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Epstein–Barr virus is rarely associated with diffuse large B cell lymphoma in Taiwan and carries a trend for a shorter median survival time
  1. Sheng-Tsung Chang1,2,
  2. Yi-Hsuan Lu3,
  3. Chin-Li Lu4,
  4. Shih-Feng Weng5,6,
  5. Shu-Hui Lin1,
  6. Szu-Yin Kuo1,
  7. Yu-Ting Chuang1,
  8. Kengo Takeuchi7,
  9. Koichi Ohshima8,
  10. Shih-Sung Chuang1,9,10
  1. 1Departments of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
  2. 2Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan
  3. 3Department of Radiology, Liouying Chi Mei Hospital, Tainan, Taiwan
  4. 4Department of Medical Research, Chia-Yi Christian Hospital, Chiayi, Taiwan
  5. 5Department of Public Health, National Cheng-Kung University, Tainan, Taiwan
  6. 6Department of Medical Research, Chi-Mei Medical Centre, Tainan, Taiwan
  7. 7Pathology Project for Molecular Targets and Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
  8. 8Department of Pathology, School of Medicine, Kurume University, Kurume, Japan
  9. 9Department of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
  10. 10Department of Pathology, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Professor Shih-Sung Chuang, Department of Pathology, Chi-Mei Medical Centre, 901 Chung-Hwa Road, Yung-Kang City, Tainan County 710, Taiwan; cmh5301{at}


Aims Epstein–Barr virus (EBV)-positive diffuse large B cell lymphoma (DLBCL) of the elderly is characterised by frequent extranodal involvement, a morphological spectrum from polymorphous to monomorphous and a poor prognosis. The frequency is higher in Japan and Korea but lower in the West, while the status in Taiwan has not been reported yet.

Methods We conducted a retrospective study of DLBCL in a single institute in Taiwan by immunohistochemistry and in situ hybridisation for EBV.

Results Of the 424 consecutive DLBCL cases, 332 cases were studied for EBV. 15 (4.5%) were EBV-positive and 13 (3.9%) fulfil WHO criteria of EBV-positive DLBCL of the elderly with a median age of 75. Of these 15 cases, extranodal presentation occurred in 11 (73%) patients with predominance in the gastrointestinal tract and 6 (40%) were of germinal centre B cell phenotype. There was no difference between EBV-positive and -negative patients in terms of age, gender, nodal versus extranodal presentation, and immunophenotypical profile. EBV-positive patients showed a trend for a shorter median survival time (5.0 vs 39.3 months; p=0.058). Of all DLBCL patients, multivariable analysis revealed a significantly worse overall survival for patients older than 50 (p=0.001) and for those with bcl-6-negative tumours (p=0.003) but not with other clinicopathological factors including EBV status.

Conclusions EBV-positive DLBCL of the elderly is relatively rare in Taiwan, with an incidence intermediate between Japan/Korea and the West. Further studies are warranted to clarify the association of EBV and the clinicopathological features and the prognostic significance in patients with DLBCL.

  • Virus
  • Haematopathology
  • Lymphoma

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