宫颈淋巴组织旺炽性增生与宫颈淋巴瘤的临床病理特点及相关文献复习  

Clinicopathologic diagnostic essentials of florid reactive lymphoid hyperplasia and lymphomas of the cerivx

作　　者：王红 贾丛伟[2] WANG Hong;JIA Cong-wei(Department of Pathology,Linfen Central Hospital in Shanxi Province,Shanxi Linfen 041000,China;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]山西省临汾市中心医院病理科,山西临汾041000 [2]中国医学科学院北京协和医院病理科,北京100730

出　　处：《诊断病理学杂志》2024年第12期1141-1144,1149,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的 探讨宫颈淋巴组织旺炽性增生与宫颈淋巴瘤的临床特征、病理形态特点、诊断和鉴别诊断。方法 分析2例宫颈淋巴组织增生性疾病,结合病理形态特点、免疫组化表达及临床特点,做出最终的病理诊断,并进行相关文献复习。结果 病例1宫颈口有一息肉样物,镜下未见淋巴组织浸润性生长,虽然检测到B细胞克隆性基因重排,但结合患者全身情况及血清学检测,最终诊断为淋巴组织旺炽性增生(淋巴瘤样病变)。病例2宫颈增大肥厚呈桶状,影像学提示局部与膀胱直肠及邻近阴道组织分界不清,镜下见肿瘤性坏死,侵犯鳞状上皮且向下弥漫浸润,并检测到B细胞克隆性基因重排,故最终诊断为弥漫大B细胞淋巴瘤(非生发中心B细胞来源)。结论 宫颈部位淋巴组织旺炽性增生为良性病变,淋巴细胞增殖活性较高,可见较多核分裂象,部分病例甚至可以检测出单克隆性基因重排,极易误诊为淋巴瘤;而宫颈弥漫大B细胞淋巴瘤是一种肿瘤性病变,两者在镜下形态及免疫表型甚至基因重排检测有重叠,诊断时需要结合阴道镜表现及全身检查结果等综合考虑,才能做出最终诊断。Objective To explore the clinicopathological features,diagnosis and differential diagnosis of florid reactive lymphoid hyperplasia(FRLH) and lymphoma of the cervix.Methods Two cases of lymphoproliferative diseases of the cervix were analyzed.The final pathological diagnosis was made by combining morphology,immunohistochemistry,and clinical features.Results Case 1:A polypoid object was seen at the cervical orifice.Under the microscope,there was no infiltration of lymphoid tissue growth and no clonal BCR gene rearrangement.Therefore,it was diagnosed as FRLH.Case 2:Cervical enlargement and hypertrophy were barrel shaped,with unclear boundaries between the local area and the bladder,rectum,and adjacent vaginal tissues.Under the microscope,tumor necrosis was seen,invading the squamous epithelium and infiltrating downwards.Clonal BCR gene rearrangement was detected.So the final diagnosis was diffuse large B-cell lymphoma(non-germinal center B-cell origin).Conclusion The FRLH of the cervix is a benign lesion with high proliferative activity and conspicuous mitotic activity.In some cases monoclonal gene rearrangement may be seen,which may lead to the misdiagnosis of lymphoma;while diffuse large B-cell lymphoma of the cervix is a neoplastic lesion.These lesions overlap with each other in microscopic appearance,immunophenotype,and even gene rearrangement.Therefore,colposcopic and systemic findings need to be considered before a final diagnosis can be made when dealing with FRLH and lymphoma of the cervix.

关 键 词：宫颈 淋巴瘤 淋巴组织旺炽性增生 淋巴瘤样病变 

分 类 号：R737.33[医药卫生—肿瘤]