慢性B淋巴细胞增殖性疾病的病理学及免疫表型特征分析  

Pathological features and immuonphenotyping of chronic B-cell lymphoproliferative disorders

作　　者：张会超[1] 何芳 贾晓云[1] 陈砚凝[1] 李宏[1] 丁雅雯[1] 张红[1] 王芃堉 高社军[1] 

机构地区：[1]河北医科大学第四医院,石家庄050011 [2]邢台市威县中医院

出　　处：《山东医药》2016年第30期20-24,I0002,共6页Shandong Medical Journal

基　　金：河北省医学科学研究重点课题(ZD20140082)

摘　　要：目的探讨慢性B淋巴细胞增殖性疾病(B-CLPD)的病理学和免疫表型特征,提高对此类疾病的认识。方法回顾性分析61例B-CLPD患者的临床资料,包括慢性淋巴细胞白血病(CLL)43例、套细胞淋巴瘤(MCL)9例、淋巴浆细胞淋巴瘤/华氏巨球蛋白血症(LPL/WM)4例、脾边缘区淋巴瘤(SMZL)3例、毛细胞白血病(HCL)2例。61例B-CLPD患者均进行了骨髓细胞形态学及流式细胞免疫表型检测,分析其特征。结果细胞形态学表现:CLL与MCL均以异常成熟的小淋巴细胞或中等大小的淋巴细胞为主;SMZL为细胞胞核偏位,胞质一侧具有短小的绒毛;LPL/WM的胞核染色质类似淋巴细胞核,其他方面具有浆细胞特征;HCL为胞质丰富,具有纤细和不规则的"毛发样"突起。免疫表型表现:43例CLL患者CD5、CD19、CD23的阳性率分别为97.6%、100%、95.3%;9例MCL患者CD5、CD19、CD20、CD22、FMC7均呈强阳性;4例LPL/WM患者CD19、CD20、CD79a、SIg M阳性率为100%,CD79b阳性率为75.0%,且CD19免疫表型轻链呈限制性表达;2例HCL患者CD19、CD20、CD22、CD79a、CD25、CD11c及CD103均为强阳性,CD5、CD23、CD79b均为阴性;3例SMZL患者CD19、CD20、CD22、CD24、CD79a均为强阳性,而CD5及CD23均为阴性。CLL患者CD23强表达,CD22、CD79b、FMC7弱表达的特征可与MCL患者鉴别。CLL患者淋巴结组织中CD23阳性率较高,MCL患者淋巴结组织中Cyclin D1阳性率较高。结论骨髓细胞形态学及免疫表型对B-CLPD的诊断具有重要意义,对不同类型B-CLPD的精确诊断需要结合细胞形态学、免疫表型和(或)分子遗传学检测综合诊断。Objective To invesitagte the pathological features and immuonphenotyping of chronic B-cell lymphoproliferative disorders（ B-CLPD） and to deepen the understanding of these kinds of diseases. Methods Retrospective analysis was conducted on the clinical data from 61 cases of B-CLPD patients including 43 cases of chronic lymphocytic leukemia（ CLL）,9 cases of mantle cell lymphomas（ MCL）,4 cases of lymphoplasmacytic lymphoma/Waldenstrom Macroglobulinemia（ LPL / WM）,3 cases of splenic marginal zone lymphoma（ SMZL） and 2 cases of hairy cell leukemia（ HCL）. Bone marrow cell morphology and immunophenotyping were detected in all 61 B-CLPD patients,and their characteristics were analyzed. Results Morphology of cells： there were many abnormally mature small lymphocytes or medium size lymphocytes in CLL and MCL; in SMZL,cell nuclei deviation was found and the cytoplasmic side had short fluff; in LPL / WM,chromatin of nucleus was similar to cell nucleus and other aspects had plasmacytoid features; HCl were projections with abundant cytoplasm,slender and irregular hair-like things. Immunophenotype： in 43 cases of CLL,the positive rates of CD5,CD19 and CD23 were 97. 6%,100% and 95. 3%; in 9 cases of MCL,the positive rates of CD5,CD19,CD20,CD22 and FMC7 all showed strong expression; in 4 cases of LPL / WM,the positive rates of CD19,CD20,CD79 a and SIg M were all100%,CD79 b was 75. 0%,Ig light chain showed restricted expression; in 2 cases of HCL,the positive rates of CD19,CD20,CD22,CD79 a,CD25,CD11 c and CD103 all showed strong expression,while CD5,CD23 and CD79 b were negative; in 3 cases of SMZL,CD19,CD20,CD22,CD24 and CD79 a all showed strong expression,while CD5 and CD23 were negative. Strong expression of CD23 and weak expression of CD22 and CD79 b in CLL patients could be used for the identification of CLL and MCL. The positive expression of CD23 was higher in lymph node tissues of CLL patients,while Cyclin D1 expression was higher in MCL patients. Conclusions Bone marrow cell morphology and immun

关 键 词：慢性B淋巴细胞增殖性疾病 慢性淋巴细胞白血病 淋巴瘤 骨髓穿刺 免疫表型 流式细胞术 

分 类 号：R551.2[医药卫生—血液循环系统疾病]