艾滋病患者CMV感染致消化道假瘤5例临床病理分析  

Clinicopathological analysis of 5 cases of digestive tract pseudotumor caused by CMV infection in AIDS patients

作　　者：肖艳华[1] 李凌华[2] 苏锦清 粟海霞 欧志涛[3] 肖冠英[1] XIAO Yan-hua;LI Ling-hua;SU Jin-qing;SU Hai-xia;OU Zhi-tao;XIAO Guan-ying(Department of Pathology,Guangzhou Eighth People’s Hospital of Guangdong Province,Guangzhou 510440,China;Infectious Disease Center,Guangzhou Eighth People’s Hospital of Guangdong Province,Guangzhou 510440,China;Department of Gastroenterology,Guangzhou Eighth People’s Hospital of Guangdong Province,Guangzhou 510440,China)

机构地区：[1]广东省广州市第八人民医院病理科,广州510440 [2]广东省广州市第八人民医院感染病中心,广州510440 [3]广东省广州市第八人民医院消化内科,广州510440

出　　处：《临床与实验病理学杂志》2021年第2期157-161,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：“十三五”国家科技重大专项(2018ZX10302103-002、2018ZX10302104-001-007)。

摘　　要：目的探讨艾滋病(acquired immune deficiency syndrome, AIDS)患者巨细胞病毒(cytomegalovirus, CMV)感染导致消化道假瘤的临床病理特征、诊断与鉴别诊断。方法 5例患者均经内镜活检,采用HE、免疫组化染色,计数CD4阳性细胞,分析AIDS患者CMV感染致消化道假瘤的临床病理特征、免疫表型,并复习相关文献。结果 5例患者临床均表现为溃疡型肿物,镜下未见肿瘤细胞,可见黏膜水肿、坏死、炎症及溃疡形成,其间大量炎性肉芽组织、纤维血管组织增生或肉芽肿形成,导致局部形成肿块或假瘤样表现;可见病毒包涵体,形成"鹰眼"样征象,部分包涵体形态不典型;CMV经免疫组化染色可以更好地显示病毒包涵体。有3例患者外周血CMV-DNA水平增高;5例患者外周血CD4^(+)T淋巴细胞计数1~72个/μL;5例患者消化道黏膜CD4^(+)T淋巴细胞阳性标记指数为1.53%±1.27%,稍低于AIDS非特异性病变患者(3.6%±0.47%)(P<0.01);显著低于无免疫缺陷患者(27.8%±4.6%)(P<0.01)。结论在AIDS或免疫缺陷患者中出现消化道肿瘤特别是内镜下提示为溃疡型肿瘤,伴血CMV-DNA水平升高(也可正常)及CD4^(+)T淋巴细胞明显减少(细胞计数<100个/μL)时,需警惕CMV感染的可能,临床与病理医师应重视内镜下活检,并行HE及免疫组化染色或行原位杂交检测。Purpose To analyze the clinicopathological characteristics,diagnosis and differential diagnosis of pseudotumor of digestive tract caused by cytomegalovirus(CMV)infection in acquired immune deficiency syndrome(AIDS)patients.Methods All patients underwent endoscopic biopsy.HE and immunohistochemical staining was used to count CD4 positive cells.The clinicopathological features and immunophenotype of gastrointestinal pseudotumor caused by CMV infection in AIDS patients were analyzed,and the related literatures was reviewed.Results Five cases of which clinically suspected digestive tract tumor were found.5 patients were ulcerative masses in the clinical manifestations.Histopathology showed no obvious tumor cells.Mucosal edema,necrosis,inflammation and ulcer were observed,a large number of inflammatory granulation tissue,fibrovascular tissue hyperplasia or granuloma formation led to the formation of local mass or pseudotumor,virus inclusion bodies were seen,forming"eagle eye"sign,some inclusion bodies were not typical.Immunohistochemical staining of CMV could better show the inclusion bodies of CMV.The levels of CMV-DNA in peripheral blood of 3 patients increased.The levels of CD4+T lymphocytes in peripheral blood of 5 patients were between 1-72/μL.The positive index of CD4+T lymphocytes in the mucosa of patients with digestive tract pseudotumor caused by CMV infection was 1.53%±1.27%,slightly lower than that of patients with non-specific disease of AIDS(3.6%±0.47%,P<0.01),significantly lower than that of patients without immune deficiency(27.8%±4.6%,P<0.01).Conclusion When digestive tract tumors appear in AIDS patients or immune deficiency patients,especially ulcerative tumors under endoscopy,with elevated blood CMV-DNA level(also normal)and obvious decrease of CD4+T lymphocytes(<100/μL),it is necessary to pay attention to the possibility of CMV infection.Clinicians and pathologists should pay attention to endoscopic biopsy,HE staining andimmunohistochemical staining or in situ hybridization for confirmation.

关 键 词：艾滋病 巨细胞病毒 消化道肿瘤 假瘤 

分 类 号：R365[医药卫生—病理学]