Kojima Masaru, Motoori Tadashi, Itoh Hideaki, Shimizu Kazuhiko, Iijima Misa, Tamaki Yoshio, Murayama Kayoko, Ohno Yoshihiro, Yoshida Katsue, Masawa Nobuhide, Nakamura Shigeo
Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, 617-1 Takabayashinishi-cho, Ohta, Japan.
Int J Surg Pathol. 2005 Jul;13(3):273-8. doi: 10.1177/106689690501300307.
Among systemic rheumatic diseases (SRDs), lymphadenopathy is frequently found in patients with rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs) may occur in patients following methotrexate therapy for RA and dermatomyositis (DM). However, little is known about the distribution of EBV in reactive LPDs in patients with SRDs who had no history of methotrexate therapy. We analyzed 49 such patients (SLE=25, RA=23, DM=1) for the presence and distribution of EBV+ cells using Epstein-Barr virus (EBV)-encoded small RNA (EBER) specific in situ hybridization. A positive signal for EBERs was identified in 9 (SLE=5, RA=4) (18%) of 49 cases, and 3 main distribution patterns of EBER+cells could be delineated: pattern A, more than 500 EBER-positive cells were located in the germinal centers as well as interfollicular area (SLE=2); pattern B, EBER + cells were located in a few germinal centers (RA=2); and pattern C, up to 100 EBER+ cells were located in the interfollicular area (SLE=3, RA=2). Recent EBV infection may be a cause of lymph node lesion in only 2 cases of patients with pattern A. However, the pathognomonic significance of pattern B and pattern C EBER + cell distribution patterns still remains unclear. Our study indicates that the underlying immune deficits of patients with SRDs may also play an important role in the development of EBV-associated LPDs in SRDs, as previously suggested by several authors.
在系统性风湿性疾病（SRD）中，类风湿关节炎（RA）和系统性红斑狼疮（SLE）患者常出现淋巴结病。在接受甲氨蝶呤治疗的RA和皮肌炎（DM）患者中，可能会发生与爱泼斯坦-巴尔病毒（EBV）相关的淋巴增殖性疾病（LPD）。然而，对于无甲氨蝶呤治疗史的SRD患者反应性LPD中EBV的分布情况知之甚少。我们使用EBV编码的小RNA（EBER）特异性原位杂交技术，分析了49例此类患者（SLE = 25例，RA = 23例，DM = 1例）中EBV+细胞的存在和分布情况。在49例病例中有9例（SLE = 5例，RA = 4例）（18%）检测到EBER阳性信号，并且可以勾勒出EBER+细胞的3种主要分布模式：模式A，超过500个EBER阳性细胞位于生发中心以及滤泡间区域（SLE = 2例）；模式B，EBER+细胞位于少数生发中心（RA = 2例）；模式C，多达100个EBER+细胞位于滤泡间区域（SLE = 3例，RA = 2例）。仅2例模式A患者的淋巴结病变可能是近期EBV感染所致。然而，模式B和模式C的EBER+细胞分布模式的病理诊断意义仍不清楚。我们的研究表明，正如几位作者之前所指出的，SRD患者潜在的免疫缺陷在SRD中与EBV相关的LPD的发生中可能也起重要作用。
