流式细胞术在弥漫性大B细胞淋巴瘤伴大量T细胞反应病理诊断中的应用  

Application of flow cytometry in diagnosis of T-cell rich diffuse large B-cell lymphoma

作　　者：夏成青[1] 齐曼[1] 徐先发[2] 李利红[3] 赵宏颖[1] 

机构地区：[1]首都医科大学附属北京朝阳医院病理科,100020 [2]首都医科大学附属北京朝阳医院耳鼻喉科,100020 [3]首都医科大学附属北京朝阳医院血液科,100020

出　　处：《中华病理学杂志》2007年第1期29-32,共4页Chinese Journal of Pathology

基　　金：2003年北京市优秀人才培养基金;2005年北京市"十百千"卫生人才工程"百"类人才专项经费资助

摘　　要：目的探讨流式细胞免疫分型技术在弥漫大 B 细胞淋巴瘤伴大量 T 细胞反应病例诊断中的应用价值。方法对3例弥漫大 B 细胞淋巴瘤伴大量 T 细胞反应病例病理形态、免疫组织化学染色及流式细胞免疫分型进行回顾性分析。结果例1:在 CD45-SSC(Side Scatter,侧向散射角)点图上可见 CD45阳性细胞明显分2群,强阳性细胞由 T 细胞和 B 细胞共同组成,但以 T 细胞为主,其中 B 细胞为免疫球蛋白轻链非限制性表达。而 CD45弱阳性细胞基本都是 B 细胞,且为免疫球蛋白轻链λ限制性表达。例2:在 CD45-SSC 点图中可见 CD45阳性细胞因 SSC 大小不同而分2群,SSC 较小的细胞群为 T、B 细胞混合存在,SSC 较大,相当于单核细胞位置的细胞群主要为 B 细胞,且为免疫球蛋白轻链κ限制性表达;例3:再作 CD19/κ/CD20,CD19/λ/CD20三重标记发现部分 CD19阳性细胞 CD20阴性,该群细胞呈κ限制性表达。结论通过多参数、多组合流式细胞免疫分型技术可以从抗原表达减弱或增强、抗原丢失、是否表达非 B 系抗原、FSC(前向散射光)和(或)SSC 的变化以及是否有表达不成熟 B 细胞的抗原6个方面将肿瘤性 B 细胞与反应性细胞区分开。Objective To investigate the application of flow cytometry in diagnosis of T-cell rich diffuse large B-cell lymphoma. Methods Histopathologic features, immunohistochemical findings and flow cytometry results of three cases of T-cell rich diffuse large B-cell lymphoma were reviewed retrospectively. Results In CD45-side scatter （SSC） dot plot of the first patient, two different CD45-positive lymphoid cell populations were identified. The bright population consisted of both T and B cells, with a T-cell predominance. The dim population consisted mainly of B cells which showed lambda light chain restriction. In the second patient, CD45-positive cells were subdivided into two groups according to CD45-SSC dot plot. The small population consisted of both T and B cells, with a T-cell predominance. The large population consisted mainly of B cells which showed kappa light chain restriction. In the third patient, CD19-positive cells were subdivided into two groups according to the expression of CD20 in CD19-CD20 dot plot. The CD20-positive population expressed both kappa and lambda light chains, while the CD20-negative population demonstrated kappa light chain restriction. Conclusions Neoplastic B cells can be distinguished from reactive lymphoid cells in T-cell rich diffuse large B-cell lymphoma by flow cytometry, according to a number of parameters which include intensity of antigen expression, loss of antigens, expression of non-B-cell lineage antigens, patterns of forward scatter （FSC） and/or SSC, and expression of immature B-cell antigens.

关 键 词：淋巴瘤 B细胞 T淋巴细胞 免疫表型分型 流式细胞术 

分 类 号：R733.1[医药卫生—肿瘤]