Synchronous discordant Epstein-Barr virus (EBV)–positive nodal T/NK-cell lymphoma and EBV-positive diffuse large B cell lymphoma in a patient with a history of EBV-positive Burkitt lymphoma

In rare cases, patients present with multiple simultaneous lymphomas at one or more anatomic sites. These may be described as composite (occurring at one anatomic site) or discordant (occurring at different anatomic sites). Although the Epstein-Barr virus (EBV) is often implicated in the development of composite lymphoma, its role in the pathogenesis of discordant lymphoma is less clear. We report a case of discordant Epstein-Barr virus–associated lymphoma consisting of nodal T/NK-cell lymphoma and diffuse large B cell lymphoma in a patient with a history of EBV-positive Burkitt lymphoma post treatment. Simultaneous biopsies of the left and right femoral lymph nodes showed a synchronous nodal T/NK-cell lymphoma (left) and diffuse large B cell lymphoma (right). The nodal T/NK-cell lymphoma was morphologically and immunohistochemical distinct from the diffuse large B cell. Both the T/NK-cell component and the B cell component showed bright nuclear positivity with in situ hybridization for EBER. Molecular studies for C-myc were negative. The role played by the Epstein-Barr virus (EBV) in the pathogenesis of discordant T cell and B cell lymphoma is uncertain but may be clinically significant, particularly in the setting of prior EBV-positive lymphoma. Additional testing for immunodeficiency should be considered in these patients.