoma and nasopharyngeal carcinoma (A to E). Low power of Burkitt lymphoma showing the classic “starry sky” appearance (A) and higher power illustrating the highly proliferative lymphoma cells (B), which are uniformly EBV⁺ (C). Nasopharyngeal carcinoma (D) with EBV-positive cells (E) demonstrated by in situ hybridization for EBV mRNA.

Figure 22-4 RECOMMENDED ALGORITHM FOR FOLLOWING PATIENTS WITH INCREASED EBV-DNA LOAD.

HSCT, Hematopoietic stem cell transplant; RI, reduction of immunosuppression; SOT, solid organ transplant.

Figure 22-5 TREATMENT STRATEGIES FOR EPSTEIN-BARR VIRUS–ASSOCIATED LYMPHOPROLIFERATIVE DISEASES (EBV-LPD).

For an explanation of symbols, see Fig. 21-1.

Hematology Diagnosis and Treatment