EBV-negative Aggressive NK-cell Leukemia/Lymphoma: Clinical, Pathologic, and Genetic Features : The American Journal of Surgical Pathology

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EBV-negative Aggressive NK-cell Leukemia/Lymphoma

Clinical, Pathologic, and Genetic Features

Nicolae, Alina MD, PhD*; Ganapathi, Karthik A. MD, PhD*; Pham, Trinh Hoc-Tran MSc*; Xi, Liqiang MD*; Torres-Cabala, Carlos A. MD; Nanaji, Nahid M. MD; Zha, Hongbin D. MD, PhD§; Fan, Zhen MD; Irwin, Sybil MD; Pittaluga, Stefania MD, PhD*; Raffeld, Mark MD*; Jaffe, Elaine S. MD*

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The American Journal of Surgical Pathology 41(1):p 67-74, January 2017. | DOI: 10.1097/PAS.0000000000000735


Aggressive natural killer cell leukemia (ANKL) is a systemic NK-cell neoplasm, almost always associated with Epstein-Barr virus (EBV). Rare cases of EBV-negative ANKL have been described, and some reports suggested more indolent behavior. We report the clinicopathologic, immunophenotypic, and molecular characteristics of 7 EBV-negative ANKL. All patients were adults, with a median age of 63 years (range 22 to 83 y) and an M:F ratio of 2.5:1. Five patients were White, 1 Black, and 1 Asian. All patients presented acutely, with fever (6/7), cytopenias (6/7), and splenomegaly (4/7). Four patients had lymphadenopathy, 4 had extranodal disease. Bone marrow involvement was present in 5, with hemophagocytosis in 3. Peripheral blood was involved in 5 with the neoplastic cells containing prominent azurophilic granules. By immunohistochemistry and/or flow cytometry, the tumor cells lacked surface CD3 and were positive for CD56 (7/7), CD2 (5/5), CD8 (3/7), CD30 (4/5), and granzyme-B (6/6). They were negative for CD4, CD5, βF1, TCRγ, LMP1, and EBV-encoded RNA. Polymerase chain reaction for TCRG clonality was polyclonal. Mutational analysis revealed missense mutations in the STAT3 gene in both cases studied. Median survival was 8 weeks from the onset of disease. One patient received allogeneic bone marrow transplant and is alive with no disease (follow-up 15 mo). EBV-negative ANKL exists but is rare. It tends to occur in older patients and is indistinguishable clinically and pathologically from EBV-positive ANKL, with a similar fulminant clinical course. The high prevalence of Asian patients seen with EBV-positive disease seems less evident with EBV-negative cases.

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