Granulomatous inflammatory pseudotumor of the spleen: association with Epstein-Barr virus

A 74-year-old woman with a clinical history of invasive ductal carcinoma of the breast was found to have a splenic mass during a routine radiographic survey. Splenectomy revealed a 3-cm well-demarcated lesion, which on histopathologic examination consisted of heterogeneous inflammatory cells. A stri...

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Bibliographic Details
Published inApplied immunohistochemistry & molecular morphology Vol. 17; no. 3; p. 259
Main Authors Zhang, Megan Q, Lennerz, Jochen K, Dehner, Louis P, Brunt, L Michael, Wang, Hanlin L
Format Journal Article
LanguageEnglish
Published United States 01.05.2009
Subjects
Aged
Epstein-Barr Virus Infections - complications
Epstein-Barr Virus Infections - diagnosis
Epstein-Barr Virus Infections - pathology
Female
Granuloma - diagnosis
Granuloma - pathology
Granuloma - virology
Granuloma, Plasma Cell - diagnosis
Granuloma, Plasma Cell - pathology
Granuloma, Plasma Cell - virology
Herpesvirus 4, Human - isolation & purification
Humans
RNA, Viral - analysis
Splenic Diseases - diagnosis
Splenic Diseases - pathology
Splenic Diseases - virology
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Summary:A 74-year-old woman with a clinical history of invasive ductal carcinoma of the breast was found to have a splenic mass during a routine radiographic survey. Splenectomy revealed a 3-cm well-demarcated lesion, which on histopathologic examination consisted of heterogeneous inflammatory cells. A striking feature of the lesion was the presence of innumerable well-formed non-necrotizing granulomas. Immunohistochemical studies confirmed the lesion to be composed mainly of mixed T and B lymphocytes, histiocytes, and plasma cells. No spindle cell component was evident on light microscopic examination or by immunohistochemical staining for smooth muscle actin, anaplastic lymphoma kinase, or follicular dendritic cell markers CD21 and CD35. Interestingly, Epstein-Barr virus-encoded RNA and latent membrane protein were detected by in situ hybridization and immunohistochemistry in numerous lymphohistiocytic cells within the lesion, but not in surrounding uninvolved splenic tissue. To our knowledge, this case represents a rare example of splenic inflammatory pseudotumor with exuberant granulomatous reaction in association with Epstein-Barr viral infection.
ISSN:1533-4058
DOI:10.1097/PAI.0b013e318189f10f