TdT阴性的淋巴母细胞性白血病/淋巴瘤3例临床病理观察  

Terminal deoxynucleotidyl transferase-negative lymphoblaslic lymphoma/leukemia: a clinicopathological analysis of three cases

作　　者：雷建园[1] 陈琳[1] 王原[1] 王萍[1] 李文生[1] LEI Jian-yuan;CHEN Lin;WANG Yuan;WANG Ping;LI Wen-sheng(Department of Pathology,People’s Hospital of Shanxi Provence,Xi'an 710068,China)

机构地区：[1]陕西省人民医院病理科,西安7100068

出　　处：《诊断病理学杂志》2020年第8期556-559,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨TdT阴性的淋巴母细胞性白血病/淋巴瘤(ALL/LBL)的临床病理特征、免疫表型、鉴别诊断及治疗预后。方法回顾性分析3例TdT阴性的ALL/LBL的临床及病理资料、随访,并进行相关文献复习。结果患者年龄分别为13岁、28岁和39岁,均为女性,临床首发症状分别为咽痛、腰背疼痛及多发皮下包块,镜下见小~中等大淋巴样细胞弥漫浸润性生长,胞质少,核染色质细腻,核仁不明显,核分裂象易见。瘤细胞CD99(3/3)、CD34(2/3)、CD43(1/2)、CD10(1/2)、PAX-5(2/3)、CD3(1/3)、CD7(1/3)(+),TdT、MPO、CD20均(-),1例诊断为T-ALL/LBL,2例为B-ALL/LBL。随访1年,2例死亡。结论 TdT是ALL/LBL的特异性标记物,TdT阴性时需结合临床、病理学形态及免疫表型综合分析明确诊断,避免误诊。Objective To explore the clinicopathological features, immunohistochemical phenotype, differential diagnosis,treatment and prognosis of terminal deoxynucleotidyl transferase(TdT)-negative lymphoblaslic lymphoma/leukemia(ALL/LBL).Methods Clinical pathological data and prognosis of 3 ALL/LBL were analyzed.Relevant literatures were reviewed.Results All the 3 patients were female,aged 13 years,28 years and 39 years,respectively.The clinical presentations were pharyngalgia,lumbago and back pain and multiple subcutaneous masses.Tumour cells ranged from small to intermediate cells with scant cytoplasm,condensed nuclear chromatin and indistinct nucleoli.Mitoses were frequent.Neoplastic cells were strongly and diffusely positive for CD99(3/3),CD34(2/3),CD43(1/2),CD10(1/2),PAX-5(2/3),CD3(1/3),and CD7(1/3),but negative for TdT,MPO and CD20.One case was diagnosed as T-ALL/LBL and 2 cases as B-ALL/LBL.Two patients died in 1 year follow-up.Conclusion TdT is an important marker of ALL/LBL;TdT-negtive is pitfall for ALL/LBL,and therefore comprehensive analysis of morphology and immunophenotyping should be conducted to confirm the diagnosis.

关 键 词：淋巴母细胞白血病/淋巴瘤 TDT 免疫组化 

分 类 号：R733.41[医药卫生—肿瘤]