Disseminated persistent lymphoid hyperplasia containing Epstein-Barr virus and clonal rearrangements of DNA

We describe the pathologic, molecular, and clinical features of a 52-year-old man who had a 7-year history of widely disseminated, persistent lymphoid hyperplasia. Exuberant follicular and interfollicular lymphoid hyperplasia with some histologic features of Castleman's disease were present at various times in the submental and cervical lymph nodes, lacrimal and parotid glands, right and left orbits, mediastinum, and hard palate of this patient. Flow cytometric and immunoperoxidase studies of two of the specimens indicated a slight predominance of cells expressing lambda-immunoglobulin light chain. In one specimen, there were clonal rearrangement of DNA coding for immunoglobulin heavy chain and for the T-cell beta-receptor. When DNA from this specimen was also examined by the polymerase chain reaction technique, Epstein-Barr viral DNA was detected. This case suggests that Epstein-Barr virus may be associated with an unusual form of aggressive and persistent lymphoid hyperplasia that contains clonal rearrangements of DNA.