Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 33 ›› Issue (1): 58-62.doi: 10.6040/j.issn.1673-3770.0.2019.304

   

Clinical characteristics of an EB virus-positive mucocutaneous ulcer on the tonsil

LI Jingjing1, XU Jinkun1, LI Li2   

  1. 1. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China;
    2. Department of Pathology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
  • Published:2020-03-06

Abstract: Objective To analyze and evaluate the clinical features, treatment, and prognosis of a patient with an Epstein-Barr virus positive mucocutaneous ulcer(EBV MCU)in order to improve our understanding, and ability to accurately diagnose and treat, this rare and recently described entity. Methods We analyzed clinical data associated with a case of EBV MCU and reviewed the literature that addresses this new disease entity in order to summarize its clinical characteristics, treatment, and prognosis. Results The patient was 91 years old and presented with a two-week history of pharyngalgia. On clinical examination we noted a sharply circumscribed, isolated, and indurated ulcer on the left tonsil. Histologically, the ulcer consisted of a polymorphous infiltrate composed predominantly of small lymphocytes and other inflammatory cells admixed with scattered large atypical cells with large irregular or lobulated nuclei and abundant cytoplasm. The histological findings were positive for CD20, CD30, Pax5, and EBEV. The patient was treated with cephalosporin antibiotics for two weeks, and the ulcer healed completely one month post-onset. Conclusion A EBV MCU in the tonsil showed morphological and imaging characteristics of a malignant tumor, but the disease was self-limited, and generally required only conservation treatment. However, close observation and follow-up are required to monitor the disease progress and potential transformation. Chemoradiotherapy can be administered when necessary.

Key words: Epstein-Barr virus positive, Mucocutaneous ulcer, Tonsil ulcer, Therapy, Prognosis

CLC Number: 

  • R766.4
[1] Dojcinov SD, Venkataraman G, Raffeld M, et al. EBV positive mucocutaneous ulcer: a study of 26 cases associated with various sources of immunosuppression[J]. Am J Surg Pathol, 2010, 34(3): 405-417. doi:10.1097/PAS.0b013e3181cf8622.
[2] Swerdlow SH, Campo E, Harris NL, et al. WHO classicfication of tumours of haematopoietic and lymphoid tissue, revised 4th edition[J]. IARC: Lyon 2017. doi: 10.1590/S0080-623420140000400008.
[3] Willemze R, Cerroni L, Kempf W, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas[J]. Blood, 2019,18,133(16):1703-1714. doi: 10.1182/blood-2018-11-881268. Epub 2019 Jan 11.
[4] Willemze R, Cerroni L, Kempf W, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas[J]. Blood, 2019, 133(16): 1703-1714. doi:10.1182/blood-2018-11-881268.
[5] Roberts TK, Chen XY, Liao JJ. Diagnostic and therapeutic challenges of EBV-positive mucocutaneous ulcer: a case report and systematic review of the literature[J]. Exp Hematol Oncol, 2015, 5: 13. doi:10.1186/s40164-016-0042-5.
[6] 陈燕坪, 陈刚, 谢建兰, 等. EB病毒阳性的皮肤黏膜溃疡临床病理学特征分析[J]. 中华病理学杂志, 2017, 46(4): 261-262. doi:10.3760/cma.j.issn.0529-5807.2017.04.011.
[7] 陈红梅, 夏成青, 查宏斌. EB病毒阳性皮肤黏膜溃疡1例及文献复习[J]. 临床与病理杂志, 2018, 38(7): 1591-1594. doi:10.3978/j.issn.2095-6959.2018.07.038. CHEN Hongmei, XIA Chengqing, ZHA Hongbin,et al. EB virus positive mucocutaneous ulcer: A case report and literature review[J]. International Journal of Pathology and Clinical Medicine, 2018, 38(7): 1591-1594. doi:10.3978/j.issn.2095-6959.2018.07.038.
[8] 马依迪丽·尼加提, 田序伟, 张斌, 等. 扁桃体鳞状细胞癌与淋巴瘤MRI征象对比分析[J]. 临床放射学杂志, 2018, 37(8): 1278-1282. doi:10.13437/j.cnki.jcr.2018.08.010. NIJIATI Mayidili, TIAN Xuwei, ZHANG Bin, et al. Comparison of MR imaging features between tonsillar carcinoma and tonsillar lymphoma[J]. Journal of Clinical Radiology, 2018, 37(8): 1278-1282. doi:10.13437/j.cnki.jcr.2018.08.010.
[9] 吴雪溪, 唐平章, 祁永发, 等. 108例扁桃体鳞癌治疗效果的回顾性分析[J]. 癌症, 2003, 22(10): 1070-1073. doi:10.3969/j.issn.1000-467X.2003.10.014. WU Xuexi, TANG Pingzhang, QI Yongfa, et al. Retrospective analysis of effectiveness of tonsillar squamous cell carcinoma: report of 108 cases[J]. Chinese Journal of Cancer, 2003, 22(10): 1070-1073. doi:10.3969/j.issn.1000-467X.2003.10.014.
[10] 吴雪溪, 唐平章, 祁永发, 等. 扁桃体鳞状细胞癌的治疗选择[J]. 中华耳鼻咽喉科杂志. 2003;38(5):379-382. doi:10.3760/j.issn:1673-0860.2003.05.016.
[11] Magalhaes M, Ghorab Z, Morneault J, et al. Age-related Epstein-Barr virus-positive mucocutaneous ulcer: a case report[J]. Clin Case Rep, 2015, 3(7): 531-534. doi:10.1002/ccr3.287.
[12] Dojcinov SD, Fend F, Quintanilla-Martinez L. EBV-positive lymphoproliferations of B- T- and NK-cell derivation in non-immunocompromised hosts[J]. Pathogens, 2018, 7(1): E28. doi:10.3390/pathogens7010028.
[13] Koens L, Senff NJ, Vermeer MH, et al. Methotrexate-associated B-cell lymphoproliferative disorders presenting in the skin: A clinicopathologic and immunophenotypical study of 10 cases[J]. Am J Surg Pathol, 2014, 38(7): 999-1006. doi:10.1097/PAS.0000000000000225.
[14] Hoshida Y, Xu JX, Fujita S, et al. Lymphoproliferative disorders in rheumatoid arthritis: clinicopathological analysis of 76 cases in relation to methotrexate medication[J]. J Rheumatol, 2007, 34(2): 322-331.
[15] Swerdlow SH, Quintanilla-Martinez L, Willemze R, et al. Cutaneous B-cell lymphoproliferative disorders: report of the 2011 Society for Hematopathology/European Association for Haematopathology workshop[J]. Am J Clin Pathol, 2013, 139(4): 515-535. doi:10.1309/AJCPNLC9NC9WTQYY.
[16] Daroontum T, Kohno K, Inaguma Y, et al. Epstein-Barr virus(EBV)-positive diffuse large B-cell lymphoma arising in patient with a history of EBV-positive mucocutaneous ulcer and EBV-positive nodal polymorphous B-lymphoproliferative disorder[J]. Pathol Int, 2019, 69(1): 37-41. doi:10.1111/pin.12738.
[17] Daroontum T, Kohno K, Eladl AE, et al. Comparison of Epstein-Barr virus-positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan[J]. Histopathology, 2018, 72(7): 1115-1127. doi:10.1111/his.13464.
[18] Attard AA, Praveen P, Dunn PJ, et al. Epstein-Barr virus-positive mucocutaneous ulcer of the oral cavity: the importance of having a detailed clinical history to reach a correct diagnosis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(2): e37-e39. doi:10.1016/j.oooo.2012.04.003.
[1] DING Yujing, LAN Lan, WANG Qiuju, JI Fei, XIONG Fen, XIE Linyi, DING Haina, XIA Yin, ZHAO Hui. Analysis of clinical characteristics and prognosis of post traumatic hearing loss [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 9-14.
[2] ZONG Xiaofang, HU Guohua, ZHONG Shixun, LEI Yan, JIANG Lizhu, KANG Houyong. Analysis of the factors affecting the prognosis of low-frequency descending sudden hearing loss without vertigo [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 33-37.
[3] CHEN Xuesong, FU Weiwei, LIU Jiangtao. The prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in intensity modulated radiation therapy for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 50-53.
[4] ZHANG Jianli, CHEN Weixiong, CHEN Ruikai, KUANG Debing, PANG Yishi. Evaluation of the effect of fiberoptic endoscopic evaluation of swallowing on long-term survivor with nasopharyngeal cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 56-59.
[5] Yangfan LIU,Jian JIA,Baoluo WAN. A retrospective study on clinic manifestation and pathological of the larynx leukoplakia in 76 cases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 162-165.
[6] Xiaobo CUI. Significance of induction chemotherapy in late treatment of locally advanced hypo-pharyngeal cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 10-17.
[7] Xiaohan SUN,Na LI. Application of laryngeal retention strategy in the treatment of laryngeal cancer - introduction to the clinical practice guide of the American Society of Clinical Oncology (2017) [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 40-42.
[8] HUANG He, OUYANG Hui. Risk factors and prognosis of esophageal cancer with hypopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 82-86.
[9] Ruofei HUANG,Lixiao CHEN,Xinwei CHEN,Ziwei YU,Bin JIN,Jiangcai ZHU,Pin DONG. Recurrent laryngeal cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 36-39.
[10] ZHANG Guiyang, HUANG He, XIAN Zhi, ZHANG Hanwen, XIE Guicai. Evaluation of clinical effects of sublingual immunotherapy with Dermatophagoides farinae drops in patients of different age groups with allergic rhinitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 60-65.
[11] Qing ZHAO,Han ZHOU,Min YIN,Jian FENG,Jiacheng ZHANG,Yaqin LIU,Yujie SHEN,Ziping LIN,Weida DONG. Value of preoperative hyperselective vascular embolization in juvenile nasopharyngeal angiofibroma treatment [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 100-105.
[12] Xi CHEN,Mingzhe QIAO. Progress of immune checkpoint inhibitors in the treatment of recurrent or metastatic head and neck squamous cell carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 42-48.
[13] Jiacheng ZHANG,Liqing ZHANG,Han ZHOU,Meiping LU,Wanyun XU,Yujie SHEN,Yaqin LIU,Min YIN,Weida DONG. Analysis of malignant melanoma of the nasal cavity and paranasal sinuses in 23 cases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 95-99.
[14] Huijun CHEN,Shenghua SONG,Han ZHOU,Weida DONG,Mingzhe QIAO,Xi CHEN,Jin XU,Ziping LIN,Guangqian XING. Preoperative platelet-lymphocyte ratio is an independent prognostic factor for laryngeal squamous cell carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 106-110.
[15] Haijun LU,Ji LIU,Xiao DING. Progress in the comprehensive treatment for nasopharyngeal carcinoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 26-30.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!