[1367] Epstein-Barr Virus Expression in Diffuse Large B-Cell Lymphoma in the Immunocompetent

K Kersch, J Hussong, R Alsabeh. Cedars-Sinai Medical Center, Los Angeles, CA

Background: Diffuse large B-cell lymphoma (DLBCL) has been associated with EBV in the settings of chronic inflammation, HIV, and chronic immunosuppression. An entity of EBV positive DLBCL of the elderly has been described in which there is EBV expression without history of immunosuppression. These cases have been attributed to immunologic senescence allowing for the development of an EBV-driven DLBCL, with the majority of data from Asia. In this study, we look at the frequency of EBV expression in DLBCL in a western immunocompetent population.
Design: 131 cases of DLBCL arising in non-immunosuppressed patients were queried for EBV status using a combination of EBER in-situ hybridization and EBV-LMP immunostain. Patients were classified by age (>50 yrs). Patients with HIV, post-transplant, or with history of immunodeficiency were excluded. Cases were reclassified according to the 2008 WHO DLBCL subtype and as germinal center-like/ non-germinal center-like based on immunohistochemistry. The proliferation rate by Ki-67 was also tabulated.
Results: Majority of patients (103/131) were >50 yrs. 3/131 (2.3%) of the cases show EBV expression and all 3 cases were >50 yrs (age 61-88 yrs). None of the DLBCL cases in patients <50 yrs show EBV expression. None of the EBV positive cases were of East Asian descent. 56.2% of the patients >50 yrs had a germinal center-B-cell like (GCB) immunophenotype, in contrast to 73.7% for those <50 yrs. Proliferation rates were the same amongst the groups.

SubtypesCases overallEBV+
DLBCL, NOS97/1312/131
Unclassifiable, with features intermediate between DLBCL and Burkitt Lymphoma8/1311/131
Unclassifiable, with features intermediate between DLBCL and Classical Hodgkin Lymphoma2/1310/131
Leg type1/1310/131
T-Cell rich1/1310/131

EBV +GC-like/totalEast AsianAve. prolif. rate
Age>503/103 (2.9%)50/89 (56.2%)8/103 (7.7%)75% n=98
Age<500/28 (0%)14/19 (73.7%)1/28 (3.6%)76% n=27

Conclusions: EBV+ DLBCL in the immunocompetent was rare, with an overall rate of 2.9% in the elderly, less than the 4-8% in Japanese studies. All EBV+ cases were over age 60 and according to the new WHO were classified as DLBCL (NOS) in 2 cases and unclassifiable with features intermediate between DLBCL and Burkitt lymphoma in 1 case. A larger percentage of non-GC-like tumors in the elderly was observed. Our study suggests that age 60 may be a more appropriate age to define EBV + DLBCL in the elderly.
Category: Hematopathology

Monday, March 22, 2010 1:00 PM

Poster Session II # 137, Monday Afternoon


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