Atypical clonal T-cell proliferation in infectious mononucleosis

Ummekalsoom R. Malik, Leslie Oleksowicz, Janice P. Dutcher, Howard Ratech, Michael J. Borowitz, Peter H. Wiernik

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


An atypical case of infectious mononucleosis characterized by fever, acute tonsillitis, and bilateral cervical adenopathy is reported in a previously healthy young man. Although serology was positive for the Epstein-Barr virus, the patient did not display peripheral blood lymphocytosis or atypical, reactive lymphocytes. The patient's tonsilar tissue revealed an expanded T-zone of diffuse, monomorphous lymphocytes suggestive of lymphoma. Immunophenotypic analysis of the tonsilar tissue demonstrated more than 90% expression of pan-T markers, while pan-B markers were positive in 5-10% of the interfollicular T-zone cells and in 90% of germinal centre cells. In situ hybridization with a probe specific for EBER1 demonstrated positive staining in approximately 1% of the interfollicular tonsilar lymphocytes. Finally, Southern blot analysis of tonsilar tissue demonstrated a clonal rearrangement of the T-cell receptor gene. The patient recovered from his infection and remains in good health years after presenting with his illness. This case illustrates that T-cell clonality must be evaluated with caution in the setting of a viral infection and can occur in association with benign, self-limited infectious mononucleosis.

Original languageEnglish (US)
Pages (from-to)207-213
Number of pages7
JournalMedical Oncology
Issue number4
StatePublished - Dec 1996


  • Epstein-Barr virus
  • T-cell lymphoproliferation
  • T-cell receptor rearrangement
  • clonality
  • infectious mononucleosis

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research


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