EBV-Positive Lymphoproliferative Diseases: A New Concept and Differential Diagnosis (Literature Review and Case Reports)

АM Kovrigina

National Research Center for Hematology, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Professor Alla Mikhailovna Kovrigina, PhD in Biology, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; e-mail: kovrigina.alla@gmail.com

For citation: Kovrigina AM. EBV-Positive Lymphoproliferative Diseases: A New Concept and Differential Diagnosis (Literature Review and Case Reports). Clinical oncohematology. 2018;11(4):326–37.

DOI: 10.21320/2500-2139-2018-11-4-326-337


In recent years increasing attention focuses on the concept of EBV-positive lymphoproliferative diseases related to primary or secondary immunodeficiency resulting from immunosuppressive therapy and persistent infections. Due to the progress of treatment methods in oncohematology and oncology this pathology also occurs as a delayed event when new surgical and therapeutic approaches are applied. The paper presents proof for the pathogenetic significance of Epstein-Barr virus (EBV) in the pathology under consideration with its various clinical manifestations and describes the evolution of knowledge on posttransplant lymphoproliferative disorders with their morphological classification underlying EBV+ lymphoproliferative diseases. The WHO Classification of Tumours of Hematopoietic and Lymphoid Tissues revised in 2017 includes new forms of EBV+ lymphoproliferative diseases (mucocutaneous ulcer, T- and NK-cell childhood lymphoproliferative disorders including cutaneous and systemic forms of chronic active EBV infection) and EBV+ large B-cell lymphomas (unspecified and fibrin-associated diffuse large B-cell lymphomas). The paper summarizes major characteristics of these diseases and exemplifies them by the author’s own experience.

Keywords: B-, T-, NK-cell lymphoproliferative diseases, Epstein-Barr virus (EBV), immunodeficiency, immune imbalance, immunosuppression, morphology, diagnosis.

Received: July 20, 2018

Accepted: September 25, 2018

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  1. Ibrahim HA, Naresh KN. Posttransplant lymphoproliferative disorders. Adv Hematol. 2012;2012:230173. doi: 10.1155/2012/230173.

  2. Swerdlow SH, Campo E, Harris NL, et al. (eds) WHO classification of tumours of haematopoietic and lymphoid tissues. 4th edition. Lyon: IARC Press; 2008.

  3. Swerdlow SH, Campo E, Harris NL, et al. (eds) WHO classification of tumours of haematopoietic and lymphoid tissues. Revised 4th edition. Lyon: IARC Press; 2017.

  4. Gratzinger D, Jaffe ES, Chadburn A. Primary/Congenital Immunodeficiency: 2015 SH/EAHP Workshop Report—Part 5. Am J Clin Pathol. 2017;147(2):204–16. doi: 10.1093/AJCP/AQW215.

  5. Epstein MA, Achong BG, Barr YM. Virus particles in cultured lymphoblasts from Burkitt’s lymphoma. Lancet. 1964;1:702–3.

  6. Гурцевич В.Э. Роль вируса Эпштейна—Барр в онкогематологических заболеваниях человека. Клиническая онкогематология. 2010;3(3):222–32.

    [Gurtsevich VE. Role of Epstein-Barr virus in human hematological malignancies. Klinicheskaya onkogematologiya. 2010;3(3):222–32. (In Russ)]

  7. Tse E, Kwong Y-L. Epstein Barr virus-associated lymphoproliferative diseases: the virus as a therapeutic target. Exp Mol Med. 2015;47(1):e136. doi: 10.1038/emm.2014.102.

  8. Roschewski M, Wilson WH. EBV-associated lymphomas in adults. Best Pract Res Clin Haematol. 2012;25(1):75–89. doi: 10.1016/j.beha.2012.01.005.

  9. Shannon-Lowe C, Rickinson AB, Bell AI. Epstein–Barr virus-associated lymphomas. Philos Trans R Soc Lond B Biol Sci. 2017;372(1732):20160271. doi: 10.1098/rstb.2016.0271.

  10. Natkunam Y, Goodlad JR, Chadburn A, et al. EBV-Positive B-Cell Proliferations of Varied Malignant Potential: 2015 SH/EAHP Workshop Report—Part 1. Am J Clin Pathol. 2017;147(2):129–52. doi: 10.1093/AJCP/AQW214.

  11. Гаврилина О.А., Троицкая В.В., Звонков Е.Е. и др. Лимфопролиферативное EBV-позитивное заболевание с поражением центральной нервной системы, ассоциированное с иммуносупрессией после органной трансплантации: длительная ремиссия без химиотерапевтического лечения. Терапевтический архив. 2017;89(7):69–75. doi: 10.17116/terarkh201789769-75.

    [Gavrilina OA, Troitskaya VV, Zvonkov EE, et al. EBV-positive central nervous system lymphoproliferative disease associated with immunosuppression after organ transplantation: long-term remission without chemotherapy. Terapevticheskii arkhiv. 2017;89(7):69–75. doi: 10.17116/terarkh201789769-75. (In Russ)]

  12. Boyer DF, McKelvie PA, de Leval L, et al. Fibrin-associated EBV-positive large B-cell lymphoma: an indolent neoplasm with features distinct from diffuse large B-cell lymphoma associated with chronic inflammation. Am J Surg Pathol. 2017;41(3):299–312. doi: 10.1097/PAS.0000000000000775.

  13. Cohen M, De Matteo E, Narbaitz M, et al. Epstein-Barr virus presence in pediatric diffuse large B-cell lymphoma reveals a particular association and latency patterns: Analysis of viral role in tumor microenvironment. Int J Cancer. 2013;132(7):1572–80. doi: 10.1002/ijc.27845.

  14. Uccini S, Al-Jadiry MF, Scarpino S, et al. Epstein-Barr virus-positive diffuse large B-cell lymphoma in children: A disease reminiscent of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly. Hum Pathol. 2015;46(5):716–24. doi: 10.1016/j.humpath.2015.01.011.

  15. Nicolae A, Pittaluga S, Abdullah S, et al. EBV-positive large B-cell lymphomas in young patients: A nodal lymphoma with evidence for a tolerogenic immune environment. Blood. 2015;126(7):863–72. doi: 10.1182/blood-2015-02-630632.

  16. Kunitomi A, Hasegawa Y, Asano N, et al. EBV-positive reactive hyperplasia progressed into EBV-positive diffuse large B-cell lymphoma of the elderly over a 6-year period. Intern Med. 2018;57(9):1287–90. doi: 10.2169/internalmedicine.9112-17.

  17. de la Hera Magallanes AI, Montes-Moreno S, Hernandez SG, et al. Early phase of Epstein-Barr virus (EBV)-positive diffuse large B cell lymphoma of the elderly mimicking EBV-positive reactive follicular hyperplasia. Histopathology. 2011;59(3):571–5. doi: 10.1111/j.1365-2559.2011.03950.x.

  18. Roberts TK, Chen X, Liao JJ. Diagnostic and therapeutic challenges of EBV-positive mucocutaneous ulcer: a case report and systematic review of the literature. Exp Hematol Oncol. 2016;5(1):13. doi: 10.1186/s40164-016-0042-5.

  19. Dojcinov SD, Venkataraman G, Raffeld M, et al. EBV positive mucocutaneous ulcer–a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol. 2010;34(3):405–17. doi: 10.1097/PAS.0b013e3181cf8622.

  20. Docinov SD, Venkataraman G, Pittaluga S, et al. Age-related EBV-associated lymphoproliferative disorders in the Western population: a spectrum of reactive lymphoid hyperplasia and lymphoma. Blood. 2011;117(8):4726–35. doi: 10.1182/blood-2010-12-323238.

  21. Gratzinger D, Jong D, Jaffe ES, et al. T- and NK-Cell Lymphomas and Systemic Lymphoproliferative Disorders and the Immunodeficiency Setting: 2015 SH/EAHP Workshop Report—Part 4. Am J Clin Pathol. 2017;147(2):188–203. doi: 10.1093/AJCP/AQW213.