Infectious Mononucleosis Diagnosis by In Situ Hybridization in Two Cases With Atypical Features

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Abstract
Two cases of infectious mononucleosis are reported in which in situ hybridization studies were of use to distinguish this disorder from non-Hodgkin's lymphoma. One patient was an 80-year-old man with a tonsillar mass that histologically resembled non-Hodgkin's lymphoma and, on fixed tissue immunohistochemistry, appeared to contain a population of cells anomalously coexpressing the B-cell marker L26 and the T-cell marker Leu-22, suggesting diffuse large-cell non-Hodgkin's lymphoma. The second patient was a 43-year-old woman with inguinal lymphadenopathy that, on histologic examination, also mimicked diffuse large-cell lymphoma. In situ hybridization studies for Epstein-Barr virus revealed both cases to possess EBV DNA in a pattern characteristic of infectious mononucleosis. In addition, in situ hybridization studies for immunoglobulin light-chain mRNA demonstrated a polyclonal pattern of kappa and lambda mRNA expression. This report demonstrates the utility of the in situ hybridization technique as an adjunct to routine diagnosis.

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