Sadiku Shemsedin, Kurshumliu Fisnik, Krasniqi Xhevdet, Brovina Ahmet, Kryeziu Emrush, Rrudhani Ibrahim, Meqa Kastriot, Gashi-Luci Lumturije, Merz Hartmut
Institute of Anatomic Pathology, University Clinical Center of Kosovo, "Rrethi i Spitalit" p,n,10000, Prishtina, Republic of Kosova.
J Med Case Rep. 2012 Sep 11;6:288. doi: 10.1186/1752-1947-6-288.
Epstein-Barr virus-positive mucocutaneous ulcer is a newly recognized clinicopathologic entity in the spectrum of Epstein-Barr virus-positive lymphoproliferative disorders. This entity is characterized by a self-limited, indolent course.
We report the case of a 74-year-old, type 2 diabetic man who presented with an ulceroinfiltrative skin lesion on the left side of his neck. Histological examination showed that the lesion consisted of large atypical cells, some with Hodgkin-Reed-Sternberg-like morphology, in the midst of reactive lymphocytes, plasma cells, eosinophils and histiocytes. The atypical cells were partially positive for CD45, CD20, CD79a, CD30, B-cell lymphoma 2 and latent membrane protein 1 (CS.1-4), and negative for CD15, B-cell lymphoma 6 and CD10. In situ hybridization for Epstein-Barr virus-encoded ribonucleic acid was positive. Two years before, the patient had been diagnosed with a self-limited subcutaneous abscess in the same anatomic area that healed after antibiotic therapy.
Older patients with positive Epstein-Barr virus serology may develop B-cell lymphoproliferations due to age-related immune suppression. Epstein-Barr virus-encoded ribonucleic acid testing and clonality analysis, eventually complemented with close clinical follow-up, should be performed for suspicious inflammatory lesions in older patients.
爱泼斯坦-巴尔病毒阳性黏膜皮肤溃疡是爱泼斯坦-巴尔病毒阳性淋巴增殖性疾病谱中一种新确认的临床病理实体。该实体的特点是病程自限、进展缓慢。
我们报告一例74岁2型糖尿病男性患者，其左侧颈部出现溃疡性浸润性皮肤病变。组织学检查显示，病变由大的非典型细胞组成，部分细胞具有霍奇金-里德-斯腾伯格样形态，周围有反应性淋巴细胞、浆细胞、嗜酸性粒细胞和组织细胞。非典型细胞部分表达CD45、CD20、CD79a、CD30、B细胞淋巴瘤2和潜伏膜蛋白1（CS.1-4），不表达CD15、B细胞淋巴瘤6和CD10。爱泼斯坦-巴尔病毒编码核糖核酸的原位杂交呈阳性。两年前，该患者在同一解剖区域被诊断为自限性皮下脓肿，经抗生素治疗后愈合。
爱泼斯坦-巴尔病毒血清学阳性的老年患者可能因年龄相关的免疫抑制而发生B细胞淋巴增殖。对于老年患者的可疑炎症性病变，应进行爱泼斯坦-巴尔病毒编码核糖核酸检测和克隆性分析，并最终辅以密切的临床随访。
