Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma arising in patient with a history of EBV-positive mucocutaneous ulcer and EBV-positive nodal polymorphous B-lymphoproliferative disorder
Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma arising in patient with a history of EBV-positive mucocutaneous ulcer and EBV-positive nodal polymorphous B-lymphoproliferative disorder
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DOI：
10.1111/pin.12738
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发表时间：
2019-01-01
影响因子：
2.2
通讯作者：
Nakamura, Shigeo
中科院分区：
文献类型：
--
作者：
Daroontum, Teerada;Kohno, Kei;Nakamura, Shigeo
EB病毒（EBV）感染的老年患者由于免疫衰老而发生B细胞淋巴增生性疾病（B-LPD）的风险增加。在这里，我们描述的情况下，75岁的男子谁开发了EB病毒阳性（EBV+）粘膜皮肤溃疡（EBVMCU）在牙龈自发消退。消退后18个月，患者出现颈部淋巴结肿大，诊断为EBV+淋巴结多形性B-LPD，安阿伯IA期。临床医生决定观察他的临床过程，不进行任何治疗。14个月后，患者发生EBV阳性弥漫性大B细胞淋巴瘤（DLBCL），安阿伯IIA期，接受了6个疗程的年龄调整剂量化疗，达到完全缓解。通过免疫球蛋白重链的标准聚合酶链反应（PCR）分析，未发现这三种病变之间存在克隆关系的证据。然而，它们都在EBV+大B细胞和Hodgkin Reed-Sternberg样细胞中表达PD-L1。这是第一例PD-L1阳性（PD-L1+）EBVMCU和32个月内免疫衰老背景下发生多个EBV驱动的B-LPD的病例报告。
Elderly patients with Epstein-Barr virus (EBV) infection are at increased risk for developing B-cell lymphoproliferative disorder (B-LPD) due to immunosenescence. Here, we describe a case of a 75-year-old man who developed an EBV-positive (EBV+) mucocutaneous ulcer (EBVMCU) in the gingiva with spontaneous regression. Eighteen months after regression, he had a cervical lymph node enlargement that was diagnosed as EBV+ nodal polymorphous B-LPD, Ann Arbor stage IA. Clinicians decided to observe his clinical course without any treatment. Fourteen months later, the patient developed EBV-positive diffuse large B-cell lymphoma (DLBCL), Ann Arbor stage IIA, and received six courses of age-adjusted dose chemotherapy and achieved a complete remission. No evidence of a clonal relationship was found among these three lesions by standard polymerase chain reaction (PCR) analysis for immunoglobulin heavy chain. However, they all had expression of PD-L1 in the EBV+ large B-cells and Hodgkin Reed-Sternberg-like cells. This is the first case report of a PD-L1-positive (PD-L1+) EBVMCU and the development of multiple EBV-driven B-LPDs in the setting of immunosenescence within a 32-month period.