Epstein-Barr virus-positive B-cell lymphoma of the elderly at a United States tertiary medical center: an uncommon aggressive lymphoma with a nongerminal center B-cell phenotype.

Epstein-Barr virus-positive B-cell lymphoproliferative disorders similar to those seen in posttransplantation patients have recently been described in immunocompetent, elderly Asian individuals. To our knowledge, this entity has not been described in the United States. The clinicopathologic features of 6 Epstein-Barr virus-positive B-cell lymphomas of the elderly from 5 patients 60 years and older were reviewed. Three specimens exhibited a polymorphous infiltrate with Reed-Sternberg-like cells. The remaining specimens resembled conventional diffuse large B-cell lymphoma. Most tumor cells were Epstein-Barr virus-positive by in situ hybridization and had a nongerminal center B-cell immunophenotype. In addition, 90 cases of diffuse large B-cell lymphoma in patients 60 years and older were screened for Epstein-Barr virus and were negative. All 5 patients were treated with combination chemotherapy; however, they had a poor outcome. Epstein-Barr virus-positive B-cell lymphomas of the elderly occur uncommonly at a United States tertiary medical center. Pathologic features that may aid in identification and trigger Epstein-Barr virus testing include a polymorphic infiltrate, plasmacytic morphology, Reed-Sternberg-like cells, angioinvasion, necrosis, and a nongerminal center B-cell immunophenotype. Further investigation is needed to determine if Epstein-Barr virus status plays an independent role in the prognosis of diffuse large B-cell lymphoma in non-Asian countries, which would also impact the need to screen all diffuse large B-cell lymphoma in older patients for Epstein-Barr virus.