Epstein-Barr Virus-Associated Peripheral T-cell Lym
phoma with Gastrointestinal Tract Involvement
WINYOU MITARNUN, MD*, V ANNARA T SAECHAN, MSc*,
JINTANA PRADUTKANCHANA, MSc*, SUPAPORN SUWIWAT, MSc*,
SATOMI TAKAO, MSc**, TAKAFUMI ISHIDA, DSc**
Affiliation : * Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
**Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan.
AbstractPeripheral T-celllymphoma (PTCL) is a group of diseases which are common in Asia and
areas of South and Central America. They are highly associated with the Epstein-Barr virus (EBV)
infection. In the present study the authors evaluated patients with gastrointestinal involvement of PTCL
with respect to clinical findings and outcome, pathologic features, and molecular analysis for EBV
infection and the clonality of tumor cells. From January 1997 through December 2000, 7 patients with
gastrointestinal tract involvement of PTCL were identified. The frequency of gastrointestinal tract
involvement in the various types of PTCL was 5.4 per cent (7 of 129 cases). The pertinent clinical
features were prolonged fever, weight loss, anemia, hepatosplenomegaly, lymphadenopathy, multiorgan
involvement, and gastrointestinal bleeding. Laboratory results showed a significantly high serum level
of alkaline phosphatase and lactate dehydrogenase, and abnormal coagulograms. Five patients died
within 4 months after onset of illness, while two were in complete remission after chemotherapy. The
tumor cell morphology was classified into three categories: small-sized cells, mixed medium- and large
sized cells, and large-sized cells. The antigenic phenotypes of the tumor cells were LCA+, CD3+,
CD15-, CD16-, CD30-, CD45R0+, CD57-, CD68-, EMA-, j3F1-, granzyme B+, TIA-1+, and p53+. The
expression of CD4, CD8, CD 56 and CD20 was variable. EBV -RNA expression by in situ hybridization
(EBER-ISH) study was positive and T -cell receptor (TCR) beta and/or gamma gene rearrangements
were detected in all patients. DNA sequence analysis showed high identity to the human TCR germline
gene. PTCL with gastrointestinal tract involvement was associated with EBV infection. The tumor cells
were mature T cells with some NK-cell antigenic expression and all demonstrated TCR gene rearrange
ments.
Keywords : Peripheral T-cell Lymphoma, Epstein-Barr Virus, Gastrointestinal, T-cell Receptor Gene,
Clonality
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