Journal of Hematopathology

, Volume 11, Issue 4, pp 119–125 | Cite as

Synchronous discordant Epstein-Barr virus (EBV)–positive nodal T/NK-cell lymphoma and EBV-positive diffuse large B cell lymphoma in a patient with a history of EBV-positive Burkitt lymphoma

  • Madeleine P. Opsahl
  • Richard D. HammerEmail author
  • Katsiaryna Laziuk
Case Report


In rare cases, patients present with multiple simultaneous lymphomas at one or more anatomic sites. These may be described as composite (occurring at one anatomic site) or discordant (occurring at different anatomic sites). Although the Epstein-Barr virus (EBV) is often implicated in the development of composite lymphoma, its role in the pathogenesis of discordant lymphoma is less clear. We report a case of discordant Epstein-Barr virus–associated lymphoma consisting of nodal T/NK-cell lymphoma and diffuse large B cell lymphoma in a patient with a history of EBV-positive Burkitt lymphoma post treatment. Simultaneous biopsies of the left and right femoral lymph nodes showed a synchronous nodal T/NK-cell lymphoma (left) and diffuse large B cell lymphoma (right). The nodal T/NK-cell lymphoma was morphologically and immunohistochemical distinct from the diffuse large B cell. Both the T/NK-cell component and the B cell component showed bright nuclear positivity with in situ hybridization for EBER. Molecular studies for C-myc were negative. The role played by the Epstein-Barr virus (EBV) in the pathogenesis of discordant T cell and B cell lymphoma is uncertain but may be clinically significant, particularly in the setting of prior EBV-positive lymphoma. Additional testing for immunodeficiency should be considered in these patients.


Epstein-Barr virus T cell lymphoma Diffuse large B cell lymphoma Burkitt lymphoma 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Kendric K, Goyal G, Caponetti G (2016) Synchronous Hodgkin lymphoma and diffuse large B cell lymphoma: a rare coexistence [abstract]. J Hosp Med 11(suppl 1)Google Scholar
  2. 2.
    Zhang C, Yuanxue Y, Chen C, Wang J, Liu Z (2015) Discordant lymphoma consisting of mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes: a case report. Diagn Pathol 10:215CrossRefGoogle Scholar
  3. 3.
    Kuppers R, Duhrsen U, Hansmann ML (2014) Pathogenesis, diagnosis, and treatment of composite lymphomas. Lancet Oncol 15:e435–e446CrossRefGoogle Scholar
  4. 4.
    Wang E, Papavassilou P, Wang AR, Louissaint A, Wang J, Hutchinson CB et al (2014) Composite lymphoid neoplasm of B-cell and T-cell origins: a pathologic study of 14 cases. Hum Pathol 45(4):768–784CrossRefGoogle Scholar
  5. 5.
    Hirose Y, Fukushima T, Masaki Y, Shimoyama K, Karasawa H, Ogawa N, Wano Y (2004) Epstein-Barr virus-associated composite lymphoma composed of peripheral T-cell lymphoma and an anaplastic variant of a diffuse large B-cell type of non-Hodgkin’s lymphoma and strongly expressing p53 protein. Int J Hematol 79:260–265CrossRefGoogle Scholar
  6. 6.
    Xu Y, McKenna RW, Hoang MP, Collins RH, Kroft SH (2002) Composite angioimmunoblastic T-cell lymphoma and diffuse large B-cell lymphoma: a case report and review of the literature. Am J Clin Pathol 118:848–854CrossRefGoogle Scholar
  7. 7.
    Suefuji N, Niino D, Arakawa F, Karube K, Kimura Y, Kiyasu J, Takeuchi M, Miyoshi H, Yoshida M, Ichikawa A, Sugita Y, Ohshima K (2012) Clinicopathologic analysis of a composite lymphoma containing both T- and B-cell lymphomas. Pathol Int 62(10):690–698CrossRefGoogle Scholar
  8. 8.
    Zettl A, Lee SS, Rudiger T, Starostik P, Marino M, Kirchner T et al (2002) Epstein-Barr virus associated B-cell lymphoproliferative disorders in angioimmunoblastic T-cell lymphoma and peripheral T-cell lymphoma, unspecified. Am J Clin Pathol 117:368–379CrossRefGoogle Scholar
  9. 9.
    Reed D, Middlemass E, Gertsen E, Lamb MR, Discordant B (2013) T-cell non-Hodgkin’s lymphoma: a case report and review of literature. Tenn Med 106:35–37PubMedGoogle Scholar
  10. 10.
    Ng SB, Chung TH, Kato S, Nakamura S, Takahashi E, Ko YH (2018) Epstein-Barr virus-associated primary nodal T/NK-cell lymphoma shows a distinct molecular signature and copy number changes. Haematologica 103:278–287CrossRefGoogle Scholar
  11. 11.
    Kim H, Dorfman RF (1974) Morphologic studies of 84 untreated patients subjected to laparotomy for the staging of non-Hodgkin’s lymphomas. Cancer 33:657–674CrossRefGoogle Scholar
  12. 12.
    Brown JR, Weng AP, Freedman AS (2004) Hodgkin disease associated with T-cell non-Hodgkin lymphomas: case reports and review of the literature. Am J Clin Pathol 121:701–708CrossRefGoogle Scholar
  13. 13.
    Park J, Lee JE, Kim M, Lim J, Kim Y, Han K, Park G, Jung YH, Roh SY, Hong YS (2013) Discordant lymphocyte-depleted classical Hodgkin’s and peripheral T-cell lymphoma arising in a patient 11 years after diagnosis of multicentric Castleman’s disease. Int J Hematol 98:114–121CrossRefGoogle Scholar
  14. 14.
    Adu-Poku K, Thomas DW, Khan MK, Holgate CS, Smith ME (2005) Langerhans cell histiocytosis in sequential discordant lymphomas. J Clin Pathol 58:104–106CrossRefGoogle Scholar
  15. 15.
    Oka K, Nagayama R, Iijima S, Yonekawa N, Hirosawa K, Yatabe Y, Mori N (2011) Epstein-Barr virus-associated lymphoproliferative disorder presenting with classical Hodgkin lymphoma and developing as peripheral T-cell lymphoma 9 years later: a case report of composite lymphoma. Pathol Int 61:752–755CrossRefGoogle Scholar
  16. 16.
    Goteri G, Rupoli S, Stramazzotti D, DIscepoli G, Scortechini AR, Giacchetti A et al (2007) Coexistence of two discordant B-cell lymphomas in the skin and lymph node: report of a case with primary cutaneous follicle-center lymphoma and nodal mantle-cell lymphoma. Br J Dermatol 157:629–631CrossRefGoogle Scholar
  17. 17.
    Nakamura N, Oshima K, Abe M, Osamura Y (2007) Demonstration of chimeric DNA of bcl-2 and immunoglobulin heavy chain in follicular lymphoma and subsequent Hodgkin lymphoma from the same patient. J Clin Exp Hematop 47(1):9–13CrossRefGoogle Scholar
  18. 18.
    Brudno J, Tadmor T, Pittaluga S, Nicolae A, Polliack A, Dunleavy K (2016) Discordant bone marrow involvement in non-Hodgkin lymphoma. Blood 127(8):965–970CrossRefGoogle Scholar
  19. 19.
    Shannon-Lowe C, Rickinson A, Bell A (2017) Epstein-Barr virus-associated lymphomas. Philos Trans R Soc Lond Ser B Biol Sci 372(1732):20160271CrossRefGoogle Scholar
  20. 20.
    Vockerodt M, Yap LF, Shannon-Lowe C, Curley H, Wei W, Vrzalikova K, Murray P (2015) The Epstein-Barr virus and the pathogenesis of lymphoma. J Pathol 235:312–322CrossRefGoogle Scholar
  21. 21.
    Gru AA, Haverkos BH, Freud AG, Hastings J, Nowacki NB, Barrionuevo C, Vigil CE, Rochford R, Natkunam Y, Baiocchi RA, Porcu P (2015) The Epstein-Barr virus (EBV) in T cell and NK cell lymphomas: time for a reassessment. Curr Hematol Malig Rep 10(4):456–467CrossRefGoogle Scholar
  22. 22.
    Thirumala S, Esposito M, Fuchs A (2000) An unusual variant of composite lymphoma. Arch Pathol Lab Medi 124(9):1376–1378Google Scholar
  23. 23.
    Swerdlow SH, Campo E, Harris NL (2017) WHO classification of tumors of hematopoietic and lymphoid tissues. IARCH Press, Lyon, pp 444–464Google Scholar
  24. 24.
    Kamel OW, van de Rijn M, Weiss LM, del Zoppo GJ, Hench PK, Robbins BA, Montgomery PG, Warnke RA, Dorfman RF (1993) Brief report: reversible lymphomas associated with Epstein-Barr virus occurring during methotrexate therapy for rheumatoid arthritis and dermatomyositis. N Engl J Med 328:1317–1321CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Madeleine P. Opsahl
    • 1
  • Richard D. Hammer
    • 1
    Email author
  • Katsiaryna Laziuk
    • 1
  1. 1.Department of Pathology and Anatomical SciencesUniversity of MissouriColumbiaUSA

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