国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (6): 791-797.doi: 10.7518/gjkq.2025104

• 病例报告 • 上一篇    下一篇

牙龈EB病毒阳性弥漫性大B细胞淋巴瘤1例

黄润语1,2(),赵晓娴1,2,张春叶2,3,张颖1,2,周永梅1,2,吴岚1,2()   

  1. 1.上海交通大学医学院附属第九人民医院口腔黏膜病科 上海 200011
    2.上海交通大学口腔医学院;国家口腔医学中心 国家口腔疾病临床医学研究中心;上海市口腔医学重点实验室 上海市口腔医学研究所 上海 200011
    3.上海交通大学医学院附属第九人民医院口腔病理科 上海 200011
  • 收稿日期:2024-08-21 修回日期:2025-07-02 出版日期:2025-11-01 发布日期:2025-10-23
  • 通讯作者: 吴岚
  • 作者简介:黄润语，住院医师，硕士，Email：shdiver@outlook.com
  • 基金资助:
    上海市科学技术委员会基金(21S21902000);上海市卫生健康委员会项目［ZY（2021-2023）-0207-01-04,2022CX009］;上海交通大学医学院附属第九人民医院交叉基金(JYJC202111)

A case report of gingival Epstein-Barr virus-positive diffuse large B-cell lymphoma

Runyu Huang1,2(),Xiaoxian Zhao1,2,Chunye Zhang2,3,Ying Zhang1,2,Yongmei Zhou1,2,Lan Wu1,2()   

  1. 1.Dept. of Oral Mucosal Diseases, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    2.College of Stomatology, Shanghai Jiao Tong University ＆ National Center for Stomatology ＆ National Clinical Research Center for Oral Diseases ＆ Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
    3.Dept. of Oral Pathology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Received:2024-08-21 Revised:2025-07-02 Online:2025-11-01 Published:2025-10-23
  • Contact: Lan Wu
  • Supported by:
    Project of Science and Technology Commission of Shanghai(21S21902000);Cross Project Cooperation Fund of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYJC202111);Project of Shanghai Municipal Health Commission [ZY(2021-2023)-0207-01-04, 2022CX009]

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摘要：

EB病毒阳性弥漫性大B细胞淋巴瘤（EBV+ DLBCL）是一种罕见的侵袭性B细胞淋巴瘤，好发于老年人，预后不良，结外受累部位常见于胃肠道、皮肤、骨髓，发生在牙龈的EBV+ DLBCL非常罕见。EBV+ DLBCL在病理组织形态学和免疫表型上，与EB病毒阳性黏膜皮肤溃疡极其相似，明确诊断具有挑战性。本文报告了1例原先诊断为EB病毒阳性黏膜皮肤溃疡（EBVMCU）的病例，后经淋巴瘤基因重排技术确诊为EBV+ DLBCL患者的临床表现和病理组织学特征，以期加深对该疾病的认识，有助于此类恶性疾病的早期诊断与治疗。

关键词: EB病毒, 弥漫性大B细胞淋巴瘤, 口腔溃疡, 基因重排, 临床病理

Abstract:

Epstein-Barr virus-positive diffuse large B-cell lymphoma (EBV+ DLBCL) is a rare and aggressive type of B-cell lymphoma that typically occurs in elderly patients and is associated with a poor prognosis. It commonly affects extranodal sites such as the gastrointestinal tract, skin, and bone marrow. EBV+ DLBCL presenting with initial symptoms in the gingiva is extremely rare. Its similarity to EBV-positive mucocutaneous ulcer (EBVMCU) in terms of pathology and immunophenotype makes definitive diagnosis challenging. In this work, we report a case initially diagnosed as EBVMCU but later confirmed as EBV+ DLBCL through lymphoma gene rearrangement technology. The clinical manifestations and pathological histological features of the patient are presented to enhance understanding of the disease and contribute to early diagnosis and treatment of such malignant diseases.

Key words: EB virus, diffuse large B-cell lymphoma, oral ulcer, gene rearrangement, clinical pathology

中图分类号: 

  • R739.81

图 1

牙龈溃疡的临床表现"

图 2

组织病理学检查A：左下牙龈黏膜溃疡（红色箭头所示），灶性坏死，周边淋巴细胞、纤维母细胞增生（HE染色，×40）；B：非典型细胞浸润，细胞核大、不规则，细胞质丰富，偶见多核细胞（红色箭头所示）（HE染色，×400）。"

图 3

IHC检查（EnVision 法）A：非典型细胞CD20阳性表达（×200）；B：非典型细胞MUM1阳性表达（×400）；C：非典型细胞CD30散在阳性表达（×200）；D：Ki-67的增殖指数80%~90%（×200）。"

表 1

EBVMCU与EBV+ DLBCL的鉴别诊断"

鉴别诊断EBVMCUEBV+ DLBCL
WHO-HAEM5分类淋巴增生和淋巴瘤相关，伴免疫缺陷和失调成熟B细胞肿瘤
免疫状态免疫缺陷，医源性免疫抑制剂使用史无免疫缺陷，可有免疫衰老
发病人群老年；女性>男性老年、青年；男性>女性
临床表现淋巴结外受累，不伴B症状淋巴结外受累、淋巴结肿大均可出现，常伴有B症状
结外受累部位口腔、口咽、胃肠道、皮肤胃肠道、皮肤、骨髓
实验室检查血清乳酸脱氢酶水平正常或轻度升高；sIL-2R水平升高血清乳酸脱氢酶水平升高；sIL-2R明显升高
外周血EBV-DNA载量测定几乎为阴性常可检测到阳性
临床病程相对惰性，局限性，部分为自限性侵袭性，系统性
病理组织形态学特征皮肤或黏膜溃疡，多形型常见，可见在浆细胞、组织细胞及嗜酸性粒细胞背景中，散在异型大细胞，部分呈R-S样；在界限清楚的溃疡底部存在T细胞隔离带多形性亚型为主，可见R-S样细胞及大量反应性细胞成分，如：小淋巴细胞、浆细胞和组织细胞，可伴有地图样坏死、血管侵犯等
免疫表型Bcl-6（-）、Bcl-2（-/+）、PD-L1（-）Bcl-6（+/-）、Bcl-2（+）、PD-L1（+/-）
预后预后良好预后不良
相关信号通路NF-κB、抗凋亡BCL2NF-κB、JAK/STAT、Wnt

图 4

口腔溃疡的诊疗流程图MRI为magnetic resonance imaging，磁共振成像；PET-CT为positron emission tomography-computed tomography，正电子发射断层扫描-计算机断层扫描。"

《美学区贴面修复中的定深与控厚》出版发行"

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