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Case of the Week

Example of Epstein Barr Virus (EBV)-positive mucocutaneous ulcer:

An elderly patient with chronic pharyngitis was found to have a well-circumscribed, ulcerated oropharyngeal lesion. A relatively dense infiltrate of atypical lymphoid cells is seen. The latter are predominantly positive for CD20 by immunohistochemical staining and variably positive by in situ hybridization for Epstein-Barr virus-encoded small RNA (EBER) and CD30 (not shown).

These lesions may arise in the setting of immunosuppression or age-related immunosenescence, typically show an indolent course, and may resolve spontaneously, particularly if immune function can be restored. Morphology may range from those resembling a large B-cell lymphoma to more polymorphous or Hodgkin-like features. EBV-MCU is consistently associated with EBV.

This case was provided by Genevieve Crane, MD, PhD, Staff Hematopathologist at the Cleveland Clinic, Section Editor at Archives of Pathology and Laboratory Medicine, and Deputy-Editor-in-Chief at She is also the main author of the Survival Guide to Lymph Node Pathology, published by Innovative Science Press. More info at


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