J Pathol Transl Med.  2015 Sep;49(5):409-412. 10.4132/jptm.2015.06.03.

Human Herpesvirus 8-Negative and Epstein-Barr Virus-Positive Effusion-Based Lymphoma in a Patient with Human Immunodeficiency Virus

• Choi JW
• Kim Y
• Lee JH
• Kim YS

• KMID: 2381397
• DOI: http://doi.org/10.4132/jptm.2015.06.03

Abstract

A 39-year-old man infected with human immunodeficiency virus (HIV) was admitted to our hospital because of sudden onset of chest pain. Chest radiography revealed pneumothorax of the right lung. Computed tomographic scans disclosed a 5.8-cm-sized emphysematous bulla in the right middle lobe of the lung. Histologically, the wedge-resected lung showed medium to large atypical cells within the bullous cavity of the Pneumocystis jirovecii pneumonia, without solid mass formation. These atypical cells were confirmed to be large B-cell lymphoma, Epstein-Barr virus-positive and human herpesvirus 8-negative. Therefore, this case was not diagnosed as primary effusion lymphoma, but effusion-based lymphoma arising in an emphysematous cavity of an HIV-infected patient. This type of effusion-based lymphoma has never been reported, and, although rare, it should be noted in order to clinically diagnose this lymphoma.

Keyword

Effusion-based lymphoma; Human herpesvirus 8; Epstein-Barr virus; HIV

MeSH Terms

Adult
Chest Pain
Herpesvirus 4, Human
Herpesvirus 8, Human
HIV*
Humans*
Lung
Lymphoma*
Lymphoma, B-Cell
Lymphoma, Primary Effusion
Pneumocystis jirovecii
Pneumonia
Pneumothorax
Radiography
Thorax

Figure

• 

  Fig. 1. A computed tomographic scan (A) and serial lung sections (B) displaying a 5.8-cm multilocular emphysematous bulla surrounded by pneumonic consolidation in the right middle lobe of the lung. The left lung shows diffuse ground glass opacities, which is consistent with interstitial pneumonia.

• 

  Fig. 2. Lymphoma cells have large eccentric pleomorphic nuclei and basophilic cytoplasm, showing plasmablastic features (A). Proliferating and necrotic tumor cells (arrows) are located in the bullous cavity, representing effusion-based nature (A inset). Tumor cells are positive for CD20 immunohistochemistry (IHC) (B), Epstein-Barr virus (EBV) in situ hybridization (C) and also EBV nuclear antigen-2 IHC (D).

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