Age-related epstein-barr virus (EBV) associated B-cell lymphoproliferative disorders: Comparison with EBV-positive classic hodgkin lymphoma in elderly patients

Age-related Epstein-Barr virus-associated IB-cell lymphoproliferative disorder (aEBVLPD) is a disease group characterized by EBV- associated large B-cell lymphoma in the elderly without predisposing immunodeficiency. In nearly one-third of cases, aEBV- LPD occurs as a polymorphous subtype with reactive cell-rich components, bearing a morphologic similarity to classic Hodgkin lymphoma (cHL). The aim of this study was to clarify clinicopathologic differences between the polymorphic subtype of aEBVLPD (n = 34) and EBV ⁺ cHL (n = 108) in patients aged 50 years or older. Results showed that aEBVLPD was more closely associated with aggressive clinical parameters than cHL, with a higher age at onset (71 vs 63 years); lower male predominance (male-female ratio, 1.4 vs 3.3); and a higher rate of involvement of the skin (18% vs 2%), gastrointestinal tract (15% vs 4%), and lung (12% vs 2%). aEBVLPD was histopathologically characterized by a higher ratio of geographic necrosis, greater increase (> 30%) in cytotoxic T cells among background lymphocytes, higher positivity for CD20 and EBNA2, and absence of CD15 expression. As predicted by the clinical profile, aEBV-LPD had a significantly poorer prognosis than EBV+ cHL (P < .001). The polymorphous subtype of a EBVLPD constitutes an aggressive group with an immune response distinct from EBV+ cHL, and requires the development of innovative therapeutic strategies.