Lymph nodes & spleen, nonlymphoma

Lymph nodes-infectious / parasitic disorders

Epstein Barr virus

Last author update: 1 July 2013
Last staff update: 17 July 2023 (update in progress)

Copyright: 2003-2023,, Inc.

PubMed Search: Epstein Barr virus [title] lymph nodes [title]

Page views in 2022: 8,080
Page views in 2023 to date: 9,630
Cite this page: DePond W. Epstein Barr virus. website. Accessed November 28th, 2023.
Definition / general
  • Causes infectious mononucleosis (typical cases); other viruses may cause atypical cases
  • Classic clinical features are teenager / young adult with fever, sore throat, cervical adenopathy and mild hepatitis; peripheral blood shows atypical lymphocytes (CD8+ cytotoxic T cells)
  • Lymph nodes should usually NOT be biopsied as diagnosis is clinical and serologic
  • Atypical cases (lymphadenopathy but no fever, no sore threat, no splenomegaly) may be biopsied to rule out lymphoma
  • Fatal cases of infectious mononucleosis are associated with monoclonal or biclonal EBV (Am J Clin Pathol 2002;117:582)
  • Associated with histiocytic necrotizing lymphadenitis (Kikuchi disease) in Taiwan (Am J Clin Pathol 2000;113:774)
  • EBV RNA also present in Peruvian patients in nonneoplastic lymph nodes in B and T cells (Mod Pathol 1993;6:729)
  • May cause post-transplant lymphoproliferative disorders (see Lymphomas - non B cell), also Hodgkin and some non-Hodgkin lymphomas
Case reports
Microscopic (histologic) description
  • Partial architectural effacement due to marked sinusoidal and capsular / extranodal infiltration by immunoblasts that often have Reed-Sternberg like features and atypia
  • Follicular hyperplasia with ragged or mottled edges, follicles have tingible body macrophages and marked mitotic activity
  • Polymorphous inflammatory cells
  • Early infections have prominent monocytoid B cell reaction and no epithelioid cells (Am J Surg Pathol 2005;29:595)
  • Necrosis is usually minimal, but may be extensive in immunocompromised
Microscopic (histologic) images

AFIP images
Missing Image Missing Image Missing Image

Infectious mononucleosis involving lymph node

Missing Image

EBV associated infectious mononucleosis

Cytology description
  • Greater than usual numbers of large immunoblastic lymphocytes
  • Polymorphic immunoblasts
  • Pattern is not specific (Diagn Cytopathol 1990;6:323)
Peripheral smear images

Images hosted on other servers:
Missing Image

Atypical lymphocytes

Positive stains
Negative stains
  • CD15 (for Reed-Sternberg like cells)
Differential diagnosis
  • Anaplastic large cell lymphoma: lymphomas have atypical cells throughout the lymph node, not confined to the sinuses as with EBV
  • Drug reactions
  • Hodgkin lymphoma: nodular distortion, mixed inflammatory cells
  • Other viral infections
  • Post vaccination
Back to top
Image 01 Image 02