间变性大细胞淋巴瘤20例临床病理学特征探讨
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摘要
目的探讨间变性大细胞淋巴瘤的临床病理学特征及诊断、鉴别诊断要点。方法对20例间变性大细胞淋巴瘤进行临床病理分析及免疫组化研究,并进行文献复习。结果 20例间变性大细胞淋巴瘤的发病年龄为4～78岁,其中11例发生于颈部淋巴结,表现为多发淋巴结肿大,有或无压痛,伴发热、体重下降、部分有淋巴结融合,镜下普通型12例,占60%,淋巴结结构破坏,瘤细胞多形性、不规则或卵圆形、梭形,胞浆丰富、嗜酸,核空网状,核膜粗,可见1～3个不等的嗜双色核仁、中位或靠边分布,核分裂易见,可见顿挫型病理性核分裂;免疫组化示肿瘤细胞CD30(20例均阳性)、ALK(5例阳性)、CD5(18例阳性)、CD7(12例阳性)、CD138(8例阳性)、Ki-67(60%～85%阳性)、CD3(19例阳性)、CD45RO(19例阳性)、TIA-1(18例阳性)、Vim(20例均阳性)、mum-1(10例阳性)、CD2(11例阳性)、CD8(10例阳性)、CD68(1例阳性)、Bcl-2(6例阳性)、Bcl-6(12例阳性)。结论间变性大细胞淋巴瘤比较少见,其诊断和鉴别诊断需结合组织病理学、免疫组化、基因重排、临床及实验室检查。
Objective To investigate the clinicopathological features, diagnostic and differential diagnosis points of anaplastic large cell lymphoma. Methods Clinical pathological analysis and immunohistochemical study of 20 cases of anaplastic large cell lymphoma and literature review were performed. Results The onset age of 20 cases of anaplastic large cell lymphoma was 4 to 78 years old, 11 cases of which occurred cervical lymph nodes, showing multiple lymphadenopathy with or without tenderness, combined with fever, weight loss, and partial lymph node fusion. And 12 cases were common under the microscope, accounting for 60%, which showed the destroyed structure of lymph nodes, the pleomorphic, irregular or oval, fusiform tumor cells, cytoplasm rich, acidophilic, nuclear empty network, nuclear membrane thick, visible 1-3 dioxin nucleus, median or marginal distribution. And the nuclear division was easy to see, and abortive pathological mitosis was visible. Immunohistochemistry showed tumor cells CD30(20 cases with positive), ALK(5 cases with positive), CD5(18 cases with positive), CD7(12 cases with positive), CD138(8 cases with positive), Ki-67(60%～85% positive), CD3(19 cases with positive), CD45 RO(19 cases with positive), TIA-1(18 cases with positive),Vim(20 cases with positive), mum-1(10 cases with positive), CD2(11 cases with positive), CD8(10 cases with positive), CD68(1 case with positive), Bcl-2(6 cases with positive), Bcl-6(12 cases with positive). Conclusion Anaplastic large cell lymphoma is rare. Its diagnosis and differential diagnosis need to be combined with histopathology, immunohistochemistry, gene rearrangement, clinical and laboratory examination.
Objective To investigate the clinicopathological features, diagnostic and differential diagnosis points of anaplastic large cell lymphoma. Methods Clinical pathological analysis and immunohistochemical study of 20 cases of anaplastic large cell lymphoma and literature review were performed. Results The onset age of 20 cases of anaplastic large cell lymphoma was 4 to 78 years old, 11 cases of which occurred cervical lymph nodes, showing multiple lymphadenopathy with or without tenderness, combined with fever, weight loss, and partial lymph node fusion. And 12 cases were common under the microscope, accounting for 60%, which showed the destroyed structure of lymph nodes, the pleomorphic, irregular or oval, fusiform tumor cells, cytoplasm rich, acidophilic, nuclear empty network, nuclear membrane thick, visible 1-3 dioxin nucleus, median or marginal distribution. And the nuclear division was easy to see, and abortive pathological mitosis was visible. Immunohistochemistry showed tumor cells CD30(20 cases with positive), ALK(5 cases with positive), CD5(18 cases with positive), CD7(12 cases with positive), CD138(8 cases with positive), Ki-67(60%～85% positive), CD3(19 cases with positive), CD45 RO(19 cases with positive), TIA-1(18 cases with positive),Vim(20 cases with positive), mum-1(10 cases with positive), CD2(11 cases with positive), CD8(10 cases with positive), CD68(1 case with positive), Bcl-2(6 cases with positive), Bcl-6(12 cases with positive). Conclusion Anaplastic large cell lymphoma is rare. Its diagnosis and differential diagnosis need to be combined with histopathology, immunohistochemistry, gene rearrangement, clinical and laboratory examination.
引文
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[8] Kadin ME. Ki-1/CD30+anaplastic large-cell lymphoma.Maturation of a clinicopathologic eneity with prospects of effective therapy[J].J Chin Oncol,1994,12(5):884-887.
[9] Shulman LN,Frisard B,Antin JH,et al. Primary Ki-1anaplastic large-cell lymphoma in adults. Clinical characteristics and therapentic outcome[J]. J Chin Oncol,1993,11(6):937-942.
[10] Delsol G,Campo E,Gascoyne R. ALK-positive large Bcell lymphoma.//Swerdlow SH,Campo E,Harris NL,et al. WHO classification of tumours of haematopoietic and lymphiod tissues, ed.4[J]. Lyon,IARC Press,2008:254-255.
[11] Klapper W,Bohm M,Siebert R,et al. Morphological variability of lymphohistiocytic variant of anaplastic large cell lymphoma(former lymphohistiocytic lymphoma according to the Kiel classification)[J]. Virchows Arch,2008,452(10):599-605.
[12] Chan JK. The perivascular cuff of large lymphoid cells:a clue to diagnosis of anaplastic large cell lymphoma[J]. Int J Surg Pathol,2000,8(3):153-156.
[13] Chan JK,Buchanan R,Fletcher CD. Sarcomatoid variant of anaplastic large-cell Ki-1 lymphoma[J]. Am J Surg Pathol,1990,14(3):983-988.
[14] Falini B,Liso A,Pasqualucci L,et al. CD30+anaplastic large-cell lymphoma,null type,with signet-ring appearance[J]. Histopathology,1997,30(12):90-92.
[15] Mc Cluggage WG,Walsh MY,Bharucha H. Anaplastic large cell malignant lymphoma with extensive eosinophilic or neutrophilic infiltration[J]. Histopathology,1998,32(7):110-115.
[16] Falini B,Bigerna B,Fizzotti M,et al. ALK expression defines a distinct group of T/null lymphomas(ALK lymphomas)with a wide morphological spectrum[J]. Am J Pathol,1998,153(8):875-886.
[17]朱梅刚,林汉良.淋巴瘤病理诊断图谱[M].广州:广东科技出版社,2010:144-150.
[2] Chott A,Kaserer K,Augustin I,et al. Ki-1 positive large cell lymphoma. A clinicopathologic study of 41 cases[J]. Am J surg Pathol,1990,14(2):439-448.
[3] Kandewitz P,Greer JP,Glick AD,et al. Anaplastic large-cell Ki-1 maliguant lymphomas. Recognition,biological and clinical implications[J]. Pathol Amu,1991,26(pt.1):1-24.
[4] Kandewitz P,Stein H,Dallenbach F,et al. Primarg and secoudary cutaneous Ki-1+(CD30+)anaplastic large cell lymphomas. Morphologic,immunohistologic,and clinical characteristics[J]. Am J Pathol,1989,135(7):359-367.
[5] Banerjee SS,Heald J,Harris M. Twelve cases of Ki-1positive anaplastic large cell lymphoma of skin[J]. J Chin Pathol,1991,44(2):119-125.
[6] Chan JK,Ng CS,Hui PK.Leung TW,et al. Anaplastic large cell Ki-1 lymphoma. Delineation of two morphological types[J]. Histopathology,1989,15(4):11-34.
[7] D Amore ES,Menin A,Bonoldi E,et al. Anaplastic large cell lymphomas:a study of 75 pediatric patients[J]. Padiatr Dev Pathol 2007,10(9):181-191.
[8] Kadin ME. Ki-1/CD30+anaplastic large-cell lymphoma.Maturation of a clinicopathologic eneity with prospects of effective therapy[J].J Chin Oncol,1994,12(5):884-887.
[9] Shulman LN,Frisard B,Antin JH,et al. Primary Ki-1anaplastic large-cell lymphoma in adults. Clinical characteristics and therapentic outcome[J]. J Chin Oncol,1993,11(6):937-942.
[10] Delsol G,Campo E,Gascoyne R. ALK-positive large Bcell lymphoma.//Swerdlow SH,Campo E,Harris NL,et al. WHO classification of tumours of haematopoietic and lymphiod tissues, ed.4[J]. Lyon,IARC Press,2008:254-255.
[11] Klapper W,Bohm M,Siebert R,et al. Morphological variability of lymphohistiocytic variant of anaplastic large cell lymphoma(former lymphohistiocytic lymphoma according to the Kiel classification)[J]. Virchows Arch,2008,452(10):599-605.
[12] Chan JK. The perivascular cuff of large lymphoid cells:a clue to diagnosis of anaplastic large cell lymphoma[J]. Int J Surg Pathol,2000,8(3):153-156.
[13] Chan JK,Buchanan R,Fletcher CD. Sarcomatoid variant of anaplastic large-cell Ki-1 lymphoma[J]. Am J Surg Pathol,1990,14(3):983-988.
[14] Falini B,Liso A,Pasqualucci L,et al. CD30+anaplastic large-cell lymphoma,null type,with signet-ring appearance[J]. Histopathology,1997,30(12):90-92.
[15] Mc Cluggage WG,Walsh MY,Bharucha H. Anaplastic large cell malignant lymphoma with extensive eosinophilic or neutrophilic infiltration[J]. Histopathology,1998,32(7):110-115.
[16] Falini B,Bigerna B,Fizzotti M,et al. ALK expression defines a distinct group of T/null lymphomas(ALK lymphomas)with a wide morphological spectrum[J]. Am J Pathol,1998,153(8):875-886.
[17]朱梅刚,林汉良.淋巴瘤病理诊断图谱[M].广州:广东科技出版社,2010:144-150.