A 35 years old patient with history of high-grade fever and tonsillitis 2 months back now presents with cervical lymphadenopathy. Peripheral smear shows lymphocytosis with WBC count 22 x 10 g/L. Monospot test was negative. Tonsillectomy was done and it showed large cells mixed with lymphocytes. The cells were positive for CD20, EBV-LMPl, MUMI, CD79a. Background cells were positive for CD3. The cells are negative for CDl5. The most probable diagnosis is
A. Infectious mononucleosis
B. Hodgkin lymphoma
C. EBV positive diffuse large B-cell lymphoma
D. EBV positive mucocutaneous ulcer
Answer- C. EBV positive diffuse large B-cell lymphoma
- History of high-grade fever, tonsillitis and cervical lymphadenopathy with peripheral smear showing lymphocytosis and cells positive for CD20, EBV-LMPL, MUML, CD79a, negative for CD15 is highly suggestive of EBV positive diffuse large B-cell lymphoma. EBV-LMPI positive DLBCL is a special variant of DLBCL. Mum-l DLBCLs are usually advanced B-cell type and can have EBV positivity.
- EBV-positive monoclonal large B-cell proliferation that occurs in patients >50 years of age and in whom there is no known immunodeficiency or history of lymphoma.