MALT淋巴瘤57例临床病理及克隆性分析  

Clinical pathology and clonality analysis in mucosa-associated lymphoid tissue lymphoma

作　　者：孙志刚[1] 李春梅[2] 李静[3] 关宏伟[1] 

机构地区：[1]大连医科大学附属第一医院病理科,辽宁大连116044 [2]大连医科大学形态学实验室,辽宁大连116044 [3]大连医科大学病理学与法医学教研室,辽宁大连116044

出　　处：《诊断病理学杂志》2015年第7期394-398,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的通过观察57例MALT淋巴瘤的组织形态学特点,结合免疫组化和分子病理学诊断方法,完善对MALT淋巴瘤的诊断与鉴别诊断。方法根据HE染色和免疫组化(CD20、bcl-2、CD3、CD5、CD10、CD23和cyclin D1)检测,对所有标本进行组织学评价,并应用DNA-PCR和免疫组化(kappa/lambda)检测免疫球蛋白基因重排和轻链的限制性表达。结果 157例MALT淋巴瘤,镜下常呈弥漫性生长,少数表现为结节样。MALT淋巴瘤细胞类型多样,在具有腺上皮的组织,如胃、肠、唾液腺等处常出现淋巴上皮病变(LEL)。LEL的形成是其诊断的重要依据。2肿瘤细胞的克隆性检测:57例MALT淋巴瘤中有35例出现Ig H基因单克隆性重排,占61.4%(35/57)。免疫组化:15例kappa或lambda的表达具有优势,敏感性为26.3%(15/57);其中4例Ig H基因单克隆性重排(-),而kappa或lambda(+)。两者联合应用的阳性率为68.4%。结论尽管MALT淋巴瘤缺乏特异性诊断性抗体,但是通过组织形态学特征以及免疫组化的检测,可以将MALT淋巴瘤与其他B细胞性淋巴瘤鉴别。将检测免疫球蛋白重链基因重排及轻链限制性表达,作为MALT淋巴瘤诊断的辅助检查方法具有明显的应用价值。Objective To investigate the morphological characteristics of mucosa-associated lymphoid tissue（ MALT）lymphoma,by combined with the immunohistochemical and molecular pathological diagnosis techniques to perfect the diagnostic criteria of MALT lymphoma. Methods We selected 57 cases of MALT lymphoma. According to HE staining and immunohistochemistry with a panel of antibodies CD20,bcl-2,CD3,CD5,CD10,CD23 and cyclin D1,we carried on the histological and immunophenotyping evaluation. For cloning analysis of tumor cells,we applied PCR to detect the IGH gene clonal rearrangement and applied immunohistochemistry to detect the expression of Kappa / Lambda. Results All the 57 cases were in accordance with the diagnosis criteria of MALT lymphoma. At low magnification,tumors were manifested as a diffuse growth pattern,but a few were in nodular structure. The lymphoma cellular types were various. The formation of lymphoepithelial lesions can provide the important basis for the diagnosis of MALT lymphoma. Clonal analysis results showed that Ig H gene monoclonal rearrangement was detected in 61. 40% of 57 cases MALT lymphoma（ 35 /57）.There were 15 cases with predominant kappa or lambda light chain expression; the sensitivity was 26. 32%（ 15 /57）. 4cases of monoclonal Ig H gene rearrangement analysis showed germline configuration,but kappa or lambda limitation was positive. The combined detection of both Ig H gene arrangement and light chain limitation could reach positive rate of68. 42%. Conclusion Although MALT lymphoma lacks of specific diagnostic antibodies,we can identify the MALT lymphoma and other B cell lymphoma based on its morphological and immunohistochemical features. Both Ig H gene clonal rearrangement analysis and immunohistochemical detection of Ig Kappa / Lambda have obvious significance in differential diagnosis of MALT lymphoma from reactive hyperplastic lesions.

关 键 词：MALT淋巴瘤 免疫组化 IGH基因重排 PCR 

分 类 号：R733.4[医药卫生—肿瘤]