Gelb A B, Medeiros L J, Chen Y Y, Weiss L M, Weidner N
Department of Pathology, University of California, San Francisco 94143-0102, USA.
Am J Clin Pathol. 1997 Nov;108(5):593-8. doi: 10.1093/ajcp/108.5.593.
A 61-year-old man with acquired immunodeficiency syndrome (AIDS) sought care because of the onset of progressive dysphagia. He was found to have a perforated, fungating esophageal mass. The combined histologic and immunologic findings were diagnostic of Hodgkin's disease, nodular sclerosis type, lymphocyte-depleted variant, arising in the esophagus. The Reed-Sternberg cells and mononuclear variants were positive for Epstein-Barr virus (EBV) latent membrane protein (LMP1) and EBV RNA. Occasional small lymphoid cells were also positive for EBV RNA. Polymerase chain reaction studies demonstrated the presence of EBV type A without deletion of the EBV LMP1 gene. Other authors have reported an increased frequency of type B EBV and deletion of the EBV LMP1 gene in cases of human immunodeficiency virus-associated Hodgkin's disease. Hodgkin's disease arising in the esophagus is rare in immunocompetent patients. However, in the presence of AIDS, Hodgkin's disease should be considered in the differential diagnosis of patients with signs or symptoms of esophageal disease.
一名61岁的获得性免疫缺陷综合征（AIDS）男性因进行性吞咽困难发作而寻求治疗。他被发现患有一个穿孔、呈蕈状的食管肿块。组织学和免疫学综合检查结果诊断为食管发生的霍奇金淋巴瘤，结节硬化型，淋巴细胞消减变异型。里德-斯腾伯格细胞和单核细胞变异型对爱泼斯坦-巴尔病毒（EBV）潜伏膜蛋白（LMP1）和EBV RNA呈阳性。偶尔的小淋巴细胞对EBV RNA也呈阳性。聚合酶链反应研究表明存在A型EBV且EBV LMP1基因无缺失。其他作者报告在人类免疫缺陷病毒相关霍奇金淋巴瘤病例中B型EBV频率增加且EBV LMP1基因缺失。食管发生的霍奇金淋巴瘤在免疫功能正常的患者中很少见。然而，在存在AIDS的情况下，对于有食管疾病体征或症状的患者，鉴别诊断时应考虑霍奇金淋巴瘤。
