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Primary effusion lymphoma: a distinct clinicopathologic entity associated with the Kaposi's sarcoma-associated herpes virus

RG Nador, E Cesarman, A Chadburn, DB Dawson, MQ Ansari, J Sald and DM Knowles

Department of Pathology, New York Hospital-Cornell Medical Center, New York 10021, USA.

We recently discovered the Kaposi's sarcoma-associated herpes virus (KSHV/HHV-8) in an uncommon and unusual subset of AIDS-related lymphomas that grow mainly in the body cavities as lymphomatous effusions without an identifiable contiguous tumor mass. The consistent presence of KSHV and certain other distinctive features of these body cavity-based lymphomas suggest that they represent a distinct entity. We tested this hypothesis by investigating 19 malignant lymphomatous effusions occurring in the absence of a contiguous tumor mass for their clinical, morphologic, immunophenotypic, viral, and molecular characteristics, KSHV was present in 15 of 19 lymphomas. All four KSHV- negative lymphomatous effusions exhibited Burkitt or Burkitt-like morphology and c-myc gene rearrangements and, therefore, appeared to be Burkitt-type lymphomas occurring in the body cavities. In contrast, all 15 KSHV-positive lymphomatous effusions exhibited a distinctive morphology bridging large-cell immunoblastic lymphoma and anaplastic large-cell lymphoma, and all 12 cases studied lacked c-myc gene rearrangements. In addition, these lymphomas occurred in men (15/15), frequently but not exclusively in association with HIV infection (13/15), in which homosexuality was a risk factor (13/13), presented initially as a lymphomatous effusion (14/15), remained localized to the body cavity of origin (13/15), expressed CD45 (15/15) and one or more activation-associated antigens (9/10) in the frequent absence of B-cell- associated antigens (11/15), exhibited clonal immunoglobulin gene rearrangements (13/13), contained Epstein-Barr virus (14/15), and lacked bcl-2, bcl-6, ras and p53 gene alterations (13/15). These findings strongly suggest that the KSHV-positive malignant lymphomatous effusions represent a distinct clinicopathologic and biologic entity and should be distinguished from other malignant lymphomas occurring in the body cavities. Therefore, we recommend that these malignant lymphomas be designated primary effusion lymphomas (PEL), rather than body cavity-based lymphomas, since this term describes them more accurately and avoids their confusion with other malignant lymphomas that occur in the body cavities. We further recommend that these PEL be considered for inclusion as a new entity in the Revised European- American Lymphoma Classification.

Volume 88, Issue 2, pp. 645-656, 07/15/1996
Copyright © 1996 by The American Society of Hematology


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[Abstract] [Full Text] [PDF]


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J. Virol.Home page
T. Piolot, M. Tramier, M. Coppey, J.-C. Nicolas, and V. Marechal
Close but Distinct Regions of Human Herpesvirus 8 Latency-Associated Nuclear Antigen 1 Are Responsible for Nuclear Targeting and Binding to Human Mitotic Chromosomes
J. Virol., April 15, 2001; 75(8): 3948 - 3959.
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BloodHome page
M.-Q. Du, H. Liu, T. C. Diss, H. Ye, R. A. Hamoudi, N. Dupin, V. Meignin, E. Oksenhendler, C. Boshoff, and P. G. Isaacson
Kaposi sarcoma-associated herpesvirus infects monotypic (IgM{lambda}) but polyclonal naive B cells in Castleman disease and associated lymphoproliferative disorders
Blood, April 1, 2001; 97(7): 2130 - 2136.
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J Natl Cancer Inst MonogrHome page
F. Samaniego, S. Pati, J. E. Karp, O. Prakash, and D. Bose
Human Herpesvirus 8 K1-Associated Nuclear Factor-kappa B-Dependent Promoter Activity: Role in Kaposi's Sarcoma Inflammation?
J Natl Cancer Inst Monographs, December 1, 2000; 2000(28): 15 - 23.
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J. S. Cannon, D. Ciufo, A. L. Hawkins, C. A. Griffin, M. J. Borowitz, G. S. Hayward, and R. F. Ambinder
A New Primary Effusion Lymphoma-Derived Cell Line Yields a Highly Infectious Kaposi's Sarcoma Herpesvirus-Containing Supernatant
J. Virol., November 1, 2000; 74(21): 10187 - 10193.
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A. Krithivas, D. B. Young, G. Liao, D. Greene, and S. D. Hayward
Human Herpesvirus 8 LANA Interacts with Proteins of the mSin3 Corepressor Complex and Negatively Regulates Epstein-Barr Virus Gene Expression in Dually Infected PEL Cells
J. Virol., October 15, 2000; 74(20): 9637 - 9645.
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BloodHome page
S. A. Keller, E. J. Schattner, and E. Cesarman
Inhibition of NF-kappa B induces apoptosis of KSHV-infected primary effusion lymphoma cells
Blood, October 1, 2000; 96(7): 2537 - 2542.
[Abstract] [Full Text] [PDF]


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J. Virol.Home page
B. Lubyova and P. M. Pitha
Characterization of a Novel Human Herpesvirus 8-Encoded Protein, vIRF-3, That Shows Homology to Viral and Cellular Interferon Regulatory Factors
J. Virol., September 1, 2000; 74(17): 8194 - 8201.
[Abstract] [Full Text] [PDF]


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BloodHome page
Y. Aoki, R. Yarchoan, J. Braun, A. Iwamoto, and G. Tosato
Viral and cellular cytokines in AIDS-related malignant lymphomatous effusions
Blood, August 15, 2000; 96(4): 1599 - 1601.
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J. Gen. Virol.Home page
Y.-J. Zhang, J.-H. Deng, C. Rabkin, and S.-J. Gao
Hot-spot variations of Kaposi's sarcoma-associated herpesvirus latent nuclear antigen and application in genotyping by PCR-RFLP
J. Gen. Virol., August 1, 2000; 81(8): 2049 - 2058.
[Abstract] [Full Text]


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JNCI J Natl Cancer InstHome page
R. Weiss and C. Boshoff
Addressing Controversies Over Kaposi's Sarcoma
J Natl Cancer Inst, May 3, 2000; 92(9): 677 - 679.
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JNCI J Natl Cancer InstHome page
J.-G. Judde, V. Lacoste, J. Briere, E. Kassa-Kelembho, E. Clyti, P. Couppie, C. Buchrieser, M. Tulliez, J. Morvan, and A. Gessain
Monoclonality or Oligoclonality of Human Herpesvirus 8 Terminal Repeat Sequences in Kaposi's Sarcoma and Other Diseases
J Natl Cancer Inst, May 3, 2000; 92(9): 729 - 736.
[Abstract] [Full Text] [PDF]


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J. Mullberg, T. Geib, T. Jostock, S. H. Hoischen, P. Vollmer, N. Voltz, D. Heinz, P. R. Galle, M. Klouche, and S. Rose-John
IL-6 Receptor Independent Stimulation of Human gp130 by Viral IL-6
J. Immunol., May 1, 2000; 164(9): 4672 - 4677.
[Abstract] [Full Text] [PDF]


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BloodHome page
F. Pica, A. Volpi, A. Serafino, M. Fraschetti, O. Franzese, and E. Garaci
Autocrine nerve growth factor is essential for cell survival and viral maturation in HHV-8-infected primary effusion lymphoma cells
Blood, May 1, 2000; 95(9): 2905 - 2912.
[Abstract] [Full Text] [PDF]


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H. Katano, T. Iwasaki, N. Baba, M. Terai, S. Mori, A. Iwamoto, T. Kurata, and T. Sata
Identification of Antigenic Proteins Encoded by Human Herpesvirus 8 and Seroprevalence in the General Population and among Patients with and without Kaposi's Sarcoma
J. Virol., April 15, 2000; 74(8): 3478 - 3485.
[Abstract] [Full Text] [PDF]


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L. Alexander, L. Denekamp, A. Knapp, M. R. Auerbach, B. Damania, and R. C. Desrosiers
The Primary Sequence of Rhesus Monkey Rhadinovirus Isolate 26-95: Sequence Similarities to Kaposi's Sarcoma-Associated Herpesvirus and Rhesus Monkey Rhadinovirus Isolate 17577
J. Virol., April 1, 2000; 74(7): 3388 - 3398.
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Clin. Cancer Res.Home page
T. Hideshima, D. Chauhan, G. Teoh, N. Raje, S. P. Treon, Y.-T. Tai, Y. Shima, and K. C. Anderson
Characterization of Signaling Cascades Triggered by Human Interleukin-6 versus Kaposi's Sarcoma-associated Herpes Virus-encoded Viral Interleukin 6
Clin. Cancer Res., March 1, 2000; 6(3): 1180 - 1189.
[Abstract] [Full Text]


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BloodHome page
N. Dupin, T. L. Diss, P. Kellam, M. Tulliez, M.-Q. Du, D. Sicard, R. A. Weiss, P. G. Isaacson, and C. Boshoff
HHV-8 is associated with a plasmablastic variant of Castleman disease that is linked to HHV-8-positive plasmablastic lymphoma
Blood, February 15, 2000; 95(4): 1406 - 1412.
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JEMHome page
T.-Y. Yang, S.-C. Chen, M. W. Leach, D. Manfra, B. Homey, M. Wiekowski, L. Sullivan, C.-H. Jenh, S. K. Narula, S. W. Chensue, et al.
Transgenic Expression of the Chemokine Receptor Encoded by Human Herpesvirus 8 Induces an Angioproliferative Disease Resembling Kaposi's Sarcoma
J. Exp. Med., February 7, 2000; 191(3): 445 - 454.
[Abstract] [Full Text] [PDF]


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A. J. Aguirre and E. S. Robertson
Epstein-Barr Virus Recombinants from BC-1 and BC-2 Can Immortalize Human Primary B Lymphocytes with Different Levels of Efficiency and in the Absence of Coinfection by Kaposi's Sarcoma-Associated Herpesvirus
J. Virol., January 15, 2000; 74(2): 735 - 743.
[Abstract] [Full Text] [PDF]


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BloodHome page
Y. Aoki and G. Tosato
Role of Vascular Endothelial Growth Factor/Vascular Permeability Factor in the Pathogenesis of Kaposi's Sarcoma-Associated Herpesvirus-Infected Primary Effusion Lymphomas
Blood, December 15, 1999; 94(12): 4247 - 4254.
[Abstract] [Full Text] [PDF]


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BloodHome page
K. D. Jones, Y. Aoki, Y. Chang, P. S. Moore, R. Yarchoan, and G. Tosato
Involvement of Interleukin-10 (IL-10) and Viral IL-6 in the Spontaneous Growth of Kaposi's Sarcoma Herpesvirus-Associated Infected Primary Effusion Lymphoma Cells
Blood, October 15, 1999; 94(8): 2871 - 2879.
[Abstract] [Full Text] [PDF]


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ChestHome page
A. Ibrahimbacha, M. Farah, and J. Saluja
An HIV-Infected Patient With Pleural Effusion
Chest, October 1, 1999; 116(4): 1113 - 1115.
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JEMHome page
S. W. Wong, E. P. Bergquam, R. M. Swanson, F. W. Lee, S. M. Shiigi, N. A. Avery, J. W. Fanton, and M. K. Axthelm
Induction of B Cell Hyperplasia in Simian Immunodeficiency Virus-Infected Rhesus Macaques with the Simian Homologue of Kaposi's Sarcoma-Associated Herpesvirus
J. Exp. Med., September 20, 1999; 190(6): 827 - 840.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
M. Teitell, M. A. Damore, G. G. Sulur, D. E. Turner, M.-H. Stern, J. W. Said, C. T. Denny, and R. Wall
TCL1 oncogene expression in AIDS-related lymphomas and lymphoid tissues
PNAS, August 17, 1999; 96(17): 9809 - 9814.
[Abstract] [Full Text] [PDF]


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M. Burger, J. A. Burger, R. C. Hoch, Z. Oades, H. Takamori, and I. U. Schraufstatter
Point Mutation Causing Constitutive Signaling of CXCR2 Leads to Transforming Activity Similar to Kaposi's Sarcoma Herpesvirus-G Protein-Coupled Receptor
J. Immunol., August 15, 1999; 163(4): 2017 - 2022.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
H. Katano, Y. Sato, T. Kurata, S. Mori, and T. Sata
High Expression of HHV-8-Encoded ORF73 Protein in Spindle-Shaped Cells of Kaposi's Sarcoma
Am. J. Pathol., July 1, 1999; 155(1): 47 - 52.
[Abstract] [Full Text] [PDF]


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JEMHome page
M. J. Endres, C. G. Garlisi, H. Xiao, L. Shan, and J. A. Hedrick
The Kaposi's Sarcoma-related Herpesvirus (KSHV)-encoded Chemokine vMIP-I is a Specific Agonist for the CC Chemokine Receptor (CCR)8
J. Exp. Med., June 21, 1999; 189(12): 1993 - 1998.
[Abstract] [Full Text] [PDF]


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BloodHome page
Y. Aoki, E. S. Jaffe, Y. Chang, K. Jones, J. Teruya-Feldstein, P. S. Moore, and G. Tosato
Angiogenesis and Hematopoiesis Induced by Kaposi's Sarcoma-Associated Herpesvirus-Encoded Interleukin-6
Blood, June 15, 1999; 93(12): 4034 - 4043.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
N. Dupin, C. Fisher, P. Kellam, S. Ariad, M. Tulliez, N. Franck, E. van Marck, D. Salmon, I. Gorin, J.-P. Escande, et al.
Distribution of human herpesvirus-8 latently infected cells in Kaposi's sarcoma, multicentric Castleman's disease, and primary effusion lymphoma
PNAS, April 13, 1999; 96(8): 4546 - 4551.
[Abstract] [Full Text] [PDF]


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R. P. Searles, E. P. Bergquam, M. K. Axthelm, and S. W. Wong
Sequence and Genomic Analysis of a Rhesus Macaque Rhadinovirus with Similarity to Kaposi's Sarcoma-Associated Herpesvirus/Human Herpesvirus 8
J. Virol., April 1, 1999; 73(4): 3040 - 3053.
[Abstract] [Full Text] [PDF]


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A. Matolcsy, R. G. Nador, E. Cesarman, and D. M. Knowles
Immunoglobulin VH Gene Mutational Analysis Suggests that Primary Effusion Lymphomas Derive from Different Stages of B Cell Maturation
Am. J. Pathol., November 1, 1998; 153(5): 1609 - 1614.
[Abstract] [Full Text] [PDF]


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JEMHome page
E. Geras-Raaka, A. Varma, H. Ho, I. Clark-Lewis, and M. C. Gershengorn
Human Interferon-{gamma}-inducible Protein 10 (IP-10) Inhibits Constitutive Signaling of Kaposi's Sarcoma-associated Herpesvirus G Protein-coupled Receptor
J. Exp. Med., July 20, 1998; 188(2): 405 - 408.
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BloodHome page
J. A. Reed, R. G. Nador, D. Spaulding, Y. Tani, E. Cesarman, and D. M. Knowles
Demonstration of Kaposi's Sarcoma-Associated Herpes Virus Cyclin D Homolog in Cutaneous Kaposi's Sarcoma by Colorimetric In Situ Hybridization Using a Catalyzed Signal Amplification System
Blood, May 15, 1998; 91(10): 3825 - 3832.
[Abstract] [Full Text] [PDF]


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J Natl Cancer Inst MonogrHome page
L. D. Kaplan
Clinical Management of Human Immunodeficiency Virus-Associated Non-Hodgkin's Lymphoma
J Natl Cancer Inst Monographs, April 1, 1998; 1998(23): 101 - 105.
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BloodHome page
H. Asou, J. W. Said, R. Yang, R. Munker, D. J. Park, N. Kamada, and H. P. Koeffler
Mechanisms of Growth Control of Kaposi's Sarcoma-Associated Herpes Virus-Associated Primary Effusion Lymphoma Cells
Blood, April 1, 1998; 91(7): 2475 - 2481.
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JEMHome page
E. Geras-Raaka, L. Arvanitakis, C. Bais, E. Cesarman, E. A. Mesri, and M. C. Gershengorn
Inhibition of Constitutive Signaling of Kaposi's Sarcoma-associated Herpesvirus G Protein-Coupled Receptor by Protein Kinases in Mammalian Cells in Culture
J. Exp. Med., March 2, 1998; 187(5): 801 - 806.
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