Infectious mononucleosis lymphoadenitis showing histologic findings indistinguishable from toxoplasma lymphadenitis. A report of three cases

被引:9
作者
Kojima, Masaru [1 ]
Kashimura, Makoto [2 ]
Itoh, Hideaki [3 ,4 ]
Noro, Masahiro [5 ]
Matsuda, Hazuki [1 ]
Tsukamoto, Norihumi [6 ]
Akikusa, Bunshiro [5 ]
Masawa, Nobuhide [1 ]
Morita, Yukio [7 ]
机构
[1] Dokkyo Med Univ, Sch Med, Dept Anat & Diagnost Pathol, Mibu, Tochigi 3210293, Japan
[2] Matsudo City Hosp, Dept Hematol, Matsudo, Chiba, Japan
[3] Maebashi Red Cross Hosp, Dept Pathol, Maebashi, Gunma, Japan
[4] Maebashi Red Cross Hosp, Clin Labs, Maebashi, Gunma, Japan
[5] Matsudo City Hosp, Dept Pathol, Matsudo, Chiba, Japan
[6] Gunma Univ, Sch Med, Dept Med & Clin Sci, Maebashi, Gunma 371, Japan
[7] Tokyo Kasei Univ, Lab Food Hyg, Coll Nutr Sci, Tokyo, Japan
关键词
Infectious mononucleosis; Lymph node/toxoplasmic lymphadenitis; Clinical findings; Polymerase chain reaction; INSITU HYBRIDIZATION; LYMPH-NODE; DIAGNOSIS; SPECTRUM;
D O I
10.1016/j.prp.2009.12.010
中图分类号
R36 [病理学];
学科分类号
100103 [病原生物学];
摘要
Lymph node lesions in infectious mononucleosis (IM) show a marked histologic diversity. We report here three cases of IM lymphadenitis with histologic findings indistinguishable from those of toxoplasmic lymphadenitis. The histologic findings of the three cases presented here showed a histologic triad of toxoplasmic lymphadenitis, including (i) numerous lymphoid follicles with hyperplastic germinal centers; (ii) small clusters or single epithelioid histiocytes; and (iii) multiple foci of monocytoid B-cells. Moreover, all three lesions contained isolated or small clusters of epithelioid histiocytes within the hyperplastic germinal centers and the periphery of lymphoid follicles, which are the most specific histologic findings of toxoplasmic lymphadenitis. However, serologic findings confirmed EBV infection in all three cases. On in situ hybridization, numerous Epstein-Barr virus (EBV)encoded small RNA (EBER)-positive cells were demonstrated in the germinal center, as well as in interfolicular areas in all three cases. Toxoplasmosis gondii infection was excluded in at least one case, based on serologic findings. Polymerase chain reaction analysis also demonstrated that there was no T. gondii DNA in the remaining two cases. Two of our three cases showed atypical clinical presentations, including an absence of atypical lymphocytosis in peripheral blood in two cases, age more than 30 years, and an absence of systemic symptoms in one case. It appears that previous descriptions emphasize the differential diagnostic problems between IM lymphadenitis and malignant lymphomas. However, from a therapeutic perspective, it is important to discriminate IM lymphadenitis from toxoplasmic lymphadenitis particularly in patients showing atypical clinical features. (C) 2010 Elsevier GmbH. All rights reserved.
引用
收藏
页码:361 / 364
页数:4
相关论文
共 20 条
[1]
Primary nodal marginal zone lymphomas of splenic and MALT type [J].
Campo, E ;
Miquel, R ;
Krenacs, L ;
Sorbara, L ;
Raffeld, M ;
Jaffe, ES .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1999, 23 (01) :59-68
[2]
INFECTIOUS-MONONUCLEOSIS - THE SPECTRUM OF MORPHOLOGICAL-CHANGES SIMULATING LYMPHOMA IN LYMPH-NODES AND TONSILS [J].
CHILDS, CC ;
PARHAM, DM ;
BERARD, CW .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1987, 11 (02) :122-132
[3]
Toxoplasmic lymphadenitis - clinical and serologic profile [J].
Durlach, RA ;
Kaufer, F ;
Carral, L ;
Hirt, J .
CLINICAL MICROBIOLOGY AND INFECTION, 2003, 9 (07) :625-631
[4]
Gowing N F, 1975, Pathol Annu, V10, P1
[5]
GRAY GF, 1972, AM J PATHOL, V69, P349
[6]
EPSTEIN-BARR VIRUS SPECIFIC DIAGNOSTIC TESTS IN INFECTIOUS-MONONUCLEOSIS [J].
HENLE, W ;
HENLE, GE ;
HORWITZ, CA .
HUMAN PATHOLOGY, 1974, 5 (05) :551-565
[7]
Ioachim HL, 2009, IOACHIMS LYMPH NODE, V4th, P159
[8]
Ioachim HL, 2009, IOACHIMS LYMPH NODE, V4th, P76
[9]
Jones CD, 2000, INVEST OPHTH VIS SCI, V41, P634
[10]
JONES TC, 1965, JAMA-J AM MED ASSOC, V192, P87