Int J Stomatol

Int J Stomatol ›› 2025, Vol. 52 ›› Issue (6): 791-797.doi: 10.7518/gjkq.2025104

• Case Report • Previous Articles     Next Articles

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 E-mail:shdiver@outlook.com;teana_wu@sina.com
  • 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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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

CLC Number: 

  • R739.81

TrendMD: 

Fig 1

Clinical features of gingival ulcer"

Fig 2

Histopathological examination"

Fig 3

IHC examination (EnVision method)"

Tab 1

Differential diagnosis of EBVMCU and EBV+ DLBCL"

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

Fig 4

Flowchart summarizing diagnosis and treatment of oral ulcer"

"

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