霍奇金淋巴瘤侵犯骨髓的形态学及免疫表型分析  

Analysis of morphology and immunophenotype of bone marrow involvement of Hodgkin's lymphoma

作　　者：张会超[1,2] 张燕林[1,3] 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,北京100050 [2]河北医科大学第四医院东院区血液病实验室,石家庄050011 [3]北京房山区良乡人民医院病理科,北京102401

出　　处：《临床与实验病理学杂志》2016年第9期980-984,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(81272633);河北省卫计委医学科学研究重点课题(ZD20140082)

摘　　要：目的探讨霍奇金淋巴瘤侵犯骨髓的形态学、免疫表型特征及诊断与鉴别诊断要点。方法通过骨髓活检组织行HE、免疫组化Eli Vision两步法染色及EBER原位杂交,并结合临床资料进行分析。结果 10例经典型霍奇金淋巴瘤均可见由肿瘤性的大细胞(HRS细胞)及背景细胞和造血细胞形成的实体性或肉芽肿样结构;2例结节性淋巴细胞为主型霍奇金淋巴瘤可见由"爆米花"样细胞及背景细胞和造血细胞形成的实体瘤样结构。骨髓增生明显活跃者8例,造血组织三系增生减低者4例。有病态造血变化者8例表现为粒、红、巨三系分化及成熟异常,原始造血细胞增多。PET/CT示4例有骨质破坏,且伴骨髓纤维化及造血组织细胞三系减低的现象。免疫表型:2例结节性淋巴细胞为主霍奇金淋巴瘤CD20、BCL-6、OCT-2、CD45、EMA及BOB-1均阳性,而CD30、CD15均阴性;10例经典型霍奇金淋巴瘤CD30阳性,6例CD15阳性,9例Pax-5弱阳性,3例OCT-2阳性,3例CD20阳性。对8例混合细胞型经典型霍奇金淋巴瘤行EBER原位杂交检测,其中4例阳性。结论霍奇金淋巴瘤侵犯骨髓时,造血组织有病态造血的变化,尤其是粒细胞形态学的变化易与肿瘤性的大细胞混淆,在免疫表型上CD15亦阳性,需借助Pax-5加以鉴别,因为大多数肿瘤细胞Pax-5弱阳性,而粒细胞不表达Pax-5。骨髓活检可确诊霍奇金淋巴瘤骨髓浸润,对于无淋巴结侵犯或取材受限(如原发于呼吸道、纵隔等)的患者,在PET/CT引导下骨髓穿刺活检不仅可对其直接进行病理诊断,还有望提高淋巴瘤侵犯骨髓的检出率。Purpose This research aims to explore the morphological characteristics, immuohpenotype character and the key point for identification and disgnosis of bone marrow involvement of Hodgkin＇ s lymphoma （HL）. Method Histomorphological and immunohis- tochemical characteristics were observed through HE and immunohistochemical of EliVision two-step staining and EBER in situ hybrid- ization was performed on bone marrow biopsy, and analyzed with clinical data. Results Substantive and granuloma like construction composed of large neoplastic cells （HRS cell） and background cells and hematopoietic cells was seen in bone trabecula in ten classical Hodgkin＇ s lymphoma （CHL） cases. Substantive structure composed of popcorn cells and background cells and hematopoietic cells could be seen in bone trabecula in 2 nodular lymphocyte predominant Hodgkin＇ s lymphoma （NLPHL） cases. 8 cases of HL had obvi- ously active bone marrow hemopoietic and 4 cases experienced decrease of hemopioetie cell hyperplasia. 8 cases with pathological he- matopoiteic change presented with the abnormal differentiation and maturation of granulocyte, erythroeyte and megakaryocyte and in- crease of primitive hematopoietic cells. PET/CT showed that 4 cases had bone destruction with myelofibrosis and decrease of hemopi- oetic cell hyperplasia. Immunohistochemically, 2 cases of NLPHL retained CD20, BCL-6, OCT-2, CIM5, EMA and BOB-I expres- sion, but negative for CD30 and CD15. 10 classical Hodgkin＇ s lymphomas were CD30 positive, CD15 positive in 6 cases, Pax-5 weak positive in 9 cases, OCT-2 positive in 2 cases, CD20 positive in 3 cases. EBER in situ hybridization was performed in 8 cases of mixed cell classical HL, and 4 cases were positive. Conclusion When HL invade bone marrow, hemopoietic tissue has pathological chan- ges, especially in that the morphological changes of granulocytes can be hardly differentiated from large neoplastic cells. In the immune phenotype, CD15 is also positive but Pax-5 may useful for the differential diagno

关 键 词：结节性淋巴细胞为主型霍奇金淋巴瘤 经典型霍奇金淋巴瘤 骨髓侵犯 

分 类 号：R446[医药卫生—诊断学] R392.31[医药卫生—临床医学]