328 EBV and HHV1 Positive CNS Inflammatory Pseudotumor: A Case Report. (11th January 2018)

• Record Type: Journal Article
• Authors: Salib, Christian; Farooq, Taliya; Kleinman, George
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S141
• Page End: S142
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx127.327
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Inflammatory pseudotumor (IPT) is a rare benign lesion of unknown cause, commonly involving the lung and orbit but found in virtually every body site. IPT was first described in 1954 based on imaging findings that mimicked those of malignant tumors. This rare entity, which consists of mixed inflammatory cells and myofibroblastic spindle cells, is often associated with Epstein-Barr virus (EBV) positivity. Here we are presenting a case of a 56-year-old Hispanic woman with a history of headaches, dizziness, and frequent falls. MRI of the head demonstrated a right temporal lesion with enhancement along the temporal convexity, extending into the insula. A lumbar puncture yielded atypical lymphocytes with increased nuclear to cytoplasmic ratio, irregular nuclear contours, and coarse chromatin. Cerebral spinal fluid flow cytometry revealed a mixed population of cells, including B-cells expressing CD19, CD20, kappa, and lambda. A subsequent open biopsy revealed areas of dense, mixed infiltrates consisting of lymphocytes, histiocytes, plasma cells and eosinophils. Immunohistochemical staining demonstrated positivity for IgG, IgG4, IgA, kappa and lambda light chains, CD3, CD10, CD15, CD20, CD79A, BCL-2, MUM-1, and CD138. A neu N stain disclosed focal, minimal neuronal loss while GFAP demonstrated background reactive astrocytes. The lesion showed positivity for EBV, which is consistent with current literature, but also for human herpesvirus 1 (HHV1) proven by polymerase chain reaction (PCR). This case is noteworthy for the rarity of presentation, diagnostic challenges and positivity for EBV and HHV1 by PCR.