Table 2 Comparison of high-power microscopic findings and ancillary testing in EBV lymphadenitis versus selected lymphomas
Active EBV Lymphadenitis | cHL | ALCL | DLBCL Non-GCB Subtype | AITL | |
|---|---|---|---|---|---|
Large Atypical Cells | Viral cytopathic effects, polymorphic lymphoid cells, immunoblasts, R-S-like cells | R-S cells | Small, medium, and large anaplastic cells, hallmark cells, occasional doughnut cells, R-S-like cells | Large atypical lymphoid cells, immunoblasts, centroblasts, R-S-like cells | Small to intermediate cells with clear cytoplasm and minimal atypia, immunoblasts, R-S-like cells |
Positive: CD30, CD20, MUM1, OCT-2, BOB.1 | Positive: CD30, ± CD15, PAX5 (weak), -/ + CD20, MUM1 | Positive: CD30, ± ALK-1, EMA, CD2, CD3, CD4, and/or CD5 | Positive: CD30, CD20, MUM1 | Reactive Immunoblasts: Positive for CD30, CD20 | |
Negative: CD15 | Negative: CD45, OCT2, BOB.1 | Negative: CD15 | Negative: CD10, BCL6 | Negative: CD15 | |
Small Background Cells | T-cells (CD8 + predominant); No significant eosinophils | T-cells (CD4 + predominant) Eosinophils, plasma cells, histiocytes | Lymphocytes, histiocytes; No eosinophils | Lymphocytes, plasma cells, histiocytes | Eosinophils, lymphocytes, plasma cells, histiocytes |
EBER-ISH | Positive (large cells and small cells) | ± Positive (+ mostly in large cells) | Negative (always) | ± Positive (often + in immune deficiency related subtypes) | Positive in background B-immunoblasts, negative in neoplastic T-cells |
EBV Serology (IgM) | Positive | Negative | Negative | Negative | Negative |
EBV PCR (peripheral blood) | Positive (high viral load) | Positive (low viral load) or Negative | Negative | Positive/ Negative | Positive/ Negative |