ObjectiveTo improve the understanding of the diagnosis and therapy of chronic active Epstein-Barr virus (CAEBV) infection. MethodsData of 9 cases of CAEBV infection diagnosed between October 2008 and January 2013 were analyzed retrospectively,including clinical and auxiliary examination results,pathological data,especially EB virus (EBV) antibodies and DNA in peripheral blood mononuclear cells (PBMC) and infected tissue,and follow-up information. ResultsThe major manifestations of the 9 patients were fever,splenomegaly,hepatomegaly,lymphadenopathy,and others,including general fatigue,nausea,skin rash,jaundice,and so on.The abnormalities of auxiliary examination were as follows:anemia,leucopenia,neutropenia,thrombocytopenia,elevated LDH and HBDH levels,liver dysfunction and abnormal chest CT findings.EBV serologic tests revealed high IgA antibody levels against EB viral capsid antigen (VCA) in 6 patients,and 8 patients had positive IgG antibody levels against early D antigen (EAD).The mean load of EBV-DNA detected by real time polymerase chain reaction (PCR) in the PBMC was 3.07×105 copies/mL.Six of the nine patients presented a poor clinical course.One of them died of intracranial hemorrhage,one of them died of multiple organ failure,one of them died of EBV-associated hemophagocytic syndrome,and one of them died of severe pulmonary infection.Four patients developed lymphoma.One of them died of hepatic failure and one of them died of severe infection in the process of anti-tumor treatment. ConclusionThe clinical feature of CAEBV infection is varied.More attention should be paid to the disease because of its severe complications,poor prognosis and high mortality.
ObjectiveTo explore the imaging manifestations of posttransplantation lymphoproliferative disease (PTLD) for making a further understanding of this disease and its imaging diagnosis. MethodsBy the method of litera-ture review, the imaging manifestations of PTLD in the abdomen, thorax, head and neck, and central nervous system were summarized, respectively, and also the epidemiologic features, pathogenesis and pathologic classification were reviewed. ResultsPTLD is a spectrum of lymphoproliferative diseases following transplantation mainly caused by Epstein-Barr virus and immunosuppressive therapy with different pathologic types.Lesions at imaging examinations may be the first clue to diagnose, and the appearance of PTLD at imaging can vary depending on the region. ConclusionImproving the cognition of PTLD and the imaging features plays a pivotal role in identifying the presence of disease, guiding tissue sampling, and evaluating response to treatment.
Objective To investigate the clinicopathologic features, diagnosis, treatment and prognosis of the primary lymphoepithelioma-like carcinoma (PLELC) of the lung. Methods Clinical and pathological data of one patient with PLELC of the lung were reviewed. PLELC of the lung was analyzed through review of literatures. Results A mass in the upper lobe of the left lung and atelectasis were detected by CT in a 36 year old nonsmoker male. He presented with cough, expectoration, fever and shortness of breath for one month. Neoplasm in left main bronchus was observed through bronchoscopy. Histological study showed cohesive clusters of comprising syncytial-appearing cells with vesicular nuclei and tumor infiltrating lymphocytes. Immunohistochemistry showed positive expression of Epstein-Barr virus (EBV) encoded small nuclear RNA. Nasal CT scan was negative for suspicious nasopharyngeal mucosal lesion or tumor. Then he was diagnosed as PLELC. The patient received docetaxel+nedaplatin regimens for 6 cycles with stable disease, but one month later after the end of chemotherapy, he was readmitted to hospital for dyspnea. CT scans showed progression of the lesion with massive pericardial effusion and pleural effusion. The patient could not tolerate chemotherapy, then received supportive treatment and died soon. Totally 18 Chinese articles and 25 foreign articles were screened out. Literature review suggested that patients with PLELC of the lung usually occurred in young nonsmokers and without gender difference. PLELC of the lung was closely associated with EBV infection. Its clinical manifestations were not specific, so that histopathological and immunohistochemical analyses were the main method of diagnosis. PLELC of the lung may respond to chemotherapy and radiotherapy. Surgery-based multimodality treatment was recommended. Patients with early or resectable disease had better prognosis, but patients with unresectable disease had poor prognosis. Conclusions PLELC of the lung may be closely associated with EBV infection. Histopathological and immunohistochemical analysis is the main method of diagnosis. Surgery-based multimodality treatment should be recommended because of its high response to chemotherapy and radiotherapy. Patients with early or resectable disease have better prognosis.
Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare type of lung cancer with special characteristics of epidemiology, clinical diagnosis, treatment and prognosis. It has close relationship with Epstein-Barr virus (EBV) infection and has prominent regional feature. Most patients are young and non-smoking. There is no specificity of clinical manifestation. Most patients are asymptomatic at the time of diagnosis. As for treatment, the standard treatment for early stage disease is complete resection. Platinum-based doublet chemotherapy has been applied in locally advanced disease as the first line therapy. Due to its rarity, the treatment of advanced PPLELC is still lack of evidence of large sample randomized controlled trial. Whether target therapy or immunotherapy is effective is worth further study. This article reviews the research progress of PPLELC, to give a particular sight for clinicians and provides a better understanding of this rare tumor for researchers.
ObjectiveTo explore the application value of plasma Epstein-Barr virus (EBV) DNA test in the clinical diagnosis of patients with nasopharyngeal carcinoma in non-high-incidence areas of Southwest China and its significance for monitoring patients after treatment. MethodsA total of 235 patients diagnosed with non-keratinized nasopharyngeal carcinoma between January 2014 and December 2015 were retrospectively collected. The plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment, the positive rates of the plasma EBV-DNA test before treatment and within 6 months of treatment, and the relationship between the positivity of plasma EBV-DNA within 6 months of treatment and the prognosis of nasopharyngeal carcinoma were analyzed. ResultsThe plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment was 69.79% (164/235), with a positive rate of 90.85% (149/164). A total of 131 patients were tested for EBV-DNA within 6 months of treatment, whose positive rate was 89.31% (117/131) before treatment and 21.37% (28/131) within 6 months of treatment, respectively, with a statistically significant difference (P<0.001). Comparing the prognosis of EBV-DNA positive patients and negative patients within 6 months of treatment, the difference in 3-year recurrence rate between the two groups was not statistically significant (10.71% vs. 3.88%, P=0.341); however, the 3-year metastasis rate (21.43% vs. 4.85%, P=0.016) and the 3-year disease progression rate (32.14% vs. 6.80%, P=0.001) of the EBV-DNA positive patients were higher than those of the EBV-DNA negative patients, and the log-rank test slao showed that the 3-year progression-free survival rate (67.86% vs. 93.20%, P<0.001) and the 3-year metastasis-free survival rate (78.57% vs. 95.15%, P=0.004) of the EBV-DNA positive patients were lower than those of the EBV-DNA negative patients. There was no statistically significant between-group difference in the 3-year progression-free survival curve when grouped by age, gender, or TNM staging (P>0.05).ConclusionsFor patients with non-keratinized nasopharyngeal carcinoma in non-high-incidence areas of Southwest China, EBV-DNA detection is important for the screening and diagnosis of nasopharyngeal carcinoma, and the positivity of EBV-DNA test within half a year of treatment is an important factor affecting the prognosis and progression of patients. Plasma EBV-DNA levels should be monitored regularly before and after treatment.
Objective To explore the relationship between Epstein-Barr virus (EBV) infection with serum human kissin-1 (KISS-1) and matrix metalloproteinase 2 (MMP2) levels and prognosis in patients with colon cancer. Methods A total of 86 colon cancer patients who were hospitalized in our hospital from April 2015 to April 2016 were selected as the colon cancer group; in the same period, 84 cases of physical examination person in our hospital were selected as the control group. Real-time fluorescent quantitative PCR (qRT-PCR) was used to test colon cancer patients for EBV DNA, and divided the patients into EBV DNA negative group and EBV DNA positive group according to the test results. Enzyme-linked immunosorbent (ELISA) method was used to detect serum KISS-1 and MMP2 levels. Pearson method was used to analyze the correlation between serum KISS-1 and MMP2 levels in patients with colon cancer infected with EBV. The survival curve was drawn by Kaplan-Meier method, and the relationship between EBV infection and prognosis of colon cancer patients was analyzed by log-rank test. Multivariate Cox regression analysis were used to analyze the factors affecting the prognosis of colon cancer patients. Results Compared with the control group, the positive rate of EBV DNA in the colon cancer group was higher (χ2=21.854, P<0.001). The EBV DNA positive rate of patients with lymph node metastasis, TNM stage Ⅲ–Ⅳ, tumor low differentiation and tumor infiltration T3–T4 was higher than those without lymph node metastasis, TNM stage Ⅰ–Ⅱ, tumor high/medium differentiation and tumor infiltration T1–T2 (P<0.05). Compared with the EBV DNA negative group, the serum KISS-1 level of the EBV DNA positive group decreased, and the MMP2 level increased (P<0.001). There was a negative correlation between serum KISS-1 and MMP2 levels in colon cancer patients with EBV infection (r=–0.510, P<0.001). The 5-year survival rates of colon cancer patients in the EBV DNA-negative group and the EBV DNA-positive group were 52.94% (27/51) and 14.29% (5/35), respectively, the difference between the two groups was statistically significant (χ2=13.274, P<0.001). EBV infection, MMP2 high expression, and lymph node metastasis were independent risk factors affecting the prognosis of colon cancer patients (P<0.05), and KISS-1 low expression was a protective factor affecting the prognosis of colon cancer patients (P<0.05). Conclusions EBV infection is closely related to the progression and prognosis of colon cancer. The down-regulation of KISS-1 and the up-regulation of MMP2 may be related to EBV infection.
Objective To investigate the clinicopathological features, treatment and prognosis of primary pulmonary lymphoepithelioma-like carcinoma (PPLELC). Methods Forty-five patients with PPLELC admitted to Sichuan Cancer Hospital from April 2016 to March 2023 were retrospectively analyzed. Their clinical data and survival were collected and summarized. Results Of the 45 patients, 28.9% (13/45) were asymptomatic, 97.2% (35/36) were positive for Epstein-Barr virus encoded small RNA, 83.3% (10/12) were positive for programmed cell death-ligand 1 (PD-L1), and the tumor proportion score (TPS) fluctuated between 10.0% to 95.0%. Genetic testing revealed 1 case of EGFR gene 19-Del mutation. Among the 45 patients, 28 cases received surgical treatment, of which 16 received adjuvant chemotherapy, 8 received adjuvant radiotherapy, and 2 received neoadjuvant chemotherapy. As of the follow-up cut-off date, 33 patients survived and 12 patients died, with a median survival time not reached and an overall survival rate of 70.2% and 63.2% at 3 and 5 years, respectively. The 3- and 5-year disease-free survival rates were 67.2% and 57.6% for the 28 operated patients, respectively, and the progression-free survival rates were 58.3% and 29.2% for the 13 stage Ⅳ patients, respectively. Conclusions PPLELC is associated with Epstein-Barr virus infection and is a rare subtype of non-small cell lung cancer (NSCLC). Most patients do not have common gene mutations such as EGFR or ALK and have a high rate of positive PD-L1 expression. The disease is usually treated with a multi-method combination of mainly surgery, and is sensitive to radiotherapy and chemotherapy and has a better prognosis than other types of NSCLC.