Peripheral T-cell lymphoma with Epstein-Barr virus-positive reed-Sternberg-like B-cells in a 59-year-old hispanic man

Patient: A 59-year-old Hispanic man. Chief Complaint: Generalized pruritic rash; bilateral axillary, inguinal, and cervical lymphadenopathy; unintentional 20-lb weight loss over the past 8 months. Past Medical History: Hypertension, type 2 diabetes mellitus, and paroxysmal atrial fibrillation. Family and Social History: Noncontributory Principal Laboratory Findings: Excisional biopsy of an inguinal lymph node revealed diffuse nodal effacement by atypical small-to mediumsized lymphoid cells. We identified scattered large mononuclear and binuclear cells with prominent eosinophilic nucleoli and abundant cytoplasm resembling Hodgkin variants and classic Reed-Sternberg (RS) cells throughout the lymph nodes. Via immunohistochemical staining, the small-to medium-sized cells were CD2 positive (CD2+), CD3+, CD4 negative (CD4-), CD5+, CD7+, CD8-/+, and CD30-. The large RS-like cells were weakly CD20+ , weakly PAX-5+, CD30+, CD15+, and CD45-; they lacked T-cell markers CD2, CD3, CD4, CD5, CD7, and CD8. In situ hybridization results for Epstein-Barr Virus-encoded RNA (EBER) were positive in the RS-like cells. Concurrent flow cytometric testing confirmed an aberrant population of small T cells but did not detect an abnormal B-cell population. Polymerase chain reaction analysis demonstrated clonal rearrangements of the T-cell receptor gamma chain. We also detected clonal rearrangements of the immunoglobulin genes (immunoglobulin heavy chain [IgH] and immunoglobulin kappa [IGκ] loci) which provided further support for B-cell derivation of the RS-like cells.