Human Pathology
Volume 41, Issue 3 , Pages 352-357, March 2010

Epstein-Barr virus–positive diffuse large B-cell lymphoma in elderly patients is rare in Western populations

  • Sylvia Hoeller, MD

      Affiliations

    • Institute of Pathology, University Hospital, University of Basel, 4031 Basel, Switzerland
    • ,
  • Alexandar Tzankov, MD

      Affiliations

    • Institute of Pathology, University Hospital, University of Basel, 4031 Basel, Switzerland
    • ,
  • Stefano A. Pileri, MD

      Affiliations

    • Department of Hematology and Oncological Sciences “L. and A. Seràgnoli”, Hematopathology Section, Bologna University School of Medicine, St. Orsola Hospital, 40138 Bologna, Italy
    • ,
  • Philip Went, MD

      Affiliations

    • Institute of Pathology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zürich, Switzerland
    • ,
  • Stephan Dirnhofer, MD

      Affiliations

    • Institute of Pathology, University Hospital, University of Basel, 4031 Basel, Switzerland
    • Corresponding Author InformationCorresponding author.

Received 24 April 2009; received in revised form 17 June 2009; accepted 2 July 2009. published online 16 November 2009.

Summary 

In the currently published World Health Organization-Classification, the new entity of Epstein-Barr virus–positive diffuse large B-cell lymphoma of the elderly was introduced largely based on findings from East-Asian populations. Little is known about its frequency or characteristics in the West, especially in European populations. Using a tissue microarray approach, we identified 8 out of 258 diffuse large B-cell lymphoma cases fulfilling the World Health Organization criteria of an Epstein-Barr virus–positive diffuse large B-cell lymphoma of the elderly, suggesting an incidence of 3.1% in a European population. The median patient age was 65 years. The highest diagnostic sensitivity was only achieved by EBER in situ hybridization. No correlation between Epstein-Barr virus status and outcome was noted except in latency type 3 lymphomas, which had a very poor survival. Sixty-seven percent of Epstein-Barr virus–positive cases showed the presence of necrosis and 50% expressed the activation marker CD30. However, no morphological or immunohistochemical features reliably distinguished all Epstein-Barr virus–positive diffuse large B-cell lymphoma cases. Thus, to identify these Epstein-Barr virus–positive diffuse large B-cell lymphoma in the elderly, EBER in situ hybridization of all de novo diffuse large B-cell lymphoma cases of patients older than 50 years should be considered. In summary, Epstein-Barr virus–positive diffuse large B-cell lymphoma of the elderly is rare in Europeans older than 50 years. It can only be diagnosed by EBER-ISH, and its precise prognostic role is unclear. Whether routine testing of all diffuse large B-cell lymphoma patients older than 50 years can be recommended depends essentially on its clinical relevance. Future studies are needed to address this question.

Keywords: Epstein barr virus, EBV, Diffuse large b-cell lymphoma, EBV-positive diffuse large b-cell lymphoma of the elderly

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PII: S0046-8177(09)00292-5

doi:10.1016/j.humpath.2009.07.024

Human Pathology
Volume 41, Issue 3 , Pages 352-357, March 2010

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