浆膜腔富于淋巴细胞性积液的细胞学诊断探讨  

Cytological diagnosis of lymphocyte⁃rich effusion in the serosal cavity

作　　者：唐福婷 葛凤林 章宜芬[1] TANG Fu-tinɡ;GE Fenɡ-lin;ZHANG Yi-fen(Department of Pathology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院病理科,南京210029

出　　处：《诊断病理学杂志》2024年第10期957-962,共6页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨浆膜腔富于淋巴细胞性积液(LRSE)的细胞学诊断特征。方法回顾性分析43例浆膜腔LRSE的临床资料、细胞学涂片、免疫表型,并回顾相关文献。结果25例为反应性淋巴细胞积液(RLE),13例为B系肿瘤性积液(BCLE),5例为T系肿瘤性积液(TCLE)。2/25例RLE具有细胞不典型性。RLE组中,T细胞比例中位数为80%,B细胞比例中位数为5%,CD4:CD8比值中位数为3,Ki⁃67指数中位数为6%,23/25例CD3(+),25/25例CD5(+)。BCLE组中,B细胞比例中位数为80%,T细胞比例中位数为10%,Ki⁃67指数中位数为50%,与RLE组比较,B细胞比例中位数、T细胞比例中位数、Ki⁃67指数均具有显著差异(p<0.001)。TCLE组中,B细胞比例中位数为0,T细胞比例中位数为95%,Ki⁃67指数中位数为70%,5例CD4:CD8比值异常;与RLE组比较,Ki⁃67指数、CD4:CD8比值均具有显著差异(p<0.001)。结论RLE以成熟的T淋巴细胞为主、增殖指数低,当B细胞比例增多、Ki⁃67指数增高、CD4:CD8比值异常,提示为淋巴瘤/白血病性积液,需要进一步检查避免漏诊。Objective To explore the cytological diagnostic characteristics of lymphocyte⁃rich serosal effusion(LRSE).Methods The clinical data,cytological smears,and immunophenotypes of 43 cases of LRSE were retrospectively analyzed,and relevant literatures were reviewed.Results There were 25 cases of reactive lymphocyte effusion(RLE),13 cases of B⁃cell lymphoma effusion(BCLE),and 5 cases of T⁃cell lymphoma effusion(TCLE).2/25 cases of RLE showed cellular atypia.In the RLE group,the median T⁃cells and B⁃cells proportion was 80%and 5%,respectively,the medium CD4:CD8 ratio was 3,and the median Ki⁃67 index was 6%.23/25 cases showed CD3 positive,and 25/25 cases CD5 positive.In the BCLE group,the median B⁃cells and T⁃cells proportion was 80%and 10%,respectively and the median Ki⁃67 index was 50%.Compared with the RLE group,the median B⁃cells and T⁃cells proportion,and Ki⁃67 index were all significantly different(P<0.001).In the TCLE group,the median B⁃cells and T⁃cells proportion was 0 and 95%,respectively,the median Ki⁃67 index was 70%,and 5 cases had abnormal CD4/CD8 ratio.Compared with the RLE group,the Ki⁃67 index,CD4/CD8 ratio were significant differences in TCLE group(P<0.001).Conclusion RLE is dominated by mature T lymphocytes with low proliferation index.When B⁃cells proportion and Ki⁃67 index increase and CD4:CD8 ratio is abnormal,it indicates lymphoma/leukemia effusion,and further examination is needed.

关 键 词：淋巴细胞性积液 浆膜腔积液 细胞学 淋巴瘤 

分 类 号：R365[医药卫生—病理学]