McGrath M S, Shiramizu B, Meeker T C, Kaplan L D, Herndier B
Department of Medicine, University of California, San Francisco.
J Acquir Immune Defic Syndr (1988). 1991;4(4):408-15.
High-grade non-Hodgkins B-cell lymphoma is one of the principle malignancies that occurs in individuals infected with the human immunodeficiency virus (HIV-1). Immunoblastic lymphomas that arise in immunosuppressed transplant patients have been described as both monoclonal and polyclonal, and occur in association with Epstein-Barr virus (EBV) infection. To test whether polyclonal lymphoma occurred in patients with AIDS we studied tumors from multiple sites in three patients who died with widespread AIDS-associated large cell or large cell immunoblastic lymphoma. All biopsy specimens contained invasive lymphoma. Tumor cells were mature IgM-positive immunoblasts by immunohistochemical analysis, with the same B-cell phenotype observed in all tumor sites. Only a minority of sites from all patients analyzed were monoclonal as measured by immunoglobulin gene rearrangements, with one case having several foci of monoclonal disease with other histologically identical metastases showing no evidence of monoclonal proliferation. Similar to the transplant-associated polyclonal B-cell proliferations. EBV gene sequences were present in multiple sites from one autopsy. In the other two autopsies, polyclonal B-cell proliferations occurred in the absence of EBV involvement except at one site, where a minor clone of EBV-infected cells was found. In contrast to HIV-associated Burkitt's lymphoma, no c-myc rearrangements were found at any site. These studies describe the occurrence of polyclonal lymphoma in AIDS and suggest that EBV-negative polyclonal lymphoma may be a distinct disease entity unique to HIV-infected individuals.
高级别非霍奇金B细胞淋巴瘤是感染人类免疫缺陷病毒（HIV-1）个体中发生的主要恶性肿瘤之一。免疫抑制移植患者中出现的免疫母细胞淋巴瘤已被描述为单克隆和多克隆的，并与爱泼斯坦-巴尔病毒（EBV）感染有关。为了检测艾滋病患者是否发生多克隆淋巴瘤，我们研究了三名死于广泛艾滋病相关大细胞或大细胞免疫母细胞淋巴瘤患者多个部位的肿瘤。所有活检标本均含有浸润性淋巴瘤。通过免疫组织化学分析，肿瘤细胞为成熟的IgM阳性免疫母细胞，在所有肿瘤部位观察到相同的B细胞表型。通过免疫球蛋白基因重排检测，所有分析患者中只有少数部位为单克隆，其中一例有几个单克隆病变灶，而其他组织学上相同的转移灶未显示单克隆增殖迹象。与移植相关的多克隆B细胞增殖相似。在一次尸检的多个部位存在EBV基因序列。在另外两次尸检中，除一个部位发现少量EBV感染细胞克隆外，多克隆B细胞增殖在无EBV参与的情况下发生。与HIV相关的伯基特淋巴瘤不同，在任何部位均未发现c-myc重排。这些研究描述了艾滋病中多克隆淋巴瘤的发生情况，并表明EBV阴性多克隆淋巴瘤可能是HIV感染个体特有的一种独特疾病实体。
