Epstein-Barr virus-associated T-cell lymphoma in an adult patient: prominent infiltrates within the liver portal area revealed by autopsy.

We herein report the case of a 67-year-old man who initially presented with fever and hepatosplenomegaly, and soon died of progressive liver failure. The bone marrow was infiltrated with tumor cells showing a variable morphology and macrophages phagocytosing blood cells. The tumor cells were CD2(+), CD3(+), CD4(-), CD8(+), CD25(+), CD56(+/-), and HLA-DR(+) and exhibited clonal cytogenetic abnormalities. Microscopic examination of the liver postmortem revealed, prominent cellular infiltrates that were confined within the portal area. The infiltrated cells were medium-sized with the CD3(+), CD4(-), CD8(+), CD56(+/-), and granzyme B(+) phenotype. In situ hybridization detected Epstein-Barr virus (EBV)-encoded RNA-positive cells in the liver and spleen as well as the bone marrow obtained before his death. These observations indicate that EBV-associated T-cell lymphoma expressing cytotoxic proteins was the underlying disorder. Prominent portal involvement was most likely responsible for the fatal clinical outcome of this patient.