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Peripheral T-cell lymphoma complicated by a proliferation of large B cells
J P Higgins1, M van de Rijn, C D Jones
1Dept of Pathology, Stanford University Medical Center, CA, USA.
Insights
Peripheral T-cell lymphoma cases can contain CD20+ large B cells, sometimes expressing Epstein-Barr virus (EBV). This co-occurrence may lead to misdiagnosis, complicating differential diagnoses in hematopathology.
Area of Science:
- Hematopathology
- Oncology
- Immunology
Background:
- Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of lymphoid neoplasms.
- The presence of B cells within PTCL lesions can complicate diagnosis.
Purpose of the Study:
- To investigate the characteristics of CD20+ large B cells in PTCL cases.
- To determine the association of Epstein-Barr virus (EBV) with these B cells.
- To evaluate the diagnostic implications of these findings.
Main Methods:
- Morphologic assessment of 14 PTCL cases with CD20+ large B cells.
- Immunohistochemistry for CD20, kappa, and lambda light chains.
- In situ hybridization for Epstein-Barr virus encoded RNA (EBER1).
- Polymerase chain reaction (PCR) for T-cell receptor (TCR) and immunoglobulin gene rearrangements.
Main Results:
- CD20+ large B cells were found in 14 PTCL cases, with mixed kappa/lambda light chain expression in most.
- Epstein-Barr virus (EBV) RNA was detected in 10 cases and confirmed within the large B cells.
- Clonal T-cell receptor (TCR) gene rearrangement was present in 12/13 cases, while immunoglobulin gene rearrangement was clonal in 5/13 cases.
Conclusions:
- The co-existence of PTCL and CD20+ large B cells, particularly with EBV, can mimic reactive processes or T-cell-rich B-cell lymphoma.
- Accurate diagnosis requires careful integration of immunophenotypic, genotypic, and virologic findings.
Abstract:
We studied 14 cases that showed a morphologic appearance of peripheral T-cell lymphoma and contained substantial numbers of CD20+ large B cells. In all but 2 cases, the CD20+ large cells showed a mix of kappa and lambda light chain expression. Two cases showed a focal predominance of kappa expression. In situ hybridization using the EBER1 probe for detection of Epstein-Barr virus (EBV) RNA was performed on every case. EBV RNA was present in 10 cases. Of 8 cases with EBV RNA stained by immunohistochemistry for the latent membrane protein of EBV, 6 were positive. Double-labeling immunohistochemistry and in situ hybridization confirmed that EBV was present in the large B cells. Polymerase chain reaction (PCR) analysis showed a clonal rearrangement of the T-cell receptor (TCR)-gamma chain gene in 12 of 13 cases tested. One additional case showed a clonal rearrangement of the TCR-beta chain gene by Southern blot hybridization. PCR analysis showed a clonal immunoglobulin gene rearrangement in 5 cases, a suggestion of a clonal rearrangement in 1, an oligoclonal pattern in 4, and a polyclonal pattern in 4. The finding of large B and T cells may result in a misdiagnosis of a reactive process or of T-cell-rich B-cell lymphoma. The presence of EBV in some cases could cause further confusion with the reactive T- and B-immunoblastic proliferation of infectious mononucleosis.
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