Abstract
Epstein-Barr virus (EBV) prevails among more than 90% of the adult population worldwide. Most primary infections occur during young childhood and cause no or only nonspecific symptoms; then the virus becomes latent and resides in lymphocytes in the peripheral blood. Inactive latent EBV usually causes no serious consequences, but once it becomes active it can cause a wide spectrum of malignancies: epithelial tumors such as nasopharyngeal and gastric carcinomas; mesenchymal tumors such as follicular dendritic cell tumor/sarcoma; and lymphoid malignancies such as Burkitt lymphoma, lymphomatoid granulomatosis, pyothorax-associated lymphoma, immunodeficiency-associated lymphoproliferative disorders, extranodal natural killer (NK) cell/T-cell lymphoma, and Hodgkin’s lymphoma. The purpose of this article is to describe the spectrum of EBV-related diseases and their key imaging findings. EBV-related lymphoproliferative disorders and lymphomas are especially common in immunocompromised patients. Awareness of their clinical settings and imaging spectrum contributes to early detection and early treatment of possibly life-threatening disorders.
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Tao Q, Young LS, Woodman CB, Murray PG. Epstein-Barr virus (EBV) and its associated human cancers-genetics, epigenetics, pathobiology and novel therapeutics. Front Biosci 2006;11:2672–2713.
Thorley-Lawson DA. Epstein-Barr virus: exploiting the immune system. Nat Rev Immunol 2001;1:75–82.
Pattle SB, Farrell PJ. The role of Epstein-Barr virus in cancer. Expert Opin Biol Ther 2006;6:1193–1205.
Ebell MH. Epstein-Barr virus infectious mononucleosis. Am Fam Physician 2004;70:1279–1287.
Jenson HB. Acute complications of Epstein-Barr virus infectious mononucleosis. Curr Opin Pediatr 2000;12:263–268.
Kimura H, Hoshino Y, Kanegane H, Tsuge I, Okamura T, Kawa K, et al. Clinical and virologic characteristics of chronic active Epstein-Barr virus infection. Blood 2001;98:280–286.
Straus SE. The chronic mononucleosis syndrome. J Infect Dis 1988;157:405–412.
Shoji H, Kusuhara T, Honda Y, Hino H, Kojima K, Abe T, et al. Relapsing acute disseminated encephalomyelitis associated with chronic Epstein-Barr virus infection: MRI findings. Neuroradiology 1992;34:340–342.
Morita M, Tsuge I, Matsuoka H, Ito Y, Itosu T, Yamamoto M, et al. Calcification in the basal ganglia with chronic active Epstein-Barr virus infection. Neurology 1998;50:1485–1488.
Jeyakumar A, Brickman TM, Jeyakumar A, Doerr T. Review of nasopharyngeal carcinoma. Ear Nose Throat J 2006;85:168–170,172–3,184.
Chan JKC, Bary F, McCarron P, Foo W, Lee AWM, Yip T, et al. Nasopharyngeal carcinoma. In: Barnes L, Eveson JW, Reichart P, et al. editors. Pathology and genetics of head and neck tumours. Lyon: IARC Press; 2005. p. 85–97.
Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet 2005;365:2041–2054.
Chin SC, Fatterpekar G, Chen CY, Som PM. MR imaging of diverse manifestations of nasopharyngeal carcinomas. AJR Am J Roentgenol 2003;180:1715–1722.
Maeda E, Akahane M, Uozaki H, Kato N, Hayashi N, Fukayama M, et al. CT appearance of Epstein-Barr virus associated gastric carcinoma. Abdominal Imaging 2008 Jul 31. [Epub ahead of print]
Van Beek J, zur Hausen A, Klein Kranenbarg E, van de Velde CJ, Middeldorp JM, van den Brule AJ, et al. EBV-positive gastric adenocarcinomas: a distinct clinicopathologic entity with a low frequency of lymph node involvement. J Clin Oncol 2004;22:664–670.
Ojima H, Fukuda T, Nakajima T, Takenoshita S, Nagamachi Y. Discrepancy between clinical and pathological lymph node evaluation in Epstein-Barr virus-associated gastric cancers. Anticancer Res 1996;16:3081–3084.
Fukayama M, Chong JM, Uozaki H. Pathology and molecular pathology of Epstein-Barr virus-associated gastric carcinoma. Curr Top Microbiol Immunol 2001;258:91–102.
Yanai H, Nishikawa J, Mizugaki Y, Shimizu N, Takada K, Matsusaki K, et al. Endoscopic and pathologic features of Epstein-Barr virus-associated gastric carcinoma. Gastrointest Endosc 1997;45:236–242.
Nishikawa J, Yanai H, Mizugaki Y, Takada K, Tada M, Okita K. Case report: hypoechoic submucosal nodules: a sign of Epstein-Barr virus-associated early gastric cancer. J Gastroenterol Hepatol 1998;13:585–590.
Watanabe H, Enjoji M, Imai T. Gastric carcinoma with lymphoid stroma: its morphologic characteristics and prognostic correlations. Cancer 1976;38:232–243.
Weiss LM, Grogan TM, Muller-Hermelink HK, Stein H, Dura T, Farvara B, et al. Follicular dendritic cell sarcoma/tumor. In: Jaffe ES, Harris NL, Stein H, et al., editors. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 181–184.
Chan JK, Fletcher CD, Nayler SJ, Cooper K. Follicular dendritic cell sarcoma: clinicopathologic analysis of 17 cases suggesting a malignant potential higher than currently recognized. Cancer 1997;79:294–313.
Cheuk W, Chan JK, Shek TW, Chang JH, Tsou MH, Yuen NW, et al. Inflammatory pseudotumor-like follicular dendritic cell tumor: a distinctive low-grade malignant intra-abdominal neoplasm with consistent Epstein-Barr virus association. Am J Surg Pathol 2001;25:721–731.
Kiryu S, Takeuchi K, Shibahara J, Uozaki H, Fukayama M, Tanaka H, et al. Epstein-Barr virus-positive inflammatory pseudotumour and inflammatory pseudotumour-like follicular dendritic cell tumour: case report and review of the literature. Br J Radiol (in press).
Dieboid J, Jaffe ES, Raohael M, Warnke RA. Burkitt lymphoma. In: Jaffe ES, Harris NL, Stein H, et al. editors. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 181–184.
Blum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood 2004;104:3009–3020.
Hamrick-Turner JE, Saif MF, Powers CI, Blumenthal BI, Royal SA, Iyer RV. Imaging of childhood non-Hodgkin lymphoma: assessment by histologic subtype. Radiographics 1994;14:11–28.
Chao TY, Wang TY, Lee WH. Association between Epstein-Barr virus and Burkitt’s lymphoma in Taiwan. Cancer 1997;80:121–128.
Krudy AG, Dunnick NR, Magrath IT, Shawker TH, Doppman JL, Spiegel R. CT of American Burkitt lymphoma. AJR Am J Roentgenol 1981;136:747–754.
Katzenstein AL, Carrington CB, Liebow AA. Lymphomatoid granulomatosis: a clinicopathologic study of 152 cases. Cancer 1979;43:360–373.
Guinee D Jr, Jaffe E, Kingma D, Fishback N, Wallberg K, Krishnan J, et al. Pulmonary lymphomatoid granulomatosis: evidence for a proliferation of Epstein-Barr virus infected Blymphocytes with a prominent T-cell component and vasculitis. Am J Surg Pathol 1994;18:753–764.
Fauci AS, Haynes BF, Costa J, Katz P, Wolff SM. Lymphomatoid granulomatosis: prospective clinical and therapeutic experience over 10 years. N Engl J Med 1982;306:68–74.
Jaffe ES, Wilson WH. Lymphomatoid granulomatosis. In: Jaffe ES, Harris NL, Stein H, et al. editors. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 185–187.
Do KH, Lee JS, Seo JB, Song JW, Chung MJ, Heo JN, et al. Pulmonary parenchymal involvement of low-grade lymphoproliferative disorders. J Comput Assist Tomogr 2005;29:825–830.
Lee JS, Tuder R, Lynch DA. Lymphomatoid granulomatosis: radiologic features and pathologic correlations. AJR Am J Roentgenol 2000;175:1335–1339.
Tateishi U, Terae S, Ogata A, Sawamura Y, Suzuki Y, Abe S, et al. MR imaging of the brain in lymphomatoid granulomatosis. AJNR Am J Neuroradiol 2001;22:1283–1290.
Patsalides AD, Atac G, Hedge U, Janik J, Grant N, Jaffe ES, et al. Lymphomatoid granulomatosis: abnormalities of the brain at MR imaging. Radiology 2005;237:265–273.
Minami M, Kawauchi N, Yoshikawa K, Itai Y, Kokubo T, Iguchi M, et al. Malignancy associated with chronic empyema: radiologic assessment. Radiology 1991;178:417–423.
Iuchi K, Ichimiya A, Akashi A, Mizuta T, Lee YE, Tada H, et al. Non-Hodgkin’s lymphoma of the pleural cavity developing from long-standing pyothorax. Cancer 1987;60:1771–1775.
Fukayama M, Ibuka T, Hayashi Y, Ooba T, Koike M, Mizutani S. Epstein-Barr virus in pyothorax-associated pleural lymphoma. Am J Pathol 1993;143:1044–1049.
Aozasa K. Pyothorax-associated lymphoma. Int J Hematol 1996;65:9–16.
Aozasa K, Ohsawa M, Iuchi K, Tajima K, Komatsu H, Shimoyama M. Artificial pneumothorax as a risk factor for development of pleural lymphoma. Jpn J Cancer Res 1993;84:55–57.
Kim Y, Lee SW, Choi HY, Im SA, Won T, Han WS. A case of pyothorax-associated lymphoma simulating empyema necessitatis. Clin Imaging 2003;27:162–165.
Kinoshita T, Ishii K, Taira Y, Naganuma H. Malignant lymphoma arising from chronic tuberculous empyema; a case report. Acta Radiol 1997;38:833–835.
Brun V, Revel MP, Danel C, Fournier LS, Souilamas R, Frija G. Case report: pyothorax-associated lymphoma-diagnosis at percutaneous core biopsy with CT guidance. AJR Am J Roentgenol 2003;180:969–971.
Asakura H, Togami T, Mitani M, Takashima H, Yokoe K, Yamamoto Y, et al. Usefulness of FDG-PET imaging for the radiotherapy treatment planning of pyothorax-associated lymphoma. Ann Nucl Med 2005;19:725–728.
Hara S, Kami M, Miyakoshi S, Suzuki R, Takeuchi K, Seki T, et al. Central nervous system involvement in pyothorax-associated lymphoma: ring enhancement on CT scan. Ann Hematol 2001;80:174–177.
Borisch B, Raphael M, Swerdlow SH, Jaffe ES, Harris NL, Knowles DM. Immunodeficiency associated lymphoproliferative diseases. In: Jaffe ES, Harris NL, Stein H, et al. editors. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 255–271.
Carbone A, Gloghini A. AIDS-related lymphomas: from pathogenesis to pathology. Br J Haematol 2005;130:662–670.
Thurnher MM, Thurnher SA, Schindler E. CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol 1997;7:1091–1097.
Nador RG, Cesarman E, Chadburn A, Dawson DB, Ansari MQ, Sald J, et al. Primary effusion lymphoma: a distinct clinicopathologic entity associated with the Kaposi’s sarcomaassociated herpes virus. Blood 1996;88:645–656.
Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol 2005;56:155–167.
Pickhardt PJ, Siegel MJ. Posttransplantation lymphoproliferative disorder of the abdomen: CT evaluation in 51 patients. Radiology 1999;213:73–78.
Collins J, Muller NL, Leung AN, McGuinness G, Mergo PJ, Flint JD, et al. Epstein-Barr-virus-associated lymphoproliferative disease of the lung: CT and histologic findings. Radiology 1998;208:749–759.
Pickhardt PJ, Wippold FJ 2nd. Neuroimaging in posttransplantation lymphoproliferative disorder. AJR Am J Roentgenol 1999;172:1117–1121.
Oyama T, Ichimura K, Suzuki R, Suzumiya J, Ohshima K, Yatabe Y, et al. Senile EBV+ B-cell lymphoproliferative disorders: a clinicopathologic study of 22 patients. Am J Surg Pathol 2003;27:16–26.
Chan JKC, Jaffe ES, Ralfkiaer E. Extranodal NK/T-cell lymphoma, nasal type. In: Jaffe ES, Harris NL, Stein H, et al, editors. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 204–207.
Cheung MM, Chan JK, Lau WH, Foo W, Chan PT, Ng CS, et al. Primary non-Hodgkin’s lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol 1998;16:70–77.
Kwong YL, Chan AC, Liang R, Chiang AK, Chim CS, Chan TK, et al. CD56+ NK lymphomas: clinicopathological features and prognosis. Br J Haematol 1997;97:821–829.
Ooi GC, Chim CS, Liang R, Tsang KW, Kwong YL. Nasal T-cell/natural killer cell lymphoma: CT and MR imaging features of a new clinicopathologic entity. AJR Am J Roentgenol 2000;174:1141–1145.
King AD, Lei KI, Ahuja AT. MRI of neck nodes in non-Hodgkin’s lymphoma of the head and neck. Br J Radiol 2004;77:111–115.
King AD, Lei KI, Ahuja AT, Lam WW, Metreweli C. MR imaging of nasal T-cell/natural killer cell lymphoma. AJR Am J Roentgenol 2000;174:209–211.
Meyer RM, Ambinder RF, Stroobants S. Hodgkin’s lymphoma: evolving concepts with implications for practice. Hematology Am Soc Hematol Educ Program 2004:184–202.
Gandhi MK, Tellam JT, Khanna R. Epstein-Barr virus-associated Hodgkin’s lymphoma. Br J Haematol 2004;125:267–281.
Stein H, Delsol G, Pileri S, Said J, Mann R, Poppema S, et al. Classical Hodgkin lymphoma. In:Jaffe ES, Harris NL, Stein H, et al. editors. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2001. p. 244–253.
Jarrett RF, Stark GL, White J, Angus B, Alexander FE, Krajewski AS, et al. Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study. Blood 2005;106:2444–2451.
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Maeda, E., Akahane, M., Kiryu, S. et al. Spectrum of Epstein-Barr virus-related diseases: a pictorial review. Jap J Radiol 27, 4–19 (2009). https://doi.org/10.1007/s11604-008-0291-2
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DOI: https://doi.org/10.1007/s11604-008-0291-2