Pediatric oral Epstein-Barr virus associated self-remitting CD30+ lymphoproliferative disorder: A distinct entity |
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| Institution: | 1. Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA;2. SUNY Downstate College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, USA;3. NYU Langone Hospital - Brooklyn, 110 55th Street, Brooklyn, NY 11220, USA;1. Pathology Department, Istanbul Medeniyet University Goztepe Training and Research Hospital, Dr. Erkin Caddesi, Göztepe Egt. Ve Aras. Hastanesi Patoloji Laboratuar?, 34720 Kad?köy, Istanbul, Turkey;2. Istanbul Medeniyet University School of Medicine, Dr. Erkin Caddesi. Göztepe Egt. Ve Aras. Hastanesi Patoloji Laboratuar?, 34720 Kad?köy, Istanbul, Turkey;3. Pathology Department, Umraniye Training and Research Hospital, Elmal?kent Mahallesi, Adem Yavuz Cad. No:1, 34764 Ümraniye, ?stanbul, Turkey;4. Urology Department, Istanbul Medeniyet University Goztepe Training and Research Hospital, Dr. Erkin Caddesi, Göztepe Egt. Ve Aras. Hastanesi Uroloji Klinigi, 34720 Kad?köy, Istanbul, Turkey;1. Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA;2. SUNY Downstate College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, USA;3. Adult & Pediatric Dermatology PC, 526 Main Street Suite 302, Acton, MA 01720, USA;4. Massachusetts Academy of Dermatology, PO Box 549154, Waltham, MA 02454, USA;5. NewYork-Presbyterian/Queens, 56-45 Main St, Flushing, NY 11355, USA;6. Weill Cornell Medicine, 525 East 68th Street, Baker 21, New York, NY 10065, USA;1. Resident, Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia;2. Assistant Professor, Division of Allergy and Clinical Immunology, School of Medicine, Johns Hopkins University, Baltimore, MD;3. Associate Professor, Department of Hematology/Oncology, School of Medicine, University of Pennsylvania, Philadelphia, PA;4. Professor of Pathology, Department of Basic & Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA;5. Professor of Oral Medicine, Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA |
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| Abstract: | Epstein-Barr virus (EBV) has a well-known association with lymphoproliferative disorders of B and T cell origin. EBV-related B cell lymphoproliferative disorders include Hodgkin and Burkitt lymphomas, lymphomatoid granulomatosis, EBV positive diffuse large cell B cell lymphoma of the elderly, as well as B cell lymphomas associated with solid organ transplantation and methotrexate use. EBV-related T cell disorders are primarily represented by NK/T- cell lymphoma. In a subset of patients, EBV has been implicated in CD30 positive B cell lymphoproliferative disorders of the oral mucosa falling under the rubric of the mucocutaneous ulcer of the oral cavity. We previously reported on an index series of endogenous CD30 positive T cell lymphoproliferative disorder of the oral cavity resembling borderline type C lymphomatoid papulosis. The clinical manifestation of type C oral lymphomatoid papulosis is that of a recurrent self-remitting ulcer of the oral mucosa, which histologically resembles anaplastic large cell lymphoma. Such cases can be misdiagnosed as aggressive lymphoma leading to unnecessary treatment with aggressive chemotherapeutic regimens. Whereas none of the patients in our index series exhibited EBV positivity, here we discuss a very unique example of a 14-year-old girl diagnosed with EBV positive CD30 positive lymphoproliferative disorder strongly resembling the cases of intra-oral type C lymphomatoid papulosis. The patient was initially diagnosed by a senior hematopathology consultant as having EBV positive aggressive NK/T-cell lymphoma. The significance of raising physician awareness regarding pediatric oral EBV associated CD30 positive lymphoproliferative disease of the oral cavity lies in preventing inadvertent exposure to toxic chemotherapeutic agents intended for treatment of aggressive look-alikes, namely anaplastic large cell lymphoma. Additionally, we include a literature review of similar reports of pediatric intra-oral EBV positive CD30 positive T cell lymphoproliferative disease. |
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