Kanno Hiroyuki, Onodera Hanae, Endo Mikiya, Maeda Fumihiko, Chida Shoichi, Akasaka Toshihide, Sawai Takashi
Department of Pathology, Iwate Medical University School of Medicine, Morioka 020-8505, Japan.
Hum Pathol. 2005 Feb;36(2):212-8. doi: 10.1016/j.humpath.2004.11.005.
This report describes a vasculitis and subsequently developing angiodestructive lymphoma in an 11-year-old Japanese-Filipino girl exhibiting mosquito allergy with the background of chronic active Epstein-Barr virus (EBV) infection. She developed necrotic skin ulcer at the site of mosquito bite, and histopathological examination revealed EBV-positive mononuclear cell infiltration throughout the wall of small-sized muscular artery. These EBV-positive lymphoid cells were oligoclonal in Southern blot analysis for EBV terminal repeats. Effectiveness of steroid therapy also supports the nonneoplastic nature. Approximately 1 year later, she developed progressive large skin ulcer without mosquito bites. Microscopically, the angiocentric or angiodestructive pattern of EBV-positive atypical cells supported the diagnosis of extranodal natural killer/T-cell lymphoma. Southern blot analysis revealed the monoclonal neoplastic nature of EBV-positive cells. In contrast to the primary mosquito bite lesion, natural killer/T-cell lymphoma cells exhibited the higher expression of EBV latent membrane protein 1 mRNA and the apparent protein expression detected by immunohistochemistry.
本报告描述了一名11岁的日裔菲律宾女孩,她患有蚊子过敏,伴有慢性活动性爱泼斯坦-巴尔病毒(EBV)感染,先后出现了血管炎及随后发展的血管破坏性淋巴瘤。她在蚊虫叮咬部位出现坏死性皮肤溃疡,组织病理学检查显示在小肌性动脉壁全层有EBV阳性单核细胞浸润。在针对EBV末端重复序列的Southern印迹分析中,这些EBV阳性淋巴细胞是寡克隆性的。类固醇治疗的有效性也支持其非肿瘤性本质。大约1年后,她在没有蚊虫叮咬的情况下出现了进行性大皮肤溃疡。显微镜下,EBV阳性非典型细胞的血管中心性或血管破坏性模式支持结外自然杀伤/T细胞淋巴瘤的诊断。Southern印迹分析显示EBV阳性细胞具有单克隆肿瘤性质。与原发性蚊虫叮咬病变不同,自然杀伤/T细胞淋巴瘤细胞表现出EBV潜伏膜蛋白1 mRNA的高表达,并且通过免疫组织化学检测到明显的蛋白表达。