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一名慢性活动性EB病毒感染且对蚊虫叮咬过敏患者的血管病变:蚊虫叮咬诱发血管炎,伴有非肿瘤性EB病毒阳性细胞浸润,随后发展为具有血管破坏的自然杀伤/T细胞淋巴瘤。

Vascular lesion in a patient of chronic active Epstein-Barr virus infection with hypersensitivity to mosquito bites: vasculitis induced by mosquito bite with the infiltration of nonneoplastic Epstein-Barr virus-positive cells and subsequent development of natural killer/T-cell lymphoma with angiodestruction.

作者信息

Kanno Hiroyuki, Onodera Hanae, Endo Mikiya, Maeda Fumihiko, Chida Shoichi, Akasaka Toshihide, Sawai Takashi

机构信息

Department of Pathology, Iwate Medical University School of Medicine, Morioka 020-8505, Japan.

出版信息

Hum Pathol. 2005 Feb;36(2):212-8. doi: 10.1016/j.humpath.2004.11.005.

Abstract

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.

摘要

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。

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