Delgado W A, Almeida O P, Vargas P A, León J E
Department of Oral Pathology, Faculty of Stomatology, University Cayetano Heredia, Lima, Perú.
J Oral Pathol Med. 2009 Jan;38(1):120-5. doi: 10.1111/j.1600-0714.2008.00714.x.
This study describes the histopathological, immunohistochemical (IHC) and in situ hybridization (ISH) data of 25 cases of oral ulcers in HIV-positive patients, with clinical and microscopical features similar to ulcers not otherwise specified (NOS)/necrotizing ulcerative stomatitis (NUS).
Sex, age and clinical history were obtained from the clinical records. Histological analysis for H&E, Gomori-Grocott and Ziehl-Neelsen stains, IHC analysis to detect infectious agents and to characterize inflammatory cellular infiltrate, and ISH for cytomegalovirus (CMV) and EBER1/2 were performed.
Twenty-one patients were men and four were women (mean age of 34.6 years). The tongue was preferentially affected. Microscopically, the lesions showed extensive necrosis, leukocytoclasia, vasculitis with luminal fibrin clots and an intense inflammatory cellular infiltrate predominated by CD68(+) atypical large cells, normal-sized and crescent-shaped nuclei macrophages, interspersed by CD8(+) T lymphocytes. Mast cells were also observed in all samples studied. CD4(+) T lymphocytes, CD20(+) B lymphocytes and VS38c(+) plasma cells were practically absent. CMV and EBER1/2 were identified in scarce cells of 3 and 16 of 25 cases respectively.
These results show that CD68(+) macrophages, followed by CD8(+) T lymphocytes, were the predominant inflammatory cells, indicating they are relevant to the pathogenesis of the ulcers, possibly reflecting an abnormal immune response in the oral mucosa. The clinicopathological and immunoprofile features of the present cases are similar to NOS ulcers/NUS in HIV-positive patients.
本研究描述了25例HIV阳性患者口腔溃疡的组织病理学、免疫组织化学（IHC）和原位杂交（ISH）数据，其临床和显微镜特征与未另作说明的溃疡（NOS）/坏死性溃疡性口炎（NUS）相似。
从临床记录中获取性别、年龄和临床病史。进行苏木精-伊红染色、Gomori-Grocott染色和齐-尼氏染色的组织学分析，检测感染因子并表征炎性细胞浸润的免疫组织化学分析，以及针对巨细胞病毒（CMV）和EBER1/2的原位杂交。
21例为男性，4例为女性（平均年龄34.6岁）。舌头是最常受累的部位。显微镜下，病变表现为广泛坏死、白细胞破碎、伴有管腔内纤维蛋白凝块的血管炎以及以CD68(+)非典型大细胞、正常大小和新月形核巨噬细胞为主的强烈炎性细胞浸润，其间散在CD8(+) T淋巴细胞。在所有研究样本中也观察到肥大细胞。几乎不存在CD4(+) T淋巴细胞、CD20(+) B淋巴细胞和VS38c(+)浆细胞。分别在25例中的3例和16例的少数细胞中鉴定出CMV和EBER1/2。
这些结果表明，CD68(+)巨噬细胞，其次是CD8(+) T淋巴细胞，是主要的炎性细胞，表明它们与溃疡的发病机制相关，可能反映了口腔黏膜的异常免疫反应。本病例的临床病理和免疫表型特征与HIV阳性患者的NOS溃疡/NUS相似。
