移植肺EB病毒感染相关移植后淋巴组织增殖性疾病的临床病理学分析  

Epstein-Barr virus infection-related post-transplant lymphoproliferative disorders in transplanted lung:a clinicopathological analysis

作　　者：李霞[1] 邹冰清 周婧[1] 史灵芝[2] 范立[2] 杨航[2] 杨树东[1] Li Xia;Zou Bingqing;Zhou Jing;Shi Lingzhi;Fan Li;Yang Hang;Yang Shudong(Department of Pathology,Wuxi People′s Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu Province,China;Department of Pulmonary and Critical Care Medicine,Lung Transplantation Center,Wuxi People′s Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu Province,China)

机构地区：[1]南京医科大学附属无锡市人民医院病理科,214023 [2]南京医科大学附属无锡市人民医院肺移植中心呼吸与危重症医学科,214023

出　　处：《中华病理学杂志》2021年第5期465-469,共5页Chinese Journal of Pathology

基　　金：江苏省省级高层次创新创业人才引进计划专项资金(2019ZBQ);南京医科大学科技发展基金(NMUB2019292)。

摘　　要：目的探讨移植肺发生移植后淋巴组织增殖性疾病(post-transplant lymphoproliferative disorders,PTLD)的临床及病理特征,提高对其诊断和治疗水平。方法收集南京医科大学附属无锡市人民医院2014至2019年诊断的3例肺移植后移植肺PTLD的病例,分析3例患者的临床及病理特征,行HE染色、免疫组织化学EnVision法染色及原位杂交检测,结合PTLD的相关文献进行分析。结果3例患者肺移植术前均为慢性阻塞性肺疾病,接受双肺移植后均使用抗排斥药物他克莫司或吗替麦考酚酯,并联合抗病毒和/或利妥昔单抗治疗,从接受移植到诊断PTLD的时间分别为4年、7个月、5个月。而确诊后随访生存时间分别为1个月死亡、5个月死亡、随访1年仍状态良好;病理组织学类型均为单形性B细胞型PTLD(弥漫性大B细胞淋巴瘤,非特指),EB病毒原位杂交均阳性,其中1例晚发型患者合并单纯疱疹病毒感染。结论肺移植后的移植肺发生的PTLD,在形态和临床特征上有其独特性,与EB病毒感染密切相关,术前因慢性阻塞性肺疾病移植的患者可能更易发生PTLD,而晚发型患者病变见于肺门部,预后相对较差。Objective To investigate the clinicpathological characteristics of post-transplant lymphoproliferative disorders(PTLD)in transplanted lung,and to improve its diagnosis and treatment.Methods The clinicopathological characteristics of PTLD in three transplanted lungs were evaluated at Wuxi People′s Hospital Affiliated to Nanjing Medical University from 2014 to 2019.HE,immunohistochemical staining and in situ hybridization were performed.The relevant literature of PTLD was reviewed.Results All three patients had chronic obstructive pulmonary disease(COPD)before lung transplantation.After receiving both lung transplants,they were all treated with anti-rejection drugs tacrolimus or mycophenolate mofetil,and combined with antiviral and/or rituximab.The time from transplantation to diagnosis of PTLD was four years,seven months,and five months,respectively.Two patients died one month and five months after initial diagnosis,and one patient was alive with no disease after one year.Histologically,all cases were monomorphic B-cell PTLD(diffuse large B-cell lymphoma,unspecified),and the tumor cells were positive for Epstein-Barr virus by in situ hybridization;one of the late-onset patients had herpes simplex virus infection.Conclusions PTLD in the post-transplant lung tissue shows unique morphology and clinical characteristics,and is closely related to Epstein-Barr virus infection.Patients who receive lung transplantation due to COPD are more susceptible to develop PTLD,while late-onset ones occur more commonly in the hilum of lungs,and the prognosis is relatively poor.

关 键 词：肺移植 淋巴组织增殖性疾病 疱疹病毒4型 人 

分 类 号：R655.3[医药卫生—外科学]