PMC4085278_01
Histological diagnosis of synchronous nodular tuberculosis and EBV-associated lymphoproliferative disorder. Biopsy of a cervical lymph node performed on day +36 showed effacement of the architecture due to numerous granulomas (low magnification (a), which were composed of epithelioid cells (b). Between the granulomas a polymorphous lymphoid infiltrate was noted containing blasts as well as plasma cells (c). The blasts were latently EBV-infected as shown in the immunohistochemical demonstration of EBNA2 (d).
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Fig1
Histological analysis of one extirpated lymph node showed complete effacement of its architecture due to multiple epithelioid cell granulomas with only occasional necrosis (Figure  1a,b). In addition, focal polymorphous lymphoid infiltrates (Figure  1c) composed of blastic activated B cells expressing CD20 and CD30 were identified, which were accompanied by plasma cells with polytypic expression of the immunoglobulin light chains. Further immunohistological investigations revealed that the activated B-blasts expressed the EBV encoded latent membrane protein-1 and the nuclear antigen EBNA2, both of which are involved in EBV-induced B cell activation and proliferation (Figure  1d) (Thorley-Lawson ).
Radiological diagnosis of disseminated tuberculosis. CT scan of the thorax on day +43 after allogeneic stem cell transplantation revealed a borderline sized mediastinal lymph node with central necrosis (a) as well as multiple pulmonary nodules (b).
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Fig2
Repeated thoracic CT showed mediastinal and hilar lymphadenopathy of up to 20 mm and unchanged pulmonary nodules (Figure  2a,b).