Table of Contents
Definition / general | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Peripheral smear images | Positive stains | Negative stains | Differential diagnosis | Additional referencesCite this page: DePond W. Epstein Barr virus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodesebv.html. 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
- 32 year old man with extensive nodal infarction (Int J Surg Pathol 2002;10:223)
- 40 year old man with lymph node infarction (Pathol Res Pract 2004;200:53)
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
Infectious mononucleosis involving lymph node
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:
Atypical lymphocytes
Positive stains
- Reed-Sternberg like immunoblasts are usually CD20+, CD15-, CD30- (may be focally CD30+) (Am J Clin Pathol 1990;93:698)
- Also preservation of underlying reticulin architecture (Am J Surg Pathol 1987;11:122)
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
