传染性单核细胞增多症的临床病理及EB病毒定位性研究

目的 研究传染性单核细胞增多症(IM)的临床特征、病理特点、免疫表型和EB病毒原位感染特征,以提高对IM的认识和诊断水平.方法 采用HE染色以及免疫组织化学、原位杂交技术,结合临床资料分析,对15例IM进行了临床病理、免疫表型和EB病毒感染的研究.结果 (1)IM多见于儿童和青年人(中位年龄18岁),起病急,常有发热(12例),伴浅表淋巴结肿大,多数在短期内痊愈.(2)病变以T区增生为主,斑驳状改变常见,细胞混杂,种类多样,可见B细胞分化谱(活化淋巴样母细胞、免疫母细胞、浆样细胞、浆细胞),包膜不厚,间质不多.(3)病变中以CD3阳性的小T淋巴细胞为主,部分活化的淋巴样母细胞和免疫母细胞表达CD20和CD30,信号强弱不等,散在分布.(4)所有病例都有EB病毒编码的小RNA(EBER)阳性细胞,数量多少不一(10～100个/HPF),大中小淋巴细胞均可阳性,主要分布在T区,也见于套区、初级滤泡和生发中心内.结论 进一步确认了IM是EB病毒引起的一种急性自限性淋巴组织增生性疾病.IM在临床、病理、免疫表型和EB病毒感染方面都具有特点,只有综合考虑这4方面的信息才能减少错误,做出更准确的诊断.

Study of clinical and morphological features, immunophenotype and Epstein-Bar virus infection in situ of infectious mononucleosis

Objective To study the clinical and morphological features, immunophenotype and in situ detection of Epstein-Barr virus (EBV) infection in infectious mononucleosis (IM) to enhance the knowledge and diagnosis of the disease. Method Using routine haematoxylin and eosin staining, immunohistochemistry and EBER in situ hybridization together with clinical data analysis, 15 cases of IM were evaluated for their clinical features, morphology, immunophenotype and EBV infection status. Results IM was common in children and young adults with a median age of 15 years. It was an acute disease with lymphadenopathy and frequently fever. Most of the patients had a rapid recovery. Every case showed a markedly T zone expansion with a mottling pattern, composing of small to large lymphocytes, plasma cells and histiocytes. The cells also showed a B-cell differentiation profile ranging from activated lymphoblastoid cells, immunoblasts, plasmablasts, plasma-like cells and plasma cells. Many small lymphocytes in the expanded T zone expressed CD3. Some of the activated lymphoblastoid cells and immonoblasts were CD20 and CD30 positive with variable intensity signals. EBER positive (nuclear staining) cells were seen in every ease. The number of EBER positive cells ranged from 10 to more than 100 per high power field. These cellsincluded small to large lymphocytes locating mostly in the expanded T zone and a few were in the folliculargerminal centers. Conclusions IM is an EBV related acute self-recovering lymphoproliferative disease,having distinct clinical, morphological and immunophenotypic characteristics as well as EBV infection.Taking these features into consideration will facilitate the correct diagnosis of IM.