Andrea Rodrigues Cordovil Pires
Fonte Medicina Diagnostica, Brazil
Title: EBV+ diffuse large B-cell lymphoma (of the elderly) - Chromogenic in situ hybridization and immunohistochemistry using tissue microarray
Biography
Biography: Andrea Rodrigues Cordovil Pires
Abstract
EBV positive diffuse Large B-cell lymphomas (DLBCL) are clonal proliferation of EBV+ B-cells occurring in patients who have no prior history of immunodeficiency or lymphoma. Its prevalence is 8-11% among DLBCL in Japan and Mexico and less than 5% in western countries, incidence increasing with aging. A tissue microarray (TMA) with 80 cases of DLBCLs, was submitted to EBV in situ hybridization (CISH) and immunohistochemistry for molecular classification (types germinal center B cells - GCB X activated - ABC). Of the 80 cases analyzed, 3 were CISH EBV+ (3.75%). All 3 patients had more than 50 years, and two were men (stomach and bone marrow) and a woman (mediastinum). Molecular classification according to Hans´ algorithm showed the following types: ABC = 1, GCB = 1 and 1 was not rated. EBV+ DLBCL is characterized by the activation of the classical and alternative pathways of NF-kB, most cases showing ABC pattern, prevalence in patients over 50 years and predominance of extra-nodal location. These characteristics were observed in the present series. Despite all positive cases in this TMA correspond to patients over 50 years, the arbitrary cut-off point and the growing number of cases in younger patients justify the tendency towards the abolition of the term “of the elderly” in the next WHO classification review. In conclusion, recognition of EBV+ DLBCL, regardless of age, is important because new therapeutic approaches targeting EBV and the NFkB pathway can be used in these patients, which has worst prognosis.