Department of Pathology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35249, USA.
Hum Pathol. 2012 Jan;43(1):127-33. doi: 10.1016/j.humpath.2011.02.024. Epub 2011 Jul 5.
The development of lymphomas and solid malignancies in association with immunosuppression is a well-documented occurrence in the medical literature. We report the case of a young man who developed progressive diffuse lymphadenopathy with associated extremely high levels of serum Epstein-Barr virus in the setting of chronic immunosuppressive treatment of glomerulonephritis. Excisional biopsy of a right inguinal node revealed a sclerosing process with the morphologic appearance of angioimmunoblastic T-cell lymphoma with a CD3(+), CD4(+) immunophenotype. In situ hybridization of Epstein-Barr virus-encoded RNA was positive. Molecular probe studies demonstrated a clonal T-cell population. Upon reduction of immunosuppression, the patient's lymphadenopathy and Epstein-Barr virus titer have resolved without recurrence over 2 years time. This case demonstrates that a benign Epstein-Barr virus-associated process can mimic angioimmunoblastic T-cell lymphoma and should be considered particularly in the setting of immunosuppression, emphasizing the need for close communication with the treating physician in the interpretation of lymph node biopsies.
免疫抑制相关的淋巴瘤和实体恶性肿瘤的发展在医学文献中有充分的记载。我们报告了一例年轻男性的病例，他在接受肾小球肾炎的慢性免疫抑制治疗的情况下，出现进行性弥漫性淋巴结病，并伴有极高的血清 EBV（Epstein-Barr 病毒）水平。右腹股沟淋巴结切除活检显示一种硬化性过程，形态上类似于伴有 CD3(+)、CD4(+)免疫表型的血管免疫母细胞性 T 细胞淋巴瘤。EBV 编码 RNA 的原位杂交呈阳性。分子探针研究显示出克隆性 T 细胞群体。在减少免疫抑制后，患者的淋巴结病和 EBV 滴度在 2 年时间内没有复发而得到解决。该病例表明良性 EBV 相关过程可模拟血管免疫母细胞性 T 细胞淋巴瘤，尤其是在免疫抑制的情况下，需要与治疗医生密切沟通以解释淋巴结活检结果。
