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Complex interplay of Epstein-Barr virus-associated lymphoproliferative disorder, angioimmunoblastic T-cell lymphoma, and paraneoplastic syndromes: A case report

Year: 2025

Type: article

Abstract: This case report describes a 66-year-old female with a complex medical history, including Epstein-Barr Virus-Associated Lymphoproliferative Disorder (EBV+ LPD), Angioimmunoblastic T-cell Lymphoma (AITL), and early-stage endometrial adenocarcinoma, who initially presented with Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE). Her clinical course was marked by a cutaneous manifestation of EBV+ polymorphic B-cell LPD at a prior lumpectomy site, mimicking inflammatory breast carcinoma. The subsequent development of multiple malignancies and progressive lymphadenopathy, culminating in a delayed diagnosis of AITL, underscores the complexity of immune dysregulation in oncologic patients. Elevated vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of AITL, EBV-associated lymphoproliferative disorders, RS3PE, and endometrial adenocarcinoma, suggesting a potential shared pathway contributing to her multifaceted disease course. The presence of RS3PE in this setting raises questions about its role as a paraneoplastic marker in hematologic and solid malignancies. Ultimately, this case emphasizes the need for a multidisciplinary approach in evaluating atypical presentations, particularly in patients with immune dysfunction, multiple neoplasms, and VEGF-driven disease processes.

Source: Human Pathology Reports

DOI: 10.1016/j.hpr.2025.300791