Synchronous follicular lymphoma, kaposi sarcoma, and castleman's disease in a HIV-negative patient with EBV and HHV-8 coinfection.

Abstract

The authors describe the case of a 65-year-old woman who was HIV negative and had a lymph node biopsy that showed concurrent follicular lymphoma (FL; grade 3A), Kaposi sarcoma (KS), and Castleman's disease (CD) with coinfection by human herpes virus-8 (HHV-8) and Epstein-Barr virus (EBV). The lymphoma was positive for CD20, CD10, and BCL6 and negative for BCL2. Flow cytometry showed a clonal lambda B-cell population, and polymerase chain reaction (PCR) showed a clonal immunoglobulin heavy chain gene rearrangement, confirming a neoplastic B-cell process. Focally, the FL component showed numerous EBER1-positive cells, with rare HHV-8-positive cells. The KS component showed strong HHV-8 expression with rare EBER1-positive cells. The CD component showed scattered HHV-8, viral interleukin-6, and EBER1-positive cells. The simultaneous occurrence of a FL, KS, and CD in an HIV-negative patient expands the spectrum of HHV-8-positive neoplasms and suggests the possibility of HHV-8 rendering mature B-cells hyperresponsive to antigenic stimulation, providing an expanded target for second site mutations or cytokine-driven hyperplasia, culminating in lymphoma.

• Authors: Aashiyana F Koreishi, Adam J Saenz, Maria E Arcila, Cyrus Hedvat, Stephen Fleming, Julie Teruya-Feldstein
• Journal: International journal of surgical pathology (Int J Surg Pathol) Vol. 19 Issue 5 Pg. 685-91 (Oct 2011) ISSN: 1940-2465 [Electronic] United States
• PMID: 19661098 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Castleman Disease (complications, pathology, virology)
• Coinfection (pathology)
• Diabetes Mellitus, Type 2 (complications)
• Epstein-Barr Virus Infections (complications)
• Female
• Flow Cytometry
• Gastritis (complications)
• Herpesvirus 8, Human
• Humans
• Lymphoma, Follicular (pathology, virology)
• Neoplasms, Multiple Primary (pathology, virology)
• Pancreatitis (complications)
• Polymerase Chain Reaction
• Sarcoma, Kaposi (pathology, virology)