Case 34. EBV infection of chronic active type (20 y-o M)
         
    Ascites cytology from a young male presenting collagen disease-like signs and symptoms as well as intractable gastroduodenal ulcer    
         
   
Key words : 
EB virus, chronic active EBV infection, virus-associated hemophagocytic syndrome, lymphoproliferative disorder, infectious mononucleosis    
     
 
     
Large granular lymphocytes (LGLs) with distinct Azur granules in the cytoplasm are seen (Giemsa).   The presentation of atypical lymphocytes, eosinophils and lymphophagocytizing macrophages is indicative of virus-associated hemophagocytic syndrome (Papanicolaou).
     
 
     
Cell block preparation demonstrates EBER-1 reactivity in the nuclei of the atypical lymphocytes (in situ hybridization).   Gastric wall at autopsy
Diffuse infiltration of atypical lymphocytes, leading to lethal duodenal perforation (HE). Systemic infiltration of the atypical lymphocytes in various organs indicates the progression into lymphoproliferative disease.
     
 
     
Gastric wall at autopsy
CD56 (NCAM) is expressed on the infiltrating atypical lymphocytes (immunostaining). The myenteric plexus is also CD56-positive.
  Southern blot analysis of PCR products for EBV terminal repeats
Monoclonal incorporation (single band) of EBV is demonstrated. The terminal repeats (TR) on the circled viral DNA are a valuable target for judging the monoclonality.
     
 
     
Reference case 34A
Infectious mononucleosis accompanying a large gastric ulcer (33 y-o M). The ulcer healed spontaneously, showing a benign clinical course (endoscopic findings).
  Reference case 34A
Infectious mononucleosis accompanying a large gastric ulcer (33 y-o M). Biopsy specimen reveals dense infiltration of atypical lymphocytes in the lamina propria (HE).
     
 
     
Reference case 34A
Infectious mononucleosis accompanying a large gastric ulcer (33 y-o M). The infiltrating atypical lymphocytes express CD79a, thus belonging to the B-cells (immunostaining).