Sugimoto Kei-Ji, Shimada Asami, Sakurai Hiroko, Wakabayashi Mutsumi, Imai Hidenori, Sekiguchi Yasunobu, Nakamura Noriko, Sawada Tomohiro, Izumi Hiroshi, Ota Yasunori, Komatsu Norio, Noguchi Masaaki
Department of Hematology, Juntendo University Urayasu Hospital Urayasu, Japan.
Department of Hematology, Juntendo University School of Medicine Tokyo, Japan.
Int J Clin Exp Pathol. 2013 Dec 15;7(1):418-24. eCollection 2014.
The patient was a 73-year-old male who came to our hospital with a chief complaint of pain and swelling of the left side of his jaw. Computed tomography revealed a mass in his left gingiva but no bone destruction. No lesions were observed at any other sites, and an incisional biopsy was performed on the gingival mass on the left side. Histologically, the mass was a diffuse large B-cell lymphoma (DLBCL), and it was CD20-positive, and CD5-negative, CD10-negative, surface immunoglobulin-negative, and Epstein-Barr virus-encoded RNA (EBER)-negative. A serum Human immunodeficiency virus (HIV)-antibody test was negative. A complete remission was achieved after 6 courses of systemic combination chemotherapy, and the complete remission has been maintained for approximately 3 years. According to the literature, primary gingival DLBCL have a high Ki-67-positive rate and many of the cases are stage I and international prognostic index low-risk. However, HIV patients have a high EBER-positive rate and a high risk of developing a CD20-negative, CD138-positive plasmablastic lymphoma, and they have a poor prognosis. By contrast, limited-stage primary gingival lymphomas whose data can be used have been rare in human immunodeficiency virus-negative patients, and only 12 cases, including our own, have ever been reported. Many of the patients have been around 65 years of age, and all of the cases have been CD20-positive, CD138-negative DLBCLs, and the CD5-negative, Epstein-Barr virus-positive rate has been low, with most cases having been non-germinal-center B-cell-like. The prognosis for relapse-free survival has been favorable.
该患者为一名73岁男性，因左侧颌部疼痛和肿胀为主诉前来我院就诊。计算机断层扫描显示其左侧牙龈有一肿块，但无骨质破坏。在其他任何部位均未观察到病变，遂对左侧牙龈肿块进行了切开活检。组织学检查显示，该肿块为弥漫性大B细胞淋巴瘤（DLBCL），CD20阳性，CD5阴性、CD10阴性、表面免疫球蛋白阴性，且爱泼斯坦-巴尔病毒编码RNA（EBER）阴性。血清人类免疫缺陷病毒（HIV）抗体检测为阴性。经过6个疗程的全身联合化疗后实现了完全缓解，且完全缓解状态已维持约3年。根据文献报道，原发性牙龈DLBCL的Ki-67阳性率较高，许多病例为Ⅰ期且国际预后指数为低风险。然而，HIV患者的EBER阳性率较高，发生CD20阴性、CD138阳性浆母细胞淋巴瘤的风险较高，且预后较差。相比之下，在人类免疫缺陷病毒阴性患者中，可获取数据的局限性原发性牙龈淋巴瘤较为罕见，包括我们自己的病例在内，仅有12例曾被报道。许多患者年龄在65岁左右，所有病例均为CD20阳性、CD138阴性的DLBCL，且CD5阴性、爱泼斯坦-巴尔病毒阳性率较低，大多数病例为非生发中心B细胞样。无复发生存的预后良好。
