Abstract
The cytomorphological spectrum of extranodal NK/T cell lymphoma (ENKL), nasal type (nasal ENKL), is very broad. In some cases, the morphological findings are so subtle that the possibility of nasal ENKL is easily overlooked. The present study was undertaken to find overlooked or indolent cases of nasal ENKL in the nasal mucosa or nasopharynx of patients who underwent surgical resection of lesions in the nasal cavity because of nasal obstruction or a nasal polyp. We retrospectively reviewed H & E slides of 1,176 patients and selected 40 cases with predominantly small lymphoid infiltrations admixed with other inflammatory cells, presenting a diagnostic challenge and thus requiring further studies. By Epstein–Barr virus (EBV) in situ hybridization performed on 40 selected cases, we identified three cases (7.5 %) with EBV + lymphoid cells (EPLs). All three were pediatric patients. The number of EPL in each lesion ranged from 4 to more than 200 per high power field. By double immunohistochemistry, EPLs were identified as B lymphocytes in two of these cases. We added a recently encountered case in an adult man in which EPLs were T lymphocytes. The presence of EPLs in the nasal or nasopharyngeal mucosa should not be interpreted as ENKL especially in pediatric patients, because de novo nasal ENKL is very rare in childhood and EPLs are mainly B lymphocytes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Steven H, Swerdlow EC, Harris NL, Jaffe ES, Pireli SA, Stein H, Thiele J, Vardiman JW (2008) WHO classification of Tumours of haematopoietic and lymphoid tissues. World Health Organization classification of tumours. International Agency for Research on Cancer (IARC), Lyon
Watanabe K, Hanamura A, Mori N (2010) A unique case of nasal NK/T cell lymphoma with frequent remission and relapse showing different histological features during 12 years of follow up. J Clin Exp Hematopathol 50(1):65–69
Hasserjian RP, Harris NL (2007) NK-cell lymphomas and leukemias: a spectrum of tumors with variable manifestations and immunophenotype. Am J Clin Pathol 127(6):860–868. doi:10.1309/2f39nx1al3l54wu8
Ho FC, Choy D, Loke SL, Kung IT, Fu KH, Liang R, Todd D, Khoo RK (1990) Polymorphic reticulosis and conventional lymphomas of the nose and upper aerodigestive tract: a clinicopathologic study of 70 cases, and immunophenotypic studies of 16 cases. Hum Pathol 21(10):1041–1050
Tao Q, Srivastava G, Dickens P, Ho FC (1996) Detection of Epstein–Barr virus-infected mucosal lymphocytes in nasal polyps. Am J Pathol 149(4):1111–1118
Kozak FK, Mahony JB, Chernesky MA, Newhouse MT, Dolovich J, Hitch DA, Rossman CM (1991) Nasal polyposis: in search of a viral etiology using DNA hybridization. J Otolaryngol 20(6):404–407
Anagnostopoulos I, Hummel M, Kreschel C, Stein H (1995) Morphology, immunophenotype, and distribution of latently and/or productively Epstein–Barr virus-infected cells in acute infectious mononucleosis: implications for the interindividual infection route of Epstein–Barr virus. Blood 85(3):744–750
Tao Q, Srivastava G, Chan AC, Chung LP, Loke SL, Ho FC (1995) Evidence for lytic infection by Epstein-Barr virus in mucosal lymphocytes instead of nasopharyngeal epithelial cells in normal individuals. J Med Virol 45(1):71–77
Tao Q, Srivastava G, Chan AC, Ho FC (1995) Epstein–Barr-virus-infected nasopharyngeal intraepithelial lymphocytes. Lancet 345(8960):1309–1310
Niedobitek G, Herbst H, Young LS, Brooks L, Masucci MG, Crocker J, Rickinson AB, Stein H (1992) Patterns of Epstein–Barr virus infection in non-neoplastic lymphoid tissue. Blood 79(10):2520–2526
Tonoyama Y, Teramoto N, Sarker AB, Yoshino T, Hayashi K, Takahashi K, Akagi T (1996) Detection of Epstein–Barr virus RNA and related antigens in non-neoplastic lymphoid lesions. Acta Medica Okayama 50(2):89–96
Kimura H (2006) Pathogenesis of chronic active Epstein–Barr virus infection: is this an infectious disease, lymphoproliferative disorder, or immunodeficiency? Rev Med Virol 16(4):251–261. doi:10.1002/rmv.505
Ohshima K, Kimura H, Yoshino T, Kim CW, Ko YH, Lee SS, Peh SC, Chan JK (2008) Proposed categorization of pathological states of EBV-associated T/natural killer-cell lymphoproliferative disorder (LPD) in children and young adults: overlap with chronic active EBV infection and infantile fulminant EBV T-LPD. Pathol Int 58(4):209–217. doi:10.1111/j.1440-1827.2008.02213.x
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
SeungYeon Ha and Jungsuk An contributed equally and should be regarded as co-first authors.
Rights and permissions
About this article
Cite this article
Ha, S.Y., An, J. & Park, S. Detection of Epstein–Barr virus-infected lymphoid cells in nasal mucosa or nasopharynx: appearances can be deceptive. Virchows Arch 462, 391–397 (2013). https://doi.org/10.1007/s00428-013-1396-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-013-1396-2