Epstein-Barr virus-positive pleural effusion clinical features, cytomorphologic characteristics, and flow cytometric immunophenotyping

Hidehiro Takei, Dina Mody

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Objectives: The etiology of pleural effusions (PEs) varies, and a percentage of PEs remains unexplained despite an intensive workup. One previous study documented a high prevalence of Epstein-Barr virus (EBV)-DNA in unselected and unexplained PEs. Our aim is to characterize the clinical and cytomorphologic features of EBV-associated PEs, which have not been described. Methods: A database search was performed for PEs with EBV-DNA identified in the fluid by real-time quantitative polymerase chain reaction. The corresponding fluid cytology and chemistry were reviewed, and the patients' demographic data and clinical features were recorded. Results: A total of 20 cases of EBV-DNA-positive PE were found. All patients had a history of lung transplantation. Most of the PE EBV loads were relatively low. Cytologically, polymorphous lymphocytosis was present in more than 70% of PEs. Scattered lymphocytic mitosis and apoptosis were seen in some cases. Mesothelial cells varied in number, and some cases showed reactive atypia. The lymphocytes were predominantly T cells with the CD4/CD8 ratio varying from 10:1 to 3:20. Conclusions: EBV infection/reactivation can account for certain proportions of "idiopathic" PEs. Polymorphous lymphocytosis is the most common cytologic feature, but atypical features (in both lymphocytes and mesothelial cells) can be seen.

Original languageEnglish (US)
Pages (from-to)788-794
Number of pages7
JournalAmerican Journal of Clinical Pathology
Volume142
Issue number6
DOIs
StatePublished - Dec 2014

Keywords

  • Epstein-Barr virus
  • Pleural effusion
  • Real-time quantitative PCR

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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