肿瘤细胞丰富的霍奇金淋巴瘤10例临床病理分析  

A clinicopathological study of 10 cases of neoplastic cell rich Hodgkin＇s lymphoma

作　　者：方婉婷[1] 杜金荣[1] 谢建兰[2] 于冉[3] 郑晓丹[2] 朱红[2] 周小鸽[2] 

机构地区：[1]哈尔滨医科大学附属第二医院病理科,150086 [2]首都医科大学附属北京友谊医院病理科 [3]首都医科大学病理教研室

出　　处：《白血病．淋巴瘤》2010年第4期226-229,共4页Journal of Leukemia & Lymphoma

摘　　要：目的研究肿瘤细胞丰富的霍奇金淋巴瘤（NCRHL）的临床特征、病理特点、免疫表型及EB病毒感染情况，以提高对NCRHL的认识和诊断水平。方法收集10例NCRHL，应用光学显微镜观察、免疫组织化学方法及原位杂交技术，结合临床资料分析，对10例NCRHL进行临床病理、免疫表型和EB病毒感染的研究。结果NCRHL多见于青年人，中位年龄25．5岁，男女比为1：2．3，常伴浅表淋巴结及纵隔肿大。可有B症状（6例）、皮肤瘙痒（5例）、贫血（1例）等临床表现。淋巴结结构破坏，瘤细胞数量增多为其突出表现，并且瘤细胞形态多样（霍奇金细胞样、陷窝细胞样、干，1细胞样、间变细胞、奇异核细胞、多核巨细胞样细胞等），背景中的炎性细胞无明显减少，多数病例没有明显纤维化，也不形成纤维条带围绕的硬化结节，50％病例有灶状坏死。肿瘤组织表现为灶片状、坏死肉芽肿样和弥散状生长方式。免疫表型：所有检测的病例表达CD30和PAX5，不表达LCA、CO3和CD20，仅有2例（20％）表达CD荫6例行EB病毒编码的小RNA（EBER）检测，均为阴性。10例患者中，8例获得随访，其中1例死亡，1例复发，其余6例化疗后均完全缓解。结论NCRHL以肿瘤细胞数量增多为主要形态学特征，呈灶片状、坏死肉芽肿样和弥散状生长方式，无EBER表达，部分病例治疗方案效果不理想，有待探索新的治疗方案。Objective To clarify clinical and morphological features and immunophenotype and Epstain-Barr virus infection of neoplastic cell rich Hodgkin＇s lymphoma （NCRHL）and to further improve our knowledge and pathological diagnosis for NCRHL. Methods 10 cases of NCRHL were analyzed for clinical features, morphology, immunophenotype, Epstein-Barr virus infection using routine eosin and haematoxylin stain, immunohistoehemistry, Epstain-Barr virus encoded small RNA （EBER） in situ hybridization and combining clinical data. Results （1）NCRHL were more common in young people. The median age of the patients was 25.5 years old. The ratio of male to female was 1：2.3. Superficial lymph nodes were most frequently involved. Masses of mediastinum were seen commonly. Clinical manifestation of the patients included B symptom （6 cases）, pruitus （5 cases） and anemia （1 case）. （2）Architecture of lymph nodes were effeeted. Necrosis was seen in some cases. There were more tumor cells in NCRHL than that in the classical Hodgkin＇s lymphoma. The tumor cells were distributed in piece or patch or diffuse. The morphology of neoplastic cells was wore variable including Hodgkin-like cells, lacunar cell-like, mummy cell-like and anaplastic large cell-like, singular nucleated cells, and muhinucleated giant cell-like cells. Numerous neutrophils and eosinophils were present in a few cases. Focal sheet, necrosis granulomatosis-like and diffuse growth pattern were found in NCRHL. （3）All of the cases were positive for CD30 and PAX-5. 2/10 （20 %） cases were CD15 positive. LCA, CD20 and CD3 were negative. （4）EBER was not detected in all 6 tested cases. （5） Follow up data was obtained in 8/10 cases, in which one patient was dead, one case relapsed in half a year, and the other 6 eases reached complete regression. Conclusion NRCHL is characterized mainly by neoplastic cell rich morphologically and focal sheet, necrosis granulomatosis-like and diffuse growth pattern. EBER was not detected in this tumor. Some cas

关 键 词：霍奇金淋巴瘤 肿瘤细胞丰富 病理学 临床 免疫组织化学 抗原 CD30 抗原 CD15 PAX-5 

分 类 号：R733.1[医药卫生—肿瘤]