51例淋巴浆细胞淋巴瘤累及骨髓的临床病理分析  

Lymphoplasmacytic lymphoma involving bone marrow:a clinicopathological analysis of 51 cases

作　　者：张益清 张长淮 ZHANG Yi-qing;ZHANG Chang-huai(Department of Pathology,Beijing Hightrust Diagnostics,Beijing 100176,China)

机构地区：[1]北京海思特医学检验实验室病理科,北京100176

出　　处：《诊断病理学杂志》2024年第3期231-234,251,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨淋巴浆细胞淋巴瘤累及骨髓的临床病理特征、免疫表型、诊断及鉴别诊断。方法回顾性分析51例淋巴浆细胞淋巴瘤患者的骨髓活检、免疫组织化学、流式细胞学、免疫固定电泳及Ig基因重排检查结果并复习相关文献。结果男31例,女20例。淋巴浆细胞淋巴瘤累及骨髓的异常细胞比例在0.5%~95%不等,肿瘤性淋巴细胞增生模式以结节型为主,其周围及淋巴细胞间常见浆细胞少量增生,肥大细胞较常见,含铁血黄素颗粒多见。62.7%(32/51)为结节性骨髓浸润,29.4%(15/51)为弥漫性骨髓浸润,7.8%(4/51)为间质性骨髓浸润。51例行免疫组织化学,100%(51/51)均表达B细胞相关抗原(CD20、CD19、PAX-5),21%(11/51)表达CD23,浆细胞比例较低,0.5%~10%不等,限制性表达Ig轻链,70.6%(36/51)表达胞浆型单克隆Ig轻链Kappa;29.4%(15/51)表达胞浆型单克隆Ig轻链Lambda,Ki-67增殖指数在5%~10%。51例行流式细胞学免疫分型,均可见单克隆小B淋巴细胞及少量单克隆浆细胞。其中23例做了免疫固定电泳,17例是IgM-KAP型M蛋白,6例是IgM-LAM型M蛋白。11例做了Ig基因重排,10例检测到IGHV、IGK基因克隆性重排,1例检测到IGK基因克隆性重排。结论淋巴浆细胞淋巴瘤累及骨髓以结节性浸润多见,浆细胞比例可以很低,诊断需结合临床表现、骨髓活检、免疫组化、流式细胞学、免疫固定电泳及Ig基因重排检测综合诊断。Objective To investigate the clinical pathological characteristics,immunophenotype,diagnosis,and differential diagnosis of lymphoplasmacytic lymphoma involving bone marrow.Methods A retrospective analysis was conducted on the result of bone marrow biopsy,immunohistochemistry,flow cytometry,immunofixation electrophoresis,and Ig gene rearrangement tests in 51 patients with lymphoplasmacytic lymphoma,and a review of relevant literature was conducted.Results There were 31 males and 20 females.The proportion of abnormal cells involved in bone marrow in lymphoplasmacytic lymphoma ranged from 0.5%to 95%.The proliferative pattern of tumor induced lymphocytes was mainly nodular,with a small amount of plasma cell proliferation commonly around and between lymphocytes,more mast cells,and hemosiderin containing particles were more commonly detected.62.7%(32/51)were nodular bone marrow infiltration,29.4%(15/51)were diffuse bone marrow infiltration,and 7.8%(4/51)were interstitial bone marrow infiltration.51 cases underwent immunohistochemistry,with 100%(51/51)expressing B cell related antigens(CD20,CD19,PAX-5)and 21%(11/51)expressing CD23.The proportion of plasma cell components was low,ranging from 0.5%to 10%,with restricted expression of Ig light chains and 70.6%(36/51)expressing cytoplasmic monoclonal Ig light chain Kappa;29.4%(15/51)expressed cytoplasmic monoclonal Ig light chain Lambda,with Ki-67 proliferation index ranging from 5%to 10%.Flow cytometry in 51 patients showed monoclonal small B lymphocytes and a small amount of monoclonal plasma cells.Among them,23 cases underwent immunofixation electrophoresis,17 cases were IgM-KAP type M protein,and 6 cases were IgM-LAM type M protein.11 cases underwent Ig gene rearrangement analysis,10 cases were detected IGHV and IGK gene clonal rearrangement,and 1 case detected IGK gene clonal rearrangement.Conclusion Lymphoplasmacytic lymphoma often involves bone marrow with nodular infiltration,and the proportion of plasma cells can be very low.The diagnosis needs to be combined with

关 键 词：淋巴浆细胞淋巴瘤 免疫组化 流式细胞学 骨髓活检 

分 类 号：R733.3[医药卫生—肿瘤]