Dw. Kingma et al., EPSTEIN-BARR-VIRUS IS INFREQUENTLY IDENTIFIED IN NON-HODGKINS-LYMPHOMAS ASSOCIATED WITH HODGKINS-DISEASE, The American journal of surgical pathology, 18(1), 1994, pp. 48-61
Epstein-Barr virus (EBV) was identified in a subset of cases of Hodgki
n's disease (HD) and in some non-Hodgkin's lymphomas (NHLs), particula
rly those associated with immunodeficiency. Because patients with HD h
ave associated immune system defects, we hypothesized that EBV might b
e involved in NHLs associated with HD. Using fixed paraffin sections a
nd in situ hybridization for EBV EBERI RNA, we studied 12 cases of com
posite NHL + HD, two patients with NHL who simultaneously also had HD
involving a different site (simultaneous HD and NHL), 14 NHLs arising
in patients who previously had HD, and seven NHLs from patients who su
bsequently developed HD. Epstein-Barr virus was identified most freque
ntly in composite NHL + HD. Five (42%) cases of composite NHL + HD con
tained EBV in Reed-Sternberg and Hodgkin cells, four of which also had
EBV-positive NHLs, diffuse mixed or large-cell type, with 10 to more
than 50 EBV-positive cells per x 400 microscopic field. These results
suggest that in this subset of four cases, both the NHL and HD compone
nts may have arisen from the same EBV-infected progenitor cell. We did
not find EBV in two cases of simultaneous NHL and HD or in seven NHLs
preceding development of HD. We identified EBV in only two of 14 NHLs
following HD, one small noncleaved cell lymphoma and one plasmacytoma
, both containing more than 50 EBV-positive cells per x 400 microscopi
c field. These results suggest that EBV plays a minimal role in NHLs a
ssociated with HD, with the exception of composite NHL + HD. Hodgkin's
disease-associated immune defects may be involved in the pathogenesis
of a subset of NHLs following HD, but the exact pathogenesis of most
NHLs associated with HD remains uncertain. Parallels with the high-gra
de Burkitt-like lymphomas associated with human immunodeficiency virus
infection are noted.