{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T14:08:19Z","timestamp":1767276499807,"version":"3.37.3"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T00:00:00Z","timestamp":1486425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Richter transformation (<jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>) occurs in 5\u201310% of patients with chronic lymphocytic leukaemia\/small lymphocytic lymphoma (<jats:styled-content style=\"fixed-case\">CLL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SLL<\/jats:styled-content>), and is associated with a poor outcome. The histological manifestations of <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content> are variable, and include an increase in the proportion of prolymphocytes, immunoblasts, and other pleomorphic cells, along with an increased proliferation rate and often necrosis. Rarely, superimposed herpes simplex virus (<jats:styled-content style=\"fixed-case\">HSV<\/jats:styled-content>) infection involving lymph nodes in patients with <jats:styled-content style=\"fixed-case\">CLL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SLL<\/jats:styled-content> may mimic <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content> clinically and histologically. In this study, we describe four cases of <jats:styled-content style=\"fixed-case\">CLL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SLL<\/jats:styled-content> with superimposed <jats:styled-content style=\"fixed-case\">HSV<\/jats:styled-content> lymphadenitis, and we review the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We describe the clinicopathological and immunophenotypic findings of four cases of <jats:styled-content style=\"fixed-case\">CLL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SLL<\/jats:styled-content> with superimposed <jats:styled-content style=\"fixed-case\">HSV<\/jats:styled-content> infection. The patients presented with B\u2010type symptoms, and laboratory and imaging findings suggested progression of lymphoma. Histologically, there were geographical areas of necrosis and increased numbers of prolymphocytes and immunoblasts, in some areas forming sheets, with increased mitotic figures and a high proliferation (Ki67) rate. However, the necrotic regions were associated with acute inflammatory cells and larger cells, mostly necrotic, showing viral cytopathic effects. Therapy with antiviral agents resulted in improvement of clinical symptoms and laboratory and imaging findings. Additionally, we identified 11 cases of <jats:styled-content style=\"fixed-case\">CLL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SLL<\/jats:styled-content> with superimposed <jats:styled-content style=\"fixed-case\">HSV<\/jats:styled-content> infection described in the English\u2010language literature, and integrated the cases that we report here into this wider context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Herpes simplex virus infection of lymph nodes in patients with <jats:styled-content style=\"fixed-case\">CLL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SLL<\/jats:styled-content> results in clinicopathological and radiological findings that may mimic <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>. It is essential to refrain from misclassifying these cases as <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>, as patients can respond remarkably well to antiviral therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.13137","type":"journal-article","created":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T07:56:43Z","timestamp":1480579003000},"page":"821-831","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Herpes simplex infection simulating Richter transformation: a series of four cases and review of the literature"],"prefix":"10.1111","volume":"70","author":[{"given":"Alireza","family":"Salem","sequence":"first","affiliation":[{"name":"Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8980-3202","authenticated-orcid":false,"given":"Sanam","family":"Loghavi","sequence":"additional","affiliation":[{"name":"Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2621-3584","authenticated-orcid":false,"given":"Joseph D","family":"Khoury","sequence":"additional","affiliation":[{"name":"Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5309-7104","authenticated-orcid":false,"given":"Rose Lou Marie C","family":"Agbay","sequence":"additional","affiliation":[{"name":"Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey L","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6577-8006","authenticated-orcid":false,"given":"L Jeffrey","family":"Medeiros","sequence":"additional","affiliation":[{"name":"Department of Hematopathology The University of Texas MD Anderson Cancer Center Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,2,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24473"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000561"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970315)79:6<1211::AID-CNCR21>3.0.CO;2-1"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11899-007-0036-9"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2008.07166.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2013.03.012"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-09-302174"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2012.664845"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-03-489518"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12458"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22121"},{"key":"e_1_2_7_13_1","first-page":"785","article-title":"Hodgkin's variant of Richter transformation in chronic lymphocytic leukemia; 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