单形性亲上皮性肠道T细胞淋巴瘤16例临床病理学分析  

Clinicopathological features of 16 cases of monomorphic epitheliophilic intestinal T-cell lymphoma

作　　者：张景航[1,2] 薛云 张延平 高子芬[4] 黄欣[4] 李敏[4] 苏蔚[1] ZHANG Jinghang;XUE Yun;ZHANG Yanping;GAO Zifen;HUANG Xin;LI Min;SU Wei(Department of Pathology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Xinxiang Key Laboratory of Lymphohematopoietic Tumor Diagnosis,Weihui 453100,Henan Province,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China;Department of Patholog y,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]新乡医学院第一附属医院病理科,河南卫辉453100 [2]新乡市淋巴造血肿瘤诊断重点实验室,河南卫辉453100 [3]郑州大学第一附属医院病理科,河南郑州450000 [4]北京大学第三医院病理科,北京100191

出　　处：《新乡医学院学报》2021年第11期1043-1047,共5页Journal of Xinxiang Medical University

基　　金：河南省高等学校重点科研项目计划(编号:20B310010)。

摘　　要：目的探讨单形性亲上皮性肠道T细胞淋巴瘤(MEITL)的临床病理特点、免疫表型及分子遗传学改变。方法选择新乡医学院第一附属医院及北京大学第三医院收治的16例MEITL患者,采用免疫组织化学、原位杂交及T细胞受体(TCR)基因克隆性重排检测等方法检测其组织病理学,分析患者的临床病理学特点。结果16例MEITL患者中男女比例为9:7,中位发病年龄为54岁。13例患者病变部位位于小肠,1例位于升结肠近回盲部,1例位于降结肠,1例位于乙状结肠;临床表现以腹胀、腹痛、腹泻为主,部分出现腹部肿块及肠穿孔,无特异性改变;镜下肿瘤细胞形态较单一,小至中等大,细胞质淡染,核圆形、核仁不明显,染色质细腻;可见“亲上皮现象”,核分裂象及坏死易见。免疫组织化学检测结果显示,CD3、CD8、CD56、T细胞胞内抗原1(TIA-1)、B淋巴细胞瘤-2(Bcl-2)呈阳性表达,CD5、Granzyme B呈阴性表达,Ki-67增殖指数50%~90%;原位杂交结果显示,EB病毒编码的小RNA阴性。TCR重排检测阳性14例,阴性2例。结论METCL是罕见的原发胃肠道的高侵袭性淋巴瘤,多位于小肠,无特异性的临床表现,肿瘤细胞形态较单一,可见“亲上皮现象”,核分裂象及坏死易见,CD3、CD8、CD56、TIA-1、Bcl-2呈阳性表达,CD5、Granzyme B呈阴性表达,Ki-67增殖指数及TCR重排检测阳性率较高。Objective To investigate the clinicopathological features,immunophenotype and molecular genetic changes of monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL).Methods A total of 16 patients with MEITL in the First Affiliated Hospital of Xinxiang Medical University and the Peking University Third Hospital were collected.Immunohistoche-mistry,in situ hybridization and clonal rearrangement of T cell receptor(TCR)gene were used to detect their histopathology.After the diagnosis was further confirmed,the clinicopathological characteristics of the patients were analyzed.Results The ratio of male to female was 9:7 in 16 patients with MEITL,the median age of onset was 54 years old.The lesion site of 13 patients were located in the small intestine,1 patient was located in the cecum of ascending colon,1 patient was located in the descending colon,1 patient was located in the sigmoid colon;the main clinical manifestations were abdominal distension,abdominal pain and diarrhea,and some of them had abdominal masses and intestinal perforation without specific changes.The morphology of tumor cells under microscope was relatively simple,the cells was small to medium sized,the cytoplasm was light stained,the nucleus was round,the nucleolus was not obvious,and the chromatin was fine;the"epitheliotropic phenomenon"could be seen,the mitosis and necrosis were easy to be seen.Immunohistochemistry showed that CD3,CD8,CD56,T cell intracelluar antigent 1(TIA-1)and B-cell lymphoma-2(Bcl-2)were positive,CD5 and granzyme B were negative,the proliferation index of Ki-67 was 50%-90%;in situ hybridization showed small RNA encoded by Epstein Barr virus was negative.TCR rearra ngement was positive in 14 cases and negative in 2 cases.Conclusion METCL is a rare primary gastrointestinal highly invasive lymphoma,mostly located in the small intestine,with no specific clinical manifestations.The tumor cell morphology is relatively single,showing"Pro epithelial phenomenon",mitotic images and necrosis are easy to see.CD3,CD8,CD56,TIA-1 and Bcl-

关 键 词：单形性亲上皮性肠道T细胞淋巴瘤 免疫组织化学 原位杂交 T细胞受体 

分 类 号：R733.4[医药卫生—肿瘤]