血管内NK细胞淋巴瘤的临床病理分析  

Intravascular NK-cell lymphoma：a clinicopathologic study and literature review

作　　者：蒋镭[1] 谢建兰[1] 周小鸽[1] 

机构地区：[1]首都医科大学附属北京友谊医院病理科,100050

出　　处：《中华病理学杂志》2011年第10期689-693,共5页Chinese Journal of Pathology

摘　　要：目的探讨血管内NK细胞淋巴瘤（WNKL）的临床病理特征及预后特点，以提高对这一罕见疾病的认识。方法采用HE、免疫组织化学染色（EliVision法）和原位杂交技术，结合临床资料对2例IVNKL进行分析，对文献中的7例及该组2例患者进行临床病理学特征分析和预后比较。结果2例患者分别为68岁女性和22岁男性，均表现为躯干和四肢皮疹伴发热，皮肤活检结果符合典型的血管内淋巴瘤，免疫表型证实为NK细胞来源，即CD3、CD56、颗粒酶B和EBV编码的小RNA探针（EBER）阳性。2例患者均于确诊2个月后死亡。汇总文献，9例患者中男4例，女5例，平均年龄45．7岁，中位数47岁，红斑皮疹是最常见的临床表现，7例患者病程中出现多系统受累，3例中枢神经系统受累。随访时间2～17个月，9例中6例死亡，中位生存时间为9个月，1年生存率为（35．6±18．6）％。多系统受累患者的死亡率（6／7）略高于单纯皮疹者（0／2），但差异无统计学意义（P=0．083）。结论IVNKL是一种罕见疾病，确诊需要依据典型组织学特点，并结合免疫表型分析和EBER原位杂交检测。该病预后较差，需尽早确诊、及时治疗，以避免多系统受累。Objective To study the clinicopathologic features and disease outcome of intravascular natural killer-cell lymphoma （IVNKL）. Methods The histologic features, immunohistochemical findings and results of in-situ hybridization for Epstein-Barr virus-encoded RNA （EBER） were analyzed in 2 novel cases of IVNKL. Seven cases of IVNKL previously reported in the literature were reviewed. Results The patients were a 68-year-old woman and a 22-year-old man. They both presented with erythematous patches and nodules on their trunk and extremities. Skin biopsies confirmed the diagnosis of IVNKL. The tumor cells were positive for CD3, CD56, granzyme B and EBER. Both patients died 2 months after the diagnosis.Amongst the 9 reported cases, including those from the literature, the male was 4 cases, the female was 5 cases. The mean age of the patients was 45.7 years and the median age was 47 years. Skin lesions represented the commonest clinical manifestations. Multiple organ involvement was found in 7 cases and central nervous system was involved in 3 cases. Six patients died during 2 to 17 months of follow-up. The median survival was 9 months and the one-year survival rate was （35.6 ± 18.6）%. The clinical outcome of the patients with multiple organ involvement was worse than that with skin manifestations only. The difference however was not statistically significant （ P = 0.083 ）. Conclusions IVNKL is a rare disease.Diagnosis should be made according to typical histologic findings, immunophenotype and EBER in-situ hybridization results. The overall prognosis of IVNKL is poor. Early diagnosis and treatment before multiorgan involvement may be helpful in improving the clinical outcome.

关 键 词：淋巴瘤 T细胞 血管 免疫表型分型 EB病毒 预后 

分 类 号：R733.1[医药卫生—肿瘤]