Does many enlarged lymph nodes with EBV indicate lymphoma?

Question

Hello doctor,

Needle core biopsy of a 0.59-inch lymph node in the abdomen at the porta hepatis. Numerous small and large nodes are present. Flow cytometry shows a peripheral blood contaminated specimen, lymphocytes population is 97 % of total leukocytes and consists of T-cells helper and suppressor immunophenotypes and poly B cells, not suggestive of B cell lymphoproliferative neoplasm. Immuno outcomes: CD3, CD5, CD43, many positive T-cells. CD20, CD79A, and many positive B cells. CD23, Bcl-2, some positive. Cyclin D1: rare positive, only CD10 negative. Diagnosis: negative for malignancy. Question: I have a history of sibling lymphoma, and I have the Epstein-Barr virus. Should they consider mantle cell lymphoma? Needle core biopsy through an endoscope may not be definitive. Excisional would have been better. Lymphoma symptoms are present. Primary biliary cholangitis was also diagnosed 5 years ago. Lymphocytic colitis and erosions in the stomach are also found. Should I ask for more testing for lymphoma?

Kindly guide.

Answer 1

Hello,

Welcome to icliniq.com.

Hereby, I am giving my opinion on your case. You are having an Epstein-Barr virus infection. This virus can lead to hepatitis development and enlarged lymph nodes. You are right on your suspicion that multiple enlarged lymph nodes raised suspicion towards malignancy, especially lymphoma. But the main thing is that the biopsy is considered conclusive, and your flow cytometry report is clearly suggestive of a non-malignant lesion, as polyclonal cells are present. So these reports are not suggestive of any lymphoma. You have mentioned a diagnosis of primary biliary cholangitis, so in this autoimmune disease, liver enzymes can be elevated. In this disease, over time, cirrhosis can also develop. No need for repeat biopsy just now, as per the mentioned report.

I hope this information helps you.

Thank you.