EB病毒(EBV)感染可能会出现暴发性全身症状,血细胞减少症,和全身性淋巴结病,提高临床怀疑淋巴瘤和提示淋巴结和骨髓活检。在微观层面,急性EBV淋巴结炎病例的组织病理学表现可能与某些淋巴肿瘤相似,创造了一系列的鉴别诊断和诊断陷阱。我们介绍了一例青少年暴发性EBV感染的病例,其临床和影像学检查结果导致淋巴结和骨髓活检以排除淋巴瘤。诊断为急性EBV感染(传染性单核细胞增多症)一周后,一名17岁的白人男性出现症状恶化,包括持续发烧,进步,疼痛的淋巴结病,脾肿大.外周血涂片显示淋巴细胞增多,有许多反应性淋巴细胞,贫血,和血小板减少症.实验室研究显示铁蛋白升高,甘油三酯,和可溶性IL-2/CD25。颈淋巴结活检显示EBV阳性,反应性B免疫母细胞增殖与模仿霍奇金淋巴瘤的Reed-Sternberg细胞的大型非典型淋巴样细胞,除了斑片状血管炎,凝固性坏死,和显著的噬血细胞活性。双侧骨髓活检显示骨髓高细胞,具有相似EBV阳性的斑片状浸润,大型非典型淋巴样细胞,以及突出的噬血细胞活性。诊断为急性EBV相关淋巴增生并发噬血细胞性淋巴组织细胞增生症(HLH)。识别急性EBV感染的常见和罕见临床表现至关重要,特别是当组织病理学发现引起对可能的血淋巴样肿瘤的怀疑时。在EBV淋巴结炎中观察到的淋巴结结构和病毒细胞病变变化均与经典霍奇金淋巴瘤(cHL)和其他几种淋巴瘤表现出明显的形态学重叠。包括间变性大细胞淋巴瘤,弥漫性大B细胞淋巴瘤,血管免疫母细胞性T细胞淋巴瘤.识别EBV淋巴结炎的免疫组织化学染色模式对于避免误诊至关重要。相反,真正的淋巴瘤,特别是cHL,可以伪装成EBV感染。我们提供了EBV淋巴结炎的组织病理学鉴别诊断的简要讨论和表格,包括cHL和其他淋巴瘤。面对淋巴瘤的临床和病理发现时,病理学家应将急性EBV感染纳入鉴别诊断范围。特别是在青少年和年轻人中。
Epstein-Barr virus (EBV) infection may present with fulminant constitutional symptoms, cytopenia(s), and systemic lymphadenopathy, raising clinical suspicion for lymphoma and prompting lymph node and bone marrow biopsies. At the microscopic level, the histopathologic findings in cases of acute EBV lymphadenitis may mimic certain lymphoid neoplasms, creating a range of differential diagnoses and diagnostic pitfalls.We present a case of fulminant EBV infection in an adolescent whose clinical and radiographic findings led to lymph node and bone marrow biopsies to rule out lymphoma. One week after being diagnosed with acute EBV infection (infectious mononucleosis), a 17-year-old Caucasian male presented with worsening symptoms including persistent fever, progressive, painful lymphadenopathy, and splenomegaly. A peripheral blood smear showed lymphocytosis with many reactive lymphocytes, anemia, and thrombocytopenia. Laboratory studies showed elevated ferritin, triglycerides, and soluble IL-2/CD25. A cervical lymph node biopsy demonstrated an EBV-positive, reactive B-immunoblast proliferation with large atypical lymphoid cells mimicking Reed-Sternberg cells of Hodgkin lymphoma, in addition to patchy vasculitis, coagulative necrosis, and prominent hemophagocytic activity. Bilateral bone marrow biopsies showed a hypercellular marrow with patchy infiltrates of similar EBV-positive, large atypical lymphoid cells, as well as prominent hemophagocytic activity. The diagnosis of acute EBV associated lymphoproliferation with concurrent hemophagocytic lymphohistiocytosis (HLH) was rendered.Recognition of common and uncommon clinical presentations of acute EBV infection is essential, particularly when histopathologic findings raise suspicion for a possible hematolymphoid neoplasm. Both the lymph node architectural and viral cytopathic changes observed in EBV lymphadenitis exhibit significant morphologic overlap with classic Hodgkin lymphoma (cHL) and several other lymphomas, including anaplastic large cell lymphoma, diffuse large B cell lymphoma, and angioimmunoblastic T cell lymphoma. Recognition of immunohistochemical staining patterns in EBV lymphadenitis is critical to avoid misdiagnosis. Conversely, bona fide lymphoma, particularly cHL, can masquerade as EBV infection. We provide a concise discussion and tables of the histopathologic differential diagnosis of EBV lymphadenitis, including cHL and other lymphomas. Pathologists should include acute EBV infection within the differential diagnosis when confronted with clinical and pathologic findings concerning for lymphoma, particularly in adolescents and young adults.