case_images: PMC3583113_01
case_images: Liver biopsy: (a) high power view of H&E-stained section of liver core biopsy showing focally prominent mixed inflammatory cell infiltrate comprised of small lymphocytes, plasma cells, neutrophils, and rare large cells with irregular nuclear contours and prominent eosinophilic nucleoli. Arrows point to large atypical lymphocytes (100x magnification). (b) EBV in situ hybridization analysis for the detection of EBV-encoded RNA (EBER) reveals abundant positive cells with dark nuclear staining, consistent with EBV infection. Arrow points to a large atypical EBV-positive cell (50x magnification).
case_images: CRIM.MEDICINE2013-318358.001.jpg
case_images: PMC3583113_01_CRIM.MEDICINE2013-318358.001.jpg
case_images: fig1
case_images: LN sampling for a more adequate specimen, but a multidisciplinary group meeting concluded that ultrasound-guided needle percutaneous liver parenchyma and periportal LNs biopsies should be performed due to lower invasiveness and higher diagnostic yield potential. Liver and retroperitoneal LN core biopsies revealed an atypical lymphoid infiltrate (Figures 1(a) and 2(a)). Furthermore, in situ hybridization analysis of the liver and LN tissue specimens was diffusely positive for EBV-encoded RNA (Figures 1(b) and 2(b)), further confirming EBV as the cause of her constellation of symptoms in our seronegative patient.