Ho K L, Gottlieb C, Zarbo R J
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202.
Clin Neuropathol. 1991 May-Jun;10(3):127-33.
Association of glioma with AIDS is unusual. Cytomegalovirus (CMV) infection of glioma has not been documented in AIDS or non-AIDS patients. We present the case of a 37-year-old homosexual, HIV positive man who had a history of pneumocystis pneumonia and died of disseminated CMV infection and an anaplastic astrocytoma (5 x 5 x 4 cm) of the left temporal lobe. Part of the tumor was severely infected by CMV as demonstrated by immunohistochemical stain. Intranuclear and intracytoplasmic CMV inclusions were present in the cytomegalic cells whose astrocytic nature was identified by immunostain for GFAP. CMV-bearing cells were scattered throughout the astrocytoma but were rarely seen outside the tumor. CMV-bearing endothelial cells were seen in several capillaries within the tumor. Microglial nodules were scattered within the tumor and some contained CMV-infected cells. Many multinucleated giant cells (MNGC) with circularly arranged small nuclei were present in the infected area of the tumor and some showed fusion with cytomegalic cells. MNGC were absent outside the tumor. CMV ependymitis was not seen. The findings suggest that a) astrocytoma cells are permissive to CMV infection, b) that they may be more susceptible to CMV infection and replication than normal brain tissue, and c) the hyperplastic endothelia and abnormal blood brain barrier of the astrocytoma may facilitate the entry of CMV itno the tumor.
胶质瘤与艾滋病的关联并不常见。在艾滋病患者或非艾滋病患者中，均未记录到胶质瘤的巨细胞病毒（CMV）感染情况。我们报告一例37岁的同性恋HIV阳性男性病例，该患者有肺孢子菌肺炎病史，死于播散性CMV感染及左颞叶间变性星形细胞瘤（5×5×4 cm）。免疫组化染色显示肿瘤部分区域被CMV严重感染。巨细胞内可见核内和胞质内CMV包涵体，通过胶质纤维酸性蛋白（GFAP）免疫染色确定其星形细胞性质。含CMV的细胞散布于整个星形细胞瘤，但在肿瘤外很少见。在肿瘤内的几条毛细血管中可见含CMV的内皮细胞。微胶质结节散布于肿瘤内，部分含有CMV感染细胞。在肿瘤感染区域有许多小核呈环状排列的多核巨细胞（MNGC），部分显示与巨细胞融合。肿瘤外未见MNGC。未见CMV室管膜炎。这些发现提示：a）星形细胞瘤细胞允许CMV感染；b）它们可能比正常脑组织更容易受到CMV感染和复制；c）星形细胞瘤的增生性内皮和异常血脑屏障可能促进CMV进入肿瘤。
