期刊
PATHOLOGY RESEARCH AND PRACTICE
卷 202, 期 8, 页码 609-615出版社
ELSEVIER GMBH, URBAN & FISCHER VERLAG
DOI: 10.1016/j.prp.2006.04.006
关键词
Epstein-Barr virus; lymph node; middle-aged; elderly; autoimmune disease; histopathology
类别
Six cases were studied to further clarify clinicopathological findings of Epstein-Barr virus (EBV)-related lymph node lesions showing autoimmune disease-like clinicopathological findings (EBVAID) in middle-aged and elderly patients. The patients, four males and two females, ranged in age from 53 to 74 years, with a median age of 62 years. Clinically, they were characterized by systemic lymphadenopathy, Bsymptoms, polyclonal hypergammaglobulinemia, elevated serum lactate dehydrogenese and a transient presence of various autoantibodies, as well as an infrequent presence of atypical lymphocytosis in peripheral blood. Two cases were associated with idiopathic thrombocytopenic purpura. The clinical course was self-limiting. Histologically, three patterns could be delineated: pattern A, follicular hyperplasia with pronounced arborizing vasculature in the expanded paracortex (n = 3); pattern B, follicular hyperplasia with pronounced interfollicular B-immunoblastic/plasma cell proliferation (n = 2); and pattern C, paracortical hyperplasia containing numerous large transformed lymphocytes (n = 1). In situ hybridization demonstrated a varying number of EBV-infected lymphocytes in the germinal center and in the interfollicular area. Polymerase chain reaction analysis demonstrated that neither clonal rearrangement of T-cell receptor gamma-chain nor immunoglobulin heavy-chain rearrangement was detected in the three cases examined. Although EBVAID appears to be rare in middle-aged and older adults, EBVAID exhibits histological variations and should be added to the differential diagnosis of various atypical or malignant lymphoproliferative disorders, in particular autoimmune-disease-associated lymphadenopathy and angioimmunoblastic T-cell lymphoma with a hyperplastic germinal center in middle-aged and elderly patients. (c) 2006 Elsevier GmbH. All rights reserved.
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