HIV/AIDS非相关霍奇金淋巴瘤的临床病理和免疫表型分析  

Analysis of clinical pathology and immunophenotype in non-HIV/AIDS associated hodgkin lymphoma

作　　者：冯艳玲[1] 王迪[1] 曾东[1] 郑叶[1] 卢洪洲[2] 

机构地区：[1](复旦大学附属)公共卫生临床中心病理科,上海市201508 [2]上海市(复旦大学附属)公共卫生临床中心感染科,201508

出　　处：《临床内科杂志》2013年第11期737-740,共4页Journal of Clinical Internal Medicine

基　　金：上海市卫生局科研计划课题资助项目（2010047）;上海市公共卫生体系建设三年行动计划资助项目（GW Ⅲ-13）

摘　　要：目的 探讨HIV/AIDS非相关霍奇金淋巴瘤（HL）的病理组织学形态、免疫表型特点及鉴别诊断.方法 根据WHO（2008）造血和淋巴组织肿瘤分类,应用光镜、免疫组化EnVision法染色、FISH及原位杂交,并结合临床资料和文献复习对3例HIV/AIDS合并霍奇金淋巴瘤进行综合分析.结果 3例组织学形态均符合经典型HL,亚型为混合细胞型2例,1例为淋巴细胞消减型.免疫组化染色肿瘤细胞CD30、LMP1表达阳性,肝活检1例少数肿瘤细胞EMA、CD20及C D79α弱表达,Ki67增殖指数为60％～80％,LCA、CD15、CD68、PAX5、ALK、BOB.1、OCT2、CD3、p53均阴性;背景细胞可表达CD20、CD3、CD57、bcl-6.EBER原位杂交3例均阳性.FISH示IgH基因（14q32）重排1例.结论 在HIV感染者中,HL是最常见的AIDS非定义性肿瘤之一,预后较差.组织学是诊断非HIV/AIDS相关HL的基础,结合免疫组化进行分型和鉴别诊断可以减少误诊的发生,FISH和原位杂交是辅助检测HL分子遗传学改变的技术手段.Objective To explore the clinical histopathological morphology, immunophenotype characteristic and differential diagnosis in non-HIV/AIDS associated Hodgkin Lymphoma （HL）. Methods According to WHO tumor classification （2008） with hematopoiesis and lymphatic tissue, three cases of non-HIV/AIDS associated Hodgkin Lymphoma were comprehensively analyzed through the methods of light microscope, immunohistochemistry（ EnVision stains）, FISH and hybridization in situ, in combination with clinical data and literature reviews. Results All three cases were consistent with classical Hodgkin Lymphoma（CHL）. By subtype classification, two of three cases were mixed cellularity Hodgkin lymphoma （MC）, and one was lymphocyte-depleted Hodgkin lymphoma（ LDHL）. The expression of CD30 and LMP1 in HRS cell were positive by immunohisto-chemistry staining. The expression of EMA, CD20 and CD79cdn a few tumor cells presented weakly positive by hepatic biopsy; Ki67 （ Proliferation Index ） reached 60% - 80% ;The expression of LCA,CD^5 ,CD68 ,PAX5 ,ALK,BOB. 1,0CT2,CD3 and p53 were negative. CD20, CD3 ,CD57 and bcl-6 were expressed in all of the background cells. Among three cases, EBER in situ hy- bridization showed positive. IgH gene rearrangement detected by FISH showed in one case. Conclusions Among the HIV infected patients, Hodgkin Lymphoma is one of most common non-defining tumors with poor prognosis. Histological examination is the basic for diagnosis. Combined with immuno-histochemical typing and differential diagnosis can reduce misdiagnosed rate, FISH and in situ hybridization could be- come auxiliary means for detecting the change of molecular genetics in Hodgkin Lymphoma.

关 键 词：HIV AIDS 霍奇金淋巴瘤 免疫组化 原位杂交 病理诊断 

分 类 号：R512.91[医药卫生—内科学]