CD20^+T/NK细胞淋巴瘤2例临床病理观察  

CD20^+T/NK cell lymphoma:report of 2 rare cases and review of the literature

作　　者：张焕[1] 陈海霞[1] 张银华[1] 王维娜[1] 房新志[1] 陈定宝[2] 

机构地区：[1]新疆医科大学附属肿瘤医院病理科,乌鲁木齐830011 [2]北京大学人民医院病理科,北京100044

出　　处：《诊断病理学杂志》2016年第1期32-35,39,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨CD20^+T/NK细胞淋巴瘤的临床病理特征、诊断与鉴别诊断。方法收集2例CD20^+T/NK细胞淋巴瘤,回顾性分析其临床病理资料,并复习文献。结果例1扁桃体肿物。镜下见扁桃体黏膜组织中有弥漫浸润的淋巴样细胞,细胞体积大,异型明显,部分区域细胞呈窦隙状生长。免疫组化:CD2、CD3、CD5、CD30和CD20(+),而PAX-5、CD79a、ALK、CD15和CD10(-),Ki-67阳性指数70%。EBER原位杂交(-)。病理诊断:CD20+间变型大细胞淋巴瘤。例2鼻咽部肿物。病理诊断:结外鼻型NK/T细胞淋巴瘤(ENK/TCL),CD20^-。放、化疗后16个月出现胸壁皮肤肿物,活检见皮下纤维脂肪中有灶片状浸润的淋巴样细胞,细胞中等大小,核形欠规则。免疫组化:CD2、CD3、CD43、CD56、CD20和Gram-B(+),而PAX-5、CD79a、TIA-1和穿孔素(-),Ki-67阳性指数90%。EBER原位杂交(+)。病理诊断:CD20+ENK/TCL。结论 CD20+T细胞淋巴瘤少见,诊断困难,易误诊。诊断与鉴别诊断依靠组织形态学、免疫组化和分子生物学特征。Objective To study the diagnosis and differential diagnosis of CD20^＋ T/NK cell lymphoma （CD20^＋ TCL）. Methods Two cases of CD20^＋ TCL were collected, the clinical and pathological data were retrospectively analyzed and the literature was reviewed. Results Case 1 was male, 57 years old, with tonsil mass. The biopsy of tonsil tissue showed diffuse infiltration of lymphoid cells, which were large, irregular, and some cells presented as sinusoidal growth. Immunohistochemically, CD2, CD3, CD5, CD30, CD20 were positive, whereas PAX-5, CD79a, ALK, CD15 and CD10 were negative, Ki-67 positive index was 70%. EBER was negative by in situ hybridization. The pathological diagnosis was CD20^＋ ALCL. Case 2 was male, 34 years old, with nasopharyngeal mass. A pathological diagnosis of extranodal nasal type NK/T cell lymphoma（ENK/TCL） had been made, and CD20 was negative. The patient replased with skin lesions 16 months after radiotherapy and chemotherapy. The skin biopsy revealed loci and sheets of infiltration of lymphoid cells in the subcutaneous fat tissue and fiber, with medium size and irregular nuclei. Immunohistochemieally, CD2, CD3, C1M3, CD56, CD20 and granzyme-B were positive, PAX-5, CD79a, TIA-1 and perforin were negative, and Ki-67 positive index was 90%. EBER was positive. The pathological diagnosis was CD20^＋ ENK/TCL. Conclusions CD20^＋ TCL is rare and its diagnosis is difficult. The combination of morphology, immunohistochemistry and molecular studies is important for making a correct diagnosis.

关 键 词：T细胞淋巴瘤 CD20 鉴别诊断 

分 类 号：R733[医药卫生—肿瘤]