BACKGROUND Epstein-Barr virus-positive mucocutaneous ulcer (EBV-MCU) is a new category of mature B-cell neoplasms. Ulcers occur in the oropharyngeal mucosa, skin, and gastrointestinal tract. The onset of EBV-MCU is suggested to be related to the decreased immunity of the patient, the causes of which include the use of immunosuppressive agents and aging. EBV-MCU may regress spontaneously and it often has a benign course after the dose reduction or discontinuation of immunosuppressive agents or during follow-up. Here, we report the case of a patient who required surgical resection for the intestinal obstruction arising from EBV-MCU. CASE PRESENTATION A Japanese elderly male visited our hospital with chief complaints of a palpable mass and dull pain in the left upper quadrant, loss of appetite, and weight loss. Although abdominal computed tomography and total colonoscopy (TCS) revealed a tumor with circumferential ulcer in the transverse colon, histopathological analysis of a biopsy specimen of this lesion showed only nonspecific inflammation. Because the tumor spontaneously regressed during the time he underwent tests to obtain a second opinion from another hospital, TCS was reperformed on the patient. TCS revealed that the tumor decreased in size and the inflammatory changes in the surrounding mucosa tended to improve; however, tightening of the surrounding mucosa due to scarring was observed. Another histopathological analysis of a biopsy specimen showed widespread erosion of the mucosa and the formation of granulation tissue with marked infiltration of various inflammatory cells into the mucosal tissue of the large intestine. Moreover, some of the B-lymphocyte antigen CD20-positive B cells were also positive for EBV-encoded small RNA-1, suggesting the possibility of EBV-MCU. Later, the tumor developed into an intestinal obstruction; thus, the transverse colon was resected. Histopathological analysis of the resected specimen demonstrated scattered Hodgkin and Reed-Sternberg-like multinucleated large B cells in addition to EBER-1-positive cells. The patient was finally diagnosed as having EBV-MCU. CONCLUSIONS This is the first report of a case of EBV-MCU that developed into an intestinal obstruction requiring surgical resection. It is necessary to consider the possibility of EBV-MCU when examining an ulcerative or tumorous lesion in the gastrointestinal tract.

中文翻译：

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少见的爱泼斯坦-巴尔病毒阳性的粘膜皮肤溃疡发展成肠梗阻：一例病例报告。

背景爱泼斯坦-巴尔病毒阳性的粘膜皮肤溃疡（EBV-MCU）是一类新的成熟B细胞肿瘤。溃疡发生在口咽粘膜，皮肤和胃肠道。EBV-MCU的发作被认为与患者免疫力下降有关，其原因包括使用免疫抑制剂和衰老。EBV-MCU可能自发性退缩，在减少剂量或停用免疫抑制剂后或随访期间，它通常具有良性病程。在此，我们报告了因EBV-MCU引起的肠梗阻需要手术切除的患者。病例介绍一名日本老年男性到我院就诊，主要抱怨左上腹有明显的肿块和钝痛，食欲不振和体重减轻。尽管腹部计算机断层扫描和全结肠镜检查（TCS）显示出横结肠结肠周围有溃疡，但对该病灶活检标本的组织病理学分析仅显示非特异性炎症。因为在他进行检查以从另一家医院获得第二意见的时间内，肿瘤自发地消退，所以对患者进行了TCS。TCS显示肿瘤大小减小，周围粘膜的炎症变化趋于改善；然而，观察到由于疤痕而使周围的粘膜紧绷。活检标本的另一组织病理学分析显示，粘膜广泛腐蚀，肉芽组织形成，各种炎症细胞明显浸润到大肠粘膜组织中。此外，一些B淋巴细胞抗原CD20阳性的B细胞也对EBV编码的小RNA-1呈阳性，表明EBV-MCU的可能性。后来，肿瘤发展成肠梗阻。因此，切除了横结肠。对切​​除标本的组织病理学分析表明，除EBER-1阳性细胞外，还有散在的霍奇金和Reed-Sternberg样多核大B细胞。该患者最终被诊断出患有EBV-MCU。结论这是第一例EBV-MCU病例发展为需要手术切除的肠梗阻的报告。检查胃肠道溃疡或肿瘤病变时，有必要考虑EBV-MCU的可能性。提示EBV-MCU的可能性。后来，肿瘤发展成肠梗阻。因此，切除了横结肠。切除标本的组织病理学分析显示，除EBER-1阳性细胞外，还有散在的霍奇金和Reed-Sternberg样多核大B细胞。该患者最终被诊断出患有EBV-MCU。结论这是第一例EBV-MCU病例发展为需要手术切除的肠梗阻的报告。检查胃肠道溃疡或肿瘤病变时，有必要考虑EBV-MCU的可能性。提示EBV-MCU的可能性。后来，肿瘤发展成肠梗阻。因此，切除了横结肠。对切​​除标本的组织病理学分析表明，除EBER-1阳性细胞外，还有散在的霍奇金和Reed-Sternberg样多核大B细胞。该患者最终被诊断出患有EBV-MCU。结论这是第一例EBV-MCU病例发展为需要手术切除的肠梗阻的报告。检查胃肠道的溃疡性或肿瘤性病变时，有必要考虑EBV-MCU的可能性。对切​​除标本的组织病理学分析表明，除EBER-1阳性细胞外，还有散在的霍奇金和Reed-Sternberg样多核大B细胞。该患者最终被诊断出患有EBV-MCU。结论这是第一例EBV-MCU病例发展为需要手术切除的肠梗阻的报告。检查胃肠道的溃疡性或肿瘤性病变时，有必要考虑EBV-MCU的可能性。对切​​除标本的组织病理学分析表明，除EBER-1阳性细胞外，还有散在的霍奇金和Reed-Sternberg样多核大B细胞。该患者最终被诊断出患有EBV-MCU。结论这是第一例EBV-MCU病例发展为需要手术切除的肠梗阻的报告。检查胃肠道的溃疡性或肿瘤性病变时，有必要考虑EBV-MCU的可能性。