消化道慢性活动性EB病毒感染3例临床病理学分析  

Chronic active Epstein-Barr virus infection in the gastrointestinal tract:a clinicopathological study of three cases

作　　者：陈文 宋国新 王震 Chen Wen;Song Guoxin;Wang Zhen(Department of Pathology,Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University),Nanjing 210029,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院)病理科,南京210029

出　　处：《中华病理学杂志》2022年第10期1019-1023,共5页Chinese Journal of Pathology

摘　　要：目的探讨消化道慢性活动性EB病毒感染(chronic active Epstein-Barr virus infection,CAEBV)的临床病理学特征及鉴别诊断。方法收集江苏省人民医院(南京医科大学第一附属医院)病理科2018年12月至2020年8月间诊断的3例消化道CAEBV。对3例消化道CAEBV行HE染色、免疫组织化学染色及原位杂交检测,并复习相关文献。结果3例患者均为男性,年龄分别为33、32、31岁。所有患者均间断发热伴反复腹泻持续数年,以及外周血EB病毒DNA拷贝数持续升高。内镜下,所有患者肠道均受累呈溃疡状病变,1例食管同时受累呈结节样病变。光镜下,3例黏膜活检均见中等量的多形性炎性细胞浸润,其中淋巴样细胞无或仅轻度异型,例3见深在裂隙状溃疡。肿瘤细胞均表达CD3和T细胞胞质内抗原1,CD5丢失、CD56阴性;例1和例2中病变细胞呈CD4和CD8均阴性,例3病变细胞CD4阳性而CD8阴性;EB病毒编码的RNA原位杂交均为阳性。例1、例2分别随访16和17个月病变无明确进展,例3随访22个月后进展为结外NK/T细胞淋巴瘤。结论消化道CAEBV罕见,后期有转化为结外NK/T细胞淋巴瘤可能,其临床症状及组织学形态与炎症性肠病类似,尤其在小活检标本中极易混淆,重要的是整合临床病理、影像学及实验室资料以避免误诊。Objective To study the clinicopathological features of chronic active Epstein-Barr virus infection(CAEBV)in the digestive tract and to discuss its differential diagnosis.Methods The clinical data of 3 cases of CAEBV in the digestive tract diagnosed in Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University),Nanjing,China from December 2018 to August 2020 were collected.Three cases of CAEBV were evaluated using histology,immunohistochemistry and in situ hybridization.The related literature was reviewed.Results Three patients were all males,aged 33,32 and 31 years,respectively.All patients had a history of intermittent fever and repeated diarrhea for the past years with persistent increase in EB viral load(DNA copies)in peripheral blood.Endoscopically,intestinal tract was involved in all cases with ulcers,and esophagus was involved concurrently in 1 case showing nodular lesions.Microscopically,there were moderate polymorphic inflammatory infiltrate with lymphoid component displaying no or mild atypia in all cases and deep fissuring ulcers in one case(case 3).All tumor cells were positive for CD3 and TIA-1,and negative for CD56 and CD5.Cases 1 and 2 showed CD4-/CD8-,whereas case 3 displayed CD4+/CD8-.In situ hybridization for Epstein-Barr virus-encoded RNA was positive in all 3 cases.Follow-up data showed that cases 1 and 2 were free of disease progression at the end of follow-up(16 months and 17 months,respectively).However,case 3 progressed to extranodal NK/T-cell lymphoma 22 months after the initial diagnosis.Conclusions CAEBV of the digestive tract is a rare lymphoid proliferative disorder with potential transformation to extranodal NK/T-cell lymphoma.It is a great mimicker of inflammatory bowel disease,especially in small biopsy specimens.It is important to integrate clinicopathological,radiological and laboratory data to avoid misdiagnosis.

关 键 词：肠道病毒感染 疱疹病毒4型 人 疱疹病毒科感染 内窥镜检查 胃肠道 

分 类 号：R57[医药卫生—消化系统]