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7 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A diffuse large B-cell lymphoma in which Epstein-Barr virus, the virus of glandular fever, is present in the tumour cells. It is diagnosed by a stain on the biopsy, it is commoner in east Asia and Latin America than in Europe, and it is treated in the same way as diffuse large B-cell lymphoma without the virus.
What it is. Epstein-Barr virus infects almost everybody by adulthood and then lives quietly inside B cells for life. In a small proportion of diffuse large B-cell lymphomas the virus is present in the tumour cells themselves, detectable by a stain called EBER in situ hybridisation. WHO-HAEM5 recognises that group as an entity in its own right and, in 2022, dropped the qualifier that had restricted it to older people.
How it differs from its family. Not much, in the clinic. It behaves as a diffuse large B-cell lymphoma and is treated as one. What differs is how it is recognised and how it is counted. The European study that found 3.1 per cent noted that no appearance and no immunohistochemical marker reliably identified the positive cases, and that only in situ hybridisation for the viral RNA found them; necrosis was present in two-thirds of positive cases and CD30 in half, but neither was specific. The practical recommendation that came out of that work was to run the stain on every new diffuse large B-cell lymphoma in a person over 50.
| Setting | Approach | Guideline |
|---|---|---|
| Finding it | In situ hybridisation for Epstein-Barr-encoded RNA on the biopsy. The European series that put the frequency at 3.1 per cent found that no morphological or immunohistochemical feature reliably identified the positive cases, and recommended running the stain on every new diffuse large B-cell lymphoma in a person over 50. Necrosis and CD30 expression are common in positive cases but neither is specific enough to select who to test. | not mapped |
| Treatment | The same immunochemotherapy as diffuse large B-cell lymphoma without the virus; the presence of Epstein-Barr virus does not currently change the regimen. Where there is an identifiable cause of immune suppression, reducing it is part of the treatment, as it is for the post-transplant lymphoproliferative disorders. The regimens are on the diffuse large B-cell lymphoma page and in the treatment layer of this family. | not mapped |