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Epstein–Barr virus‐associated enteritis with multiple ulcers after stem cell transplantation: First histologically confirmed case
Author(s) -
Tashiro Yukie,
Goto Masamichi,
Takemoto Yoshinobu,
Sato Eiichi,
Shirahama Hiroshi,
Utsunomiya Atae,
Eizuru Yoshito,
Yonezawa Suguru
Publication year - 2006
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/j.1440-1827.2006.02001.x
Subject(s) - pathology , transplantation , stem cell , lymphoma , medicine , enteritis , epstein–barr virus , submucosa , lymphoproliferative disorders , biology , virus , gastroenterology , immunology , genetics
The present case involves unique enteritis forming multiple ulcers associated with Epstein–Barr virus (EBV). A 57‐year‐old man had undergone a reduced intensity allogeneic stem cell transplantation for a relapse of multiple myeloma following sequential autologous peripheral blood stem cell transplantation. The ileum, resected for massive melena, showed multiple irregular ulcers with occasional cobblestone‐like appearance. There was inflammation including numerous plasma cells in the ulcer bases and surrounding areas, where many EBV‐infected plasma cells were detected by double staining with EBV‐encoded small RNA‐1 (EBER‐1) in situ hybridization and CD79a, while EBV‐infected epithelial cells were not noted. The number of EBER‐1‐positive cells in the ileum (mucosa, 1451 cells/mm 2 ; submucosa, 465 cells/mm 2 ) was much larger than in control samples (malignant lymphoma or leukemia after allogeneic stem cell transplantation, n = 4, range 0–113 cells/mm 2 ; malignant lymphoma after chemotherapy, n = 14, range 0–0.89 cells/mm 2 ; colon cancer, n = 12, range 0–3.5 cells/mm 2 ). In the mucosa near the ulcers, EBER‐1‐positive cells often surrounded and involved the glandular epithelium, forming lymphoepithelial‐like lesions. The histological findings differ from post‐transplant lymphoproliferative disorders or intestinal thrombotic microangiopathy, and this is the first case of EBV‐associated enteritis with ulcers characterized by numerous plasma cells and lymphoepithelial‐like lesions after stem cell transplantation.