Raymond E, Tricottet V, Samuel D, Reynès M, Bismuth H, Misset J L
Department of Medical Oncology and Hematology, Service des Maladies Sanguines Immunitaires et Tumorales, Hospital Paul Brousse, Villejuif, France.
Cancer. 1995 Oct 15;76(8):1344-51. doi: 10.1002/1097-0142(19951015)76:8<1344::aid-cncr2820760808>3.0.co;2-k.
Localized hepatic post-transplant lymphoproliferative disease is uncommon. In such cases, lymphocyte Epstein-Barr virus (EBV) infection may promote an intrahepatic B-lymphocyte monoclonal expansion.
From 1990 to 1991, 149 patients underwent liver transplantation for various liver failures. Immunosuppressive therapy was azathioprine, cyclosporine-A, and methylprednisolone. Rejection episodes were treated by methylprednisolone bolus injection with or without OKT3 therapy. Three patients (2%), aged 38, 50, and 47 years, developed lymphoproliferative disease localized in the transplanted livers within 5 months of liver transplantation (a patient had been immunosuppressed for 3 years before the lymphoproliferative disease occurred within the third allografted liver). Diagnoses were obtained by fine needle aspiration. In situ hybridizations were performed with the kappa/lambda mRNA-kit FITC DAKO (DAKO Corporation, Carpenteria, CA) and the early mRNA-EBER oligonucleotide FITC DAKO:
Lymphoproliferative diseases were all classified as diffuse polymorphic large cell lymphomas in the working formulation and considered as lymphoproliferative disorders with polymorphic large cells in the Frizzera classification. All large cells were CD20-positive, CD45-positive and CD45RO-negative. In situ mRNA light chain hybridization demonstrated monoclonality in two cases. In all three cases, EBV mRNA was detected in large cells by early mRNA-EBV (EBER) in situ hybridization. Patients were treated with doxorubicin, cyclophosphamide, vincristine, and VM26. Two patients maintained a complete remission 3 years after six cycles of chemotherapy, whereas one died of an early opportunistic infection.
Epstein-Barr virus may play a special role in the pathogenesis of lymphoproliferative disorders that develop in patients who have undergone liver transplantation.
局限性肝移植后淋巴增生性疾病并不常见。在此类病例中，淋巴细胞爱泼斯坦-巴尔病毒（EBV）感染可能促进肝内B淋巴细胞单克隆扩增。
1990年至1991年，149例患者因各种肝功能衰竭接受肝移植。免疫抑制治疗采用硫唑嘌呤、环孢素A和甲泼尼龙。排斥反应发作时，采用甲泼尼龙大剂量注射治疗，必要时联合OKT3治疗。3例患者（2%），年龄分别为38岁、50岁和47岁，在肝移植后5个月内出现局限于移植肝脏的淋巴增生性疾病（1例患者在第3次移植肝脏内发生淋巴增生性疾病前已接受3年免疫抑制治疗）。通过细针穿刺获取诊断。使用kappa/lambda mRNA试剂盒FITC DAKO（DAKO公司，加利福尼亚州卡平特里亚）和早期mRNA-EBER寡核苷酸FITC DAKO进行原位杂交：
在工作分类中，淋巴增生性疾病均被归类为弥漫性多形性大细胞淋巴瘤，在弗里泽拉分类中被视为多形性大细胞淋巴增生性疾病。所有大细胞均为CD20阳性、CD45阳性和CD45RO阴性。原位mRNA轻链杂交显示2例为单克隆性。在所有3例病例中，通过早期mRNA-EBV（EBER）原位杂交在大细胞中检测到EBV mRNA。患者接受了阿霉素、环磷酰胺、长春新碱和VM26治疗。2例患者在6个周期化疗后3年维持完全缓解，而1例死于早期机会性感染。
爱泼斯坦-巴尔病毒可能在肝移植患者发生的淋巴增生性疾病的发病机制中起特殊作用。
