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Atypical hyperplasia of the marginal zone of b follicles in a polymorphic epstein-barr virus-associated lymphoproliferative disorder occurring in an adolescent with human immunodeficiency virus infection

par Dargent, Jean-Louis ;Haller, Annick;Durdurez, Jean Pierre;Gennotte, Anne Françeoise
Référence Pediatric and developmental pathology, 12, 1, page (59-62)
Publication Publié, 2009-01

Article révisé par les pairs

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Résumé :

Epstein-Barr virus (EBV)-associated lymphoid proliferations that are similar to post-transplantation lymphoprolif-erative disorders may occasionally occur in the setting of human immunodeficiency virus (HIV) infection. Herein, we describe such a lesion involving the adenoids in a HIV-seropositive adolescent who acquired immunity against EBV during childhood. On microscopic examination, the marginal zone of B follicles and the interfollicular area were enlarged due to the accumulation of small or intermediate-sized lymphocytes, immunoblasts, epithelioid histiocytes, and plasma cells. A few atypical immunoblasts resembling Reed-Sternberg cells were also present. Most of the cells seen in these expanded regions belonged to the B-cell lineage and displayed a phenotype consistent with that of postgerminal center B cells. No clonal rearrangement of the genes coding for the heavy chain of the immunoglobulin could be demonstrated by polymerase chain reaction analysis. In-situ hybridization studies revealed the presence of EBV early RNA in a significant number of these cells, which suggests the participation of this virus in the pathogenesis of such a B-cell proliferation. The clinical course was benign; no progression or recurrence could be seen more than 24 months after the diagnosis. This atypical lymphoproliferative disorder is probably related to poly-clonal reactivation of a latent EBV infection due to a local or systemic immune imbalance induced by HIV replication. Recognition of this reactive condition is important to prevent overtreatment.