Detection of Epstein-Barr virus early replicative phase using monoclonal antibody BZ-1 in oral hairy leukoplakia and other hyperkeratotic oral mucosal lesions: a retrospective study.

The early replicative phase of Epstein-Barr virus (EBV) was detected by immunohistochemistry, in addition to routine histology with hematoxylin eosin staining, in formalin fixed, paraffin-embedded archive specimens of 97 hyperkeratotic lesions including oral hairy leukoplakia (HL) in order to assess whether EBV is specific to HL, or if it occurs in other hyperkeratotic lesions of the oral mucosa. Monoclonal antibody (MAb) BZ-1 directed against the BZLF-1 gene product of EBV was used for immunostaining by the avidin-biotin peroxidase technique. The reaction was visualized with DAB/H2O2 solution and counterstained with PAS stain to detect any coexisting of hyphae of Candida. Eight lesions were reactive with BZ-1, confirming a diagnosis of HL, although the total number of lesions with koilocytoid features was 33. Seventy percent of the patients with confirmed HL lesions were HIV-seropositive, and 50% of the HL lesions were associated with Candida hyphae. One third of the lesions with koilocytoid features were associated with hyphae of Candida. Only one renal transplant patient had HL, confirmed by a positive BZ-1 reaction, although 60% of the hyperkeratotic lesions showed koilocytoid features in a subgroup of 15 patients with renal transplants.