We appreciate the concerns of Tan et al. In our report of enteropathy associated T-cell lymphomas (EATL) [1], we included three cases where Epstein–Barr virus (EBV) infection of the lymphoma cells was demonstrable. We were indeed mindful that cytotoxic T-cell lymphomas with EBV infection could also be classified as natural killer/T-cell (NK/T-cell) lymphomas, nasal type; according to World Health Organization classification [2]. However, none of these cases showed histopathological features suggestive of NK/T-cell lymphomas. EBV was detected in the majority of lymphoma cells. Clonal T-cell receptor gene rearrangement was found, which according to our experience was unusual in NK/T-cell lymphomas in our population. Their presentations were also indistinguishable from other cases of EATL. Therefore, we felt that these cases should not be preemptively classified as NK/T-cell lymphoma. The inclusion of these cases in our series might prompt other investigators to examine carefully if a small fraction of EATL cases might be EBV-positive. This approach will enrich our understanding of intestinal T-cell lymphomas in a population where celiac disease is not found. Finally, we also believe that pathological entities are best defined by relevant clinical syndromes than the presence or absence of a viral infection.


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  • 1
    Tse E,Gill H,Loong F, et al. Type II enteropathy-associated T-cell lymphoma: A multicenter analysis from the Asia Lymphoma Study Group. Am J Hematol 2012; 87: 663668.
  • 2
    Chan JK,Quintanilla-Martinez L,Ferry JA,Peh SC. Extranodal NK/T-cell lymphoma, nasal type. In: Swerdlow SH,Campo E,Harris NL, et al., editors. WHO Classification of Tumours of the Haematopoietic and Lymphoid Tissues, 4th ed. Lyon: IARC; 2008. pp 285288.

Yok-Lam Kwong*, * Department of Medicine, Queen Mary Hospital, Hong Kong.