Hanto D W, Gajl-Peczalska K J, Frizzera G, Arthur D C, Balfour H H, McClain K, Simmons R L, Najarian J S
Ann Surg. 1983 Sep;198(3):356-69. doi: 10.1097/00000658-198309000-00012.
Nineteen renal allograft recipients developed B-cell lymphoproliferative diseases. Clinically there were two groups: a) young patients (mean age, 23 years) who presented soon (mean, 9 months) after transplantation or antirejection therapy with fever, pharyngitis, and lymphadenopathy resembling infectious mononucleosis, and b) older patients (mean age, 48 years) who presented later (mean, 6 years) after transplantation with localized tumor masses. Histologically, the diseases were classified as polymorphic diffuse B-cell hyperplasia (PDBH) or polymorphic B-cell lymphoma (PBL). Immunologic cell typing revealed either polyclonal or monoclonal B-cell proliferations. Malignant transformation of polyclonal proliferations in two patients was suggested by the finding of clonal cytogenetic abnormalities. Epstein-Barr virus (EBV) specific serology, staining of biopsy specimens for the Epstein-Barr nuclear antigen, and EBV DNA molecular hybridization studies implicated EBV as the cause of both PDBH and PBL. Acyclovir, an antiviral agent that blocks EBV replication in vitro, inhibited oropharyngeal shedding of EBV and caused complete remission in four patients with polyclonal B-cell proliferations. The monoclonal tumors were acyclovir resistant. We suggest that surgical treatment, radiotherapy, or chemotherapy may be more appropriate therapy in selected patients with acyclovir resistant tumors. Therapeutic decisions require not only documentation of the viral etiology of these tumors, but also immunologic and cytogenetic analysis to determine the stage of tumor evolution in individual patients.
19名肾移植受者发生了B细胞淋巴增殖性疾病。临床上分为两组：a）年轻患者（平均年龄23岁），在移植或抗排斥治疗后不久（平均9个月）出现，伴有发热、咽炎和类似传染性单核细胞增多症的淋巴结病；b）老年患者（平均年龄48岁），在移植后较晚（平均6年）出现局部肿瘤肿块。组织学上，这些疾病被分类为多形性弥漫性B细胞增生（PDBH）或多形性B细胞淋巴瘤（PBL）。免疫细胞分型显示为多克隆或单克隆B细胞增殖。两名患者多克隆增殖的恶性转化通过克隆细胞遗传学异常的发现得以提示。爱泼斯坦-巴尔病毒（EBV）特异性血清学、活检标本中爱泼斯坦-巴尔核抗原的染色以及EBV DNA分子杂交研究表明EBV是PDBH和PBL的病因。阿昔洛韦是一种在体外阻断EBV复制的抗病毒药物，它抑制了EBV的口咽部脱落，并使四名多克隆B细胞增殖患者完全缓解。单克隆肿瘤对阿昔洛韦耐药。我们建议，对于某些患有阿昔洛韦耐药肿瘤的患者，手术治疗、放疗或化疗可能是更合适的治疗方法。治疗决策不仅需要记录这些肿瘤的病毒病因，还需要进行免疫和细胞遗传学分析，以确定个体患者肿瘤演变的阶段。
