Splenic Epstein-Barr Virus-Associated Inflammatory Pseudotumor.

Area of Science:

• Pathology
• Oncology
• Virology

Background:

• Splenic inflammatory pseudotumor (IPT) presents diagnostic challenges due to its varied etiology (infectious, autoimmune, reactive, neoplastic).
• Epstein-Barr virus (EBV)-associated IPTs are a specific subset characterized by EBV-infected spindle cells.
• IPT-like follicular dendritic cell tumor is the most common EBV-associated splenic IPT subtype.

Purpose of the Study:

• To review the epidemiology, clinical features, and pathogenesis of EBV-associated splenic IPTs.
• To highlight diagnostic challenges, especially for EBV-associated IPTs lacking follicular dendritic cell markers.
• To discuss the role of immunoglobulin G4 (IgG4)-positive plasma cells and granulomas in complicating diagnosis.

Main Methods:

• Review of existing literature on splenic inflammatory pseudotumors and EBV association.
• Analysis of histomorphology, immunohistochemistry, and electron microscopy findings.
• Discussion of pathogenesis and differential diagnosis of EBV-associated splenic lesions.

Main Results:

• EBV-associated splenic IPTs encompass lesions with and without follicular dendritic cell markers.
• Lesions lacking follicular dendritic cell markers are less characterized, increasing diagnostic difficulty.
• Increased IgG4-positive plasma cells and granulomas in some EBV-associated IPTs can mimic other conditions.

Conclusions:

• Accurate diagnosis of EBV-associated splenic IPTs requires careful integration of clinical, histologic, and immunohistochemical data.
• Understanding the spectrum of EBV-associated splenic IPTs, including rarer forms, is crucial for appropriate patient management.
• Further research is needed to fully elucidate the pathogenesis and refine diagnostic criteria for these challenging splenic lesions.