Epstein-Barr virus-infected cells in IgG4-related lymphadenopathy with comparison with extranodal IgG4-related disease.

Abstract

IgG4-related lymphadenopathy with increased numbers of Epstein-Barr virus (EBV)-infected cells has been reported but not fully described. We analyzed 31 cases of IgG4-related lymphadenopathy and 24 cases of extranodal IgG4-related diseases for their possible relationship with EBV. Other types of reactive lymph nodes (22) and angioimmunoblastic T-cell lymphoma (AITL) (10) were also studied for comparison. EBV-encoded RNA (EBER) in situ hybridization revealed EBER(+) cells in 18 of 31 cases (58%) of IgG4-related lymphadenopathy. Increased EBER(+) cells were found in only 4 of 22 (18.1%) non-IgG4-related reactive lymphoid hyperplasia in patients of a similar age (P=0.002) and in only 5 of 24 (21%) extranodal IgG4-related biopsies (P=0.006). Interestingly, all patients with EBER(+) progressively transformed germinal center-type IgG4-related lymphadenopathy had systemic lymphadenopathy and/or extranodal involvement. AITL also is associated with EBV, and IgG4-related lymphadenopathy sometimes mimics the morphology of AITL; however, the number of IgG4(+) cells in AITL was significantly less than that in IgG4-related lymphadenopathy (P<0.001). Increased numbers of regulatory T cells are seen in IgG4-related disease; however, there was not a significant difference between the EBER(+) and EBER(-) cases. In conclusion, the presence of increased numbers of EBV-infected cells in IgG4-related lymphadenopathy, compared with other reactive lymphadenopathy or extranodal IgG4-related disease, suggests that there may be a relationship at least between nodal IgG4-related disease and EBV. It is important to avoid overdiagnosing these cases as malignant lymphomas or EBV-related lymphoproliferative disorders.

• Authors: Mai Takeuchi, Yasuharu Sato, Hiroshi Yasui, Hiroaki Ozawa, Kyotaro Ohno, Katsuyoshi Takata, Yuka Gion, Yorihisa Orita, Tomoyasu Tachibana, Tomoo Itoh, Naoko Asano, Shigeo Nakamura, Steven H Swerdlow, Tadashi Yoshino
• Journal: The American journal of surgical pathology (Am J Surg Pathol) Vol. 38 Issue 7 Pg. 946-55 (Jul 2014) ISSN: 1532-0979 [Electronic] United States
• PMID: 24705309 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunoglobulin G
• RNA, Viral

Topics

• Adult
• Aged
• Aged, 80 and over
• Biopsy
• Epstein-Barr Virus Infections (immunology, pathology, virology)
• Female
• Herpesvirus 4, Human (genetics, isolation & purification)
• Humans
• Immunoglobulin G (analysis)
• Immunohistochemistry
• In Situ Hybridization, Fluorescence
• Lymph Nodes (immunology, pathology, virology)
• Lymphatic Diseases (immunology, pathology, virology)
• Lymphoma, T-Cell (immunology, pathology, virology)
• Male
• Middle Aged
• RNA, Viral (isolation & purification)
• T-Lymphocytes, Regulatory (immunology, virology)