摘要
目的:分析误诊为非霍奇金淋巴瘤(Non-Hodgkin's lymphoma,NHL)的非典型传染性单核细胞增多症(infectious mononucleosis,IM)成人患者的临床病理特点,以提高对该种疾病的认识,从而减少临床误诊。方法:2003年1月至2013年12月间共5例以淋巴结或扁桃体明显肿大为突出表现,抗感染等治疗无明显效果,临床高度怀疑为NHL患者行淋巴结或扁桃体活检,对标本进行病理形态、免疫组织化学、T细胞受体和免疫球蛋白基因重排、EBV编码小RNA(EBER)等相关检查,以明确诊断。结果:5例病理检查均呈现淋巴组织明显增生,初次病理检查分别诊断为弥漫大B细胞淋巴瘤和非特指型外周T细胞淋巴瘤,经进一步分子病理及EBV抗体等相关检查,最终确诊为非典型IM,对症处理后疾病均恢复,随访1-10年均健康生存。结论:非典型IM的淋巴结或扁桃体病理改变具多样性,易误诊为不同类型淋巴瘤,临床诊断时需特别注意,分子病理检查是IM有益的鉴别方法。
Objective：To investigate the clinicopathologic characteristics of adult patients with atypical infectious mononucleosis（IM）.Methods：From January 2003 to December 2013,a total of 5 cases of atypical IM misdiagnosed as lymphoma were selected,and the clinico-pathological characteristics and efficacy of treatment were analyzed.Biopsy of lymph node or tonsil was performed to evaluate the possibility of lymphoma.Peripheral blood EBV antibody and EBV-DNA were examined by ELISA and real-time fluorescence quantitative PCR,respectively.Results：All the cases were considered as lymphoma on the basis of morphological features in initial evaluation before relapse.These features included a florid immunoblastic proliferation,distortion of the underlying nodal or tonsillar architecture and the presence of necrosis.The immunophenotypic features,EBV encoded RNA（EBER） in situ hybridization and the gene rearrangement of immunoglobulin or T cell receptor may be helpful for the distinction of atypical IM from lymphoma.Conclusion：IM as EBV-related lymphoproliferative process shows marked clinical and histological diversity.Atypical case of IM may mimic many different type of lymphoma in clinical and pathologic features,and the misdiagnosis should be avoided by using molecular and pathological examination.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2016年第6期1873-1878,共6页
Journal of Experimental Hematology
