Chang Sheng-Tsung, Liao Yung-Liang, Lu Chin-Li, Chuang Shih-Sung, Li Chin-Yang
Department of Pathology, Chi-Mei Medical Center, Yung-Kang City, Taiwan.
Am J Clin Pathol. 2007 Aug;128(2):339-44. doi: 10.1309/27H8XJH31F3GUNAT.
Multiple myeloma (MM) is rarely associated with Epstein-Barr virus (EBV) irrespective of HIV status, in contrast with its morphologic mimic, plasmablastic lymphoma, which occurs mainly in immunocompromised patients with frequent EBV association. Among 58 consecutive immunocompetent patients, we found plasmablastic cytomorphologic features in 2 of 4 with plasmacytomas and 14 (26%) of 54 with MM. Of the tumors, 4 (7%; 1 plasmacytoma and 3 MMs) were EBV-encoded RNA (EBER)-positive with plasmablastic cytomorphologic features in 3. The patient with plasmacytoma was disease free for 75 months, and the remaining 3 patients with MM died at 15, 74, and 97 months, respectively; the median survival of patients with EBER- MM was 12 months. EBV+ tumors were associated with plasmablastic cytomorphologic features and high labeling indices. Rare EBER+ plasmablastic plasma cell tumors exist in immunocompetent patients. These tumors may have been driven by EBV to gain the plasmablastic cytomorphologic features and high proliferation fraction. A large cohort study is needed to clarify the prognostic impact of EBV on immunocompetent patients with MM.
多发性骨髓瘤（MM）很少与爱泼斯坦-巴尔病毒（EBV）相关，无论HIV状态如何，这与其形态学上的模仿疾病浆母细胞淋巴瘤相反，浆母细胞淋巴瘤主要发生在免疫功能低下且频繁与EBV相关的患者中。在连续58例免疫功能正常的患者中，我们在4例浆细胞瘤患者中的2例以及54例MM患者中的14例（26%）发现了浆母细胞形态学特征。在这些肿瘤中，4例（7%；1例浆细胞瘤和3例MM）为EBV编码RNA（EBER）阳性，其中3例具有浆母细胞形态学特征。浆细胞瘤患者75个月无病生存，其余3例MM患者分别在15、74和97个月死亡；EBER阳性MM患者的中位生存期为12个月。EBV阳性肿瘤与浆母细胞形态学特征和高标记指数相关。免疫功能正常的患者中存在罕见的EBER阳性浆母细胞浆细胞瘤。这些肿瘤可能是由EBV驱动而获得浆母细胞形态学特征和高增殖分数的。需要进行大规模队列研究以阐明EBV对免疫功能正常的MM患者的预后影响。
