CD200在原发纵隔大B细胞淋巴瘤诊断中的应用分析  

Application of CD200 in diagnosis of primary mediastinal large B cell lymphoma

作　　者：田薇 王璇[1] 史倩芸 陈辉 陆珍凤 石群立 周晓军 沈勤 TIAN Wei;WANG Xuan;SHI Qian-yun;CHEN Hui;LU Zhen-feng;SHI Qun-li;ZHOU Xiao-jun;SHEN Qin(Department of Pathology,the Affiliated Jinling Hospital of Nanjing University Medical School,Nanjing 210002,China;Department of Pathology,the Affiliated Hospital of Nantong University,Nanjing 226001,China;Department of Pathology,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属金陵医院/解放军南京总医院病理科,南京210002 [2]江苏省南通大学附属医院病理科,南通226001 [3]江苏省南京鼓楼医院病理科,南京210008

出　　处：《临床与实验病理学杂志》2018年第8期851-855,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(81372743)

摘　　要：目的观察原发纵隔大B细胞淋巴瘤(primary mediastinal large B cell lymphoma,PMBL)的临床表现、病理学特征、免疫表型、诊断及鉴别诊断。方法收集18例PMBL、19例弥漫大B细胞淋巴瘤-非特殊类型(diffuse large B cell lyphoma-non-specific type,DLBCL-NOS)和10例经典型霍奇金淋巴瘤(classical Hodgkin lymphoma,CHL),分析其临床特点及病理形态学改变,采用免疫组化法检测CD200的表达,并复习相关文献。结果 18例PMBL患者中位年龄31岁,均发生于前纵隔,因肿瘤巨大而引起相应压迫症状。肿瘤细胞形态多样,中等大细胞弥漫分布,细胞呈单核类圆形或多核瘤巨细胞,透明细胞或梭形细胞样多见,间质均有不同程度的硬化,与非纵隔原发DLBCL-NOS及CHL形态上有重叠。免疫组化染色示CD200在PMBL中的阳性率为100%(18/18),DLBCL-NOS阳性率为36.84%(6/19),CHL阳性率为90%(9/10)。CD200表达在PMBL与DLBCLNOS组之间差异有显著性(P=0.000),DLBCL-NOS组与CHL组间也存在差异(P=0.012),而CD200表达在PMBL组与DLBCL-NOS组间差异无统计学意义(P=0.208)。结论 PMBL属于大B细胞淋巴瘤的一种特殊类型,具有独特的临床病理特点,组织形态复杂多样,免疫组化标记CD200可协助PMBL与DLBCL-NOS的鉴别诊断,但CD200在PMBL与CHL鉴别诊断中无特殊意义。Purpose The purpose of this study was to further understand the clinical manifestations,pathological features and immunophenotype of primary mediastinal large B cell lymphoma(PMBL),and to explore its differential diagnosis from other tumors.Methods The clinical features,pathological changes and immunohistochemical staining were analyzed in 18 cases of PMBL,19 cases of diffuse large B cell lyphoma-non-specific type(DLBCL-NOS)and 10 cases of classical Hodgkin lymphoma(CHL),focusing on the positive expression of CD200 antibody and the differential diagnosis value between PMBL and other tumors.Results In this study,the median age of 18 PMBL patients was 31 years old,all of which were present in the anterior mediastinum.Most of the patients had compression symptoms from the large mass in mediastinal cavity.Histologically,the tumors were characterized by a diffuse proliferation of medium to large cells associated with some sclerosis.The morphology was similar with DLBCL-NOS and CHL,but the clear cells or spindle cells presented frequently.Immunohistochemically,the positive staining of CD200 was 100%(18/18),36.84%(6/19)and 90%(9/10),respectively,in PMBL,DLBCL-NOS and CHL.There were significant differences of CD200 expression between PMBL and DLBCL-NOS(P=0.000),there were also differences between DLBCL-NOS and CHL(P=0.012),but no difference between PMBL and DLBCL-NOS(P=0.208).Conclusion PMBL is a subtype of diffuse large B-cell lymphoma with various and non-specific morphology.Immunohistochemistry of CD200 can help differential diagnosis of PMBL from DLBCL-NOS,and there is no special significance between PMBL and CHL.

关 键 词：淋巴瘤 纵隔 B细胞 CD200 免疫组织化学 

分 类 号：R733.4[医药卫生—肿瘤]