Childs C C, Parham D M, Berard C W
Am J Surg Pathol. 1987 Feb;11(2):122-32. doi: 10.1097/00000478-198702000-00006.
Lymph-node and tonsillar biopsies occasionally are obtained from patients with the infectious mononucleosis syndrome secondary to Epstein-Barr viral infection, particularly if the clinical presentation is atypical and a viral etiology is not suspected. The presence of Reed-Sternberg-like cells in infectious mononucleosis resulting in confusion with Hodgkin's disease is well-known; however, similar difficulty in excluding a non-Hodgkin's lymphoma can be encountered. Eleven cases of reactive lymphoid hyperplasia with the morphologic features of infectious mononucleosis are reported, nine of which had documented Epstein-Barr viral infection. The spectrum of morphologic changes associated with Epstein-Barr viral infection is discussed, with emphasis on the features that permit their distinction from non-Hodgkin's lymphoma. Morphologic features mimicking lymphoma included extensive immunoblastic proliferations in sheets and nodules and marked cytologic atypia. Hodgkin's disease was simulated by the tendency in some cases for the atypical Reed-Sternberg-like cells to cluster about necrotic foci and to show pronounced cytologic atypia. Features permitting the distinction from non-Hodgkin's lymphoma included persistent reactive foci with the classic features of infectious mononucleosis, a polymorphous background of transformed lymphocytes rather than irregular or twisted lymphoid cells as seen in non-Hodgkin's lymphoma, and preservation of underlying reticulin architecture rather than destruction, even in cases with extensive immunoblastic proliferation. Hodgkin's disease was excluded by requiring strict criteria for Reed-Sternberg cells and noting the reactive background as inconsistent with Hodgkin's disease. Immunoperoxidase staining of seven of the cases with anti-Leu-M1 failed to demonstrate immunoreactivity of the Reed-Sternberg-like cells with this monoclonal antibody.
对于继发于爱泼斯坦-巴尔病毒感染的传染性单核细胞增多症综合征患者，偶尔会进行淋巴结和扁桃体活检，尤其是当临床表现不典型且未怀疑病毒病因时。传染性单核细胞增多症中存在里德-施特恩伯格样细胞，导致与霍奇金病混淆，这是众所周知的；然而，在排除非霍奇金淋巴瘤时也可能遇到类似困难。本文报告了11例具有传染性单核细胞增多症形态学特征的反应性淋巴组织增生病例，其中9例有记录的爱泼斯坦-巴尔病毒感染。讨论了与爱泼斯坦-巴尔病毒感染相关的形态学变化谱，重点是使其与非霍奇金淋巴瘤相区别的特征。模仿淋巴瘤的形态学特征包括成片和结节状的广泛免疫母细胞增生以及明显的细胞异型性。在某些病例中，非典型里德-施特恩伯格样细胞倾向于围绕坏死灶聚集并显示明显的细胞异型性，从而模拟了霍奇金病。与非霍奇金淋巴瘤相区别的特征包括持续存在具有传染性单核细胞增多症经典特征的反应性病灶、转化淋巴细胞的多形性背景而非非霍奇金淋巴瘤中所见的不规则或扭曲的淋巴细胞，以及即使在广泛免疫母细胞增生的病例中也保留了潜在的网状纤维结构而非破坏。通过要求对里德-施特恩伯格细胞有严格标准并注意到反应性背景与霍奇金病不一致，排除了霍奇金病。对其中7例病例用抗Leu-M1进行免疫过氧化物酶染色，未显示里德-施特恩伯格样细胞与该单克隆抗体的免疫反应性。
