IgG4 相关淋巴组织增生症中感染 EBV 的细胞与结外 IgG4 相关疾病的比较。
Epstein-Barr virus-infected cells in IgG4-related lymphadenopathy with comparison with extranodal IgG4-related disease.
机构信息
Departments of *Pathology ∥Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama ‡Center for Antibody and Vaccine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo §Department of Pathology, Okazaki City Hospital, Okazaki ¶Department of Otolaryngology, Himeji Red Cross Hospital, Himeji †Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe Departments of #Clinical Laboratory **Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan ††Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
出版信息
Am J Surg Pathol. 2014 Jul;38(7):946-55. doi: 10.1097/PAS.0000000000000206.
IgG4-related lymphadenopathy with increased numbers of Epstein-Barr virus (EBV)-infected cells has been reported but not fully described. We analyzed 31 cases of IgG4-related lymphadenopathy and 24 cases of extranodal IgG4-related diseases for their possible relationship with EBV. Other types of reactive lymph nodes (22) and angioimmunoblastic T-cell lymphoma (AITL) (10) were also studied for comparison. EBV-encoded RNA (EBER) in situ hybridization revealed EBER(+) cells in 18 of 31 cases (58%) of IgG4-related lymphadenopathy. Increased EBER(+) cells were found in only 4 of 22 (18.1%) non-IgG4-related reactive lymphoid hyperplasia in patients of a similar age (P=0.002) and in only 5 of 24 (21%) extranodal IgG4-related biopsies (P=0.006). Interestingly, all patients with EBER(+) progressively transformed germinal center-type IgG4-related lymphadenopathy had systemic lymphadenopathy and/or extranodal involvement. AITL also is associated with EBV, and IgG4-related lymphadenopathy sometimes mimics the morphology of AITL; however, the number of IgG4(+) cells in AITL was significantly less than that in IgG4-related lymphadenopathy (P<0.001). Increased numbers of regulatory T cells are seen in IgG4-related disease; however, there was not a significant difference between the EBER(+) and EBER(-) cases. In conclusion, the presence of increased numbers of EBV-infected cells in IgG4-related lymphadenopathy, compared with other reactive lymphadenopathy or extranodal IgG4-related disease, suggests that there may be a relationship at least between nodal IgG4-related disease and EBV. It is important to avoid overdiagnosing these cases as malignant lymphomas or EBV-related lymphoproliferative disorders.
IgG4 相关淋巴结病伴有大量 EBV（Epstein-Barr 病毒）感染细胞已被报道，但尚未完全描述。我们分析了 31 例 IgG4 相关淋巴结病和 24 例结外 IgG4 相关疾病，以研究它们与 EBV 的可能关系。还研究了其他类型的反应性淋巴结（22 例）和血管免疫母细胞性 T 细胞淋巴瘤（AITL）（10 例）作为对照。原位杂交 EBV 编码的 RNA（EBER）显示 IgG4 相关淋巴结病的 31 例（58%）中有 18 例 EBER（+）细胞。在年龄相似的非 IgG4 相关反应性淋巴组织增生患者中，仅发现 4 例（18.1%）（P=0.002）和 24 例（21%）结外 IgG4 相关活检中（P=0.006）EBER（+）细胞增加。有趣的是，所有 EBER（+）进展性转化生发中心型 IgG4 相关淋巴结病患者均有全身淋巴结病和/或结外受累。AITL 也与 EBV 相关，而 IgG4 相关淋巴结病有时模仿 AITL 的形态；然而，AITL 中的 IgG4（+）细胞数量明显少于 IgG4 相关淋巴结病（P<0.001）。在 IgG4 相关疾病中可见调节性 T 细胞数量增加；然而，EBER（+）和 EBER（-）病例之间没有显著差异。总之，与其他反应性淋巴结病或结外 IgG4 相关疾病相比，IgG4 相关淋巴结病中 EBV 感染细胞数量增加，提示至少在淋巴结 IgG4 相关疾病与 EBV 之间可能存在关系。重要的是要避免将这些病例误诊为恶性淋巴瘤或 EBV 相关淋巴增生性疾病。
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