Table 1.
Details of five patients with reactive lymphadenopathy containing EBV-positive GCs
+, Positive; −, negative; HPF, high power field.
| Case no. | Sex | Age | Tissue | Diagnosis | Serology | EBER | LMP1/LMP2A IHC |
| 1 | M | 27 | Lymph node | EBV+ classical HL. In retrospect considered as EBV-driven lymphoproliferation. Patient relapsed 4 years later with similar histology and gene expression findings | EBV IgG+ | Reactive lymphoid hyperplasia. EBER+ cells in up to 4 GCs per section (range 2–40+ cells per GC) and EBER+ interfollicular lymphocytes (range 24–63+ cells per High power field (HPF)) | LMP1 and LMP2A expression detected in interfollicular lymphocytes but not in EBER+ GC |
| 2 | M | 49 | Tonsil | Common variable immunodeficiency. EBV+ classical HL 20 years earlier. In retrospect differential diagnosis EBV+ HL or atypical reaction to EBV | EBV IgG+, IgM− | Reactive lymphoid hyperplasia. EBER+ cells in up to 2 GCs per section (range 22–133+ cells per GC). EBER+ cells within and surrounding crypt epithelium. EBER+ interfollicular lymphocytes (range 69–196+ cells per HPF) | LMP1, but not LMP2A, expression detected in interfollicular lymphocytes. EBER+ GC LMP1− and LMP2A- |
| 3 | M | 20 | Lymph node | PET+ enlarged lymph nodes left jaw angle and some smaller PET+ nodes in neck and both axillae. No IM symptoms. Diagnosed as reactive lymphadenopathy | Not known | Reactive lymphoid hyperplasia. EBER+ cells in up to 8 GCs per section (range 7–100+ cells per GC). EBER+ interfollicular lymphocytes (range 0–15+ cells per HPF) | LMP1 and LMP2A expression detected in interfollicular lymphocytes but not in EBER+ GC |
| 4 | F | 23 | Lymph node | EBV+ classical HL 5 years earlier (with some EBER+ GCs). In retrospect doubt about original HL diagnosis; differential diagnosis EBV reactive lymphadenopathy. Further cervical lymph node biopsy 1 year later shows same histology and EBER+ GC | EBV IgG+, IgM− | Reactive lymphoid hyperplasia. EBER+ cells in up to 2 GCs per section (range 16–52+ cells per GC). EBER+ interfollicular lymphocytes (range 0–58+ cells per HPF) | LMP1 and LMP2A undetectable in EBER+ GC and in interfollicular cells. Subsequent cervical lymph node biopsy showed no LMP2A and LMP1 expression in EBER+ GC. In this case interfollicular lymphocytes expressed both LMP1 and LMP2A |
| 5 | M | 32 | Tonsil | HIV+. Enlarged adenoid. Concurrent hairy leukoplakia | EBV IgG+, IgM− | Reactive lymphoid hyperplasia. EBER+ cells in up to 7 GCs per section (range 20–180+ cells per GC). EBER+ interfollicular lymphocytes (range 2–5+ cells per HPF) | LMP1 and LMP2A undetectable in GC and interfollicular cells |