传染性单核细胞增多症的临床病理学特征及免疫表型分型

摘要

目的 探讨传染性单核细胞增多症临床病理特征、免疫表型及EBV原位感染的特点,以提高对该病的认识和诊断水平.方法 收集患者临床资料、各项实验室检查、淋巴结活检病理数据,采用免疫组化EliVision两步法和EBER原位杂交双重标记检测9例传染性单核细胞增多症,并进行文献复习.结果 9例患者平均年龄22岁,起病急,病程短,发热、肝脾及颈部淋巴结肿大,多数EBV CAV-IgM抗体阳性,EBV-DNA载量均增高,多数白细胞总数增高,肝功能异常;外周血淋巴细胞比例明显增高,异型淋巴细胞比例均大于10％.外周血免疫表型为高表达全T细胞标记及CD8,而CD4表达明显减低甚至不表达,CD4+/CD8+比值倒置.淋巴结结构有不同程度破坏,呈斑驳状,可见B细胞分化谱,无包膜增厚及间质纤维增生;病变以CD3阳性的淋巴细胞为主,CD20及CD30阳性的活化淋巴样母细胞及免疫母细胞散在分布,强弱不等;EBER原位杂交阳性的部位主要在T区.结论 传染性单核细胞增多症是EBV引起的自限性淋巴组织增生性疾病,临床、病理工作中需综合考虑各方面的信息才能减少误诊,做出正确诊断.%Purpose To study the clinicopathologic characteristics,immunophenotype and Epstein-Barr virus (EBV) infection in infectious mononucleosis (IM),and to enhance the knowledge and diagnosis of the disease.Methods The clinical data,laboratory examination,and lymph nodes biopsy of 9 cases of IM were collected.Immunohistochemistry of EliVision twostep,flow cytometry and EBER in situ hybridization double labeling were studied in 9 cases.Relevant literatures were also reviewed.Results The average age of 9 cases of IM was 22 years old.Patients presented with acute onset,short disease duration,fever,and liver,spleen and lymph node enlargement,and increased abnormal lymphocyte.Also,it was positive in the antiEBV VCA-IgM detection.EBV-DNA copy numbers were all increased.Most WBC counts were increased.Liver function index was abnormal.The ratio of peripheral blood lymphoeytes obviously increased and the ratio of atypical lymphocyte was greater than 10％.Immunophenotype of peripheral blood flow cytometry was characterized by high expression of T cells markers and CD8.CD4 expression was significantly reduced or even not expressed.CD4+/CD8 + ratio was reversed.Lymph nodes were destroyed in different extent and presented mottling without the thickening of the capsule and interstitial fibrous hyperplasia.B cells differentiation spectrum was visible.The lesion cells were mostly CD3-positive cells.CD20,CD30-positive activated cells and immunoblast cells diffused distribution and showed different degrees of strength.The site of EBER in situ hybridization was mainly in T region.Conclusion IM is an EBV-related acute self-limiting lymphoproliferative disease.Taking clinical characteristics,morphology,EBV infection and immunophenotype into considerations will help to correct diagnoses.