69例套细胞淋巴瘤浸润骨髓的病理诊断分析  

Pathological diagnosis and analysis of 69 cases of mantle cell lymphoma involving bone marrow

作　　者：张益清 刘佳 张鑫 张长淮 ZHANG Yiqing;LIU Jia;ZHANG Xin;ZHANG Changhuai(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：《当代医学》2024年第23期142-145,共4页Contemporary Medicine

摘　　要：目的探讨套细胞淋巴瘤(mantle cell lymphoma,MCL)浸润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2020年1月至2022年1月北京海思特医学检验实验室收检的69例MCL浸润骨髓患者的临床病理资料。所有患者均行骨髓活检,分析患者的临床特点及MCL浸润骨髓的组织形态、免疫组织化学特征、流式细胞学检测结果。结果69例MCL浸润骨髓患者中,男40例,女29例;中位年龄60岁;多表现为淋巴结及脾增大,临床症状不明显。MCL浸润骨髓的异常细胞比例范围较大,以结节性浸润为主,占49.3%,30.4%为弥漫性骨髓浸润,20.3%为间质性骨髓浸润,87.0%伴继发性骨髓纤维化。69例MCL浸润骨髓患者均表达B细胞相关抗原,100.0%表达CD20、CD19、配对盒基因5(paired box gene 5,PAX-5)、G1/S-特异性周期蛋白-D1(G1/S-specific cyclin-D1,CCND1)、B淋巴细胞瘤-2基因(B-cell lymphoma-2,Bcl-2),94.2%表达CD5,30.4%弱表达CD23,88.4%表达Y染色体性别决定区域相关高迁移率族盒11(sex-determining regio of Y chromosome related high-mobility-group box 11,SOX-11)。经典MCL亚型占94.2%,母细胞性MCL亚型占4.3%,多形性MCL亚型占1.5%,MCL变异型均不表达CD5;经典MCL亚型Ki67增殖指数为5.0%~10.0%,MCL变异型Ki67增殖指数为20.0%~40.0%。69例行流式细胞学免疫分型,均可见单克隆B淋巴细胞,异常细胞占有核细胞的0.8%~20.0%。结论MCL是一种少见的非霍奇金淋巴瘤,浸润骨髓以结节性浸润为主,早期骨髓间质性浸润易漏诊,诊断需结合髓外肿瘤病理诊断、骨髓活检、免疫组织化学及相关基因检测综合诊断。Objective To investigate the clinical pathological characteristics,immunophenotype,diagnosis and differential diagnosis of mantle cell lymphoma(MCL)involving bone marrow.Methods The clinicopathological data of 69 patients with MCL involving bone marrow in Beijing Hightrust Diagnostics from January 2020 to January 2022 were retrospectively analyzed.Bone marrow biopsies were performed in all patient,and the clinical features,histological morphology,immunohistochemical characteristics and flow cytometry of MCL infiltrated bone marrow were analyzed.Results Among 69 patients with MCL infiltrating bone marrow,there were 40 males and 29 females;the median age was 60 years;most of the symptoms were lymph node and spleen enlargement,and the clinical symptoms were not obvious.The proportion of abnormal cells of MCL infiltrating bone marrow was large,mainly nodular invasion,accounts for 49.3%,30.4%for diffuse bone marrow infiltration,20.3%for interstitial bone marrow infiltration,and 87.0%with secondary bone marrow fibrosis.All 69 patients with MCL infiltrated bone marrow expressed B cell related antigens,100.0%expressing CD20,CD19,paired box gene 5(Pax-5),G1/S-specific cyclin D1(CCND1)and B-cell lymphoma-2(Bcl-2),94.2%expressed CD5,30.4%weakly expressed CD23,88.4%expressed sex-determining regio of Y chromosome related high-mobility-group box 11(SOX-11).The classical MCL subtype accounts for 94.2%,the blastocytic MCL subtype accounts for 4.3%,and the polymorphic MCL subtype accounts for 1.5%,and all variants of MCL did not express CD5;the Ki67 proliferation index of the classical MCL subtype was 5.0%-10.0%,and the Ki67 proliferation index of the MCL variant was 20.0%-40.0%.69 cases underwent immunophenotyping by flow cytometry,all of them showed monoclone B lymphocytes,and the abnormal cells accounting for approximately 0.8%-20.0%of nuclear cells.Conclusion MCL is a rare type of non Hodgkin's lymphoma,mainly nodular invasion of bone marrow,and early bone marrow interstitial infiltration is easily to miss diagnosis,the diagn

关 键 词：套细胞淋巴瘤 骨髓活检 免疫组化 流式细胞学 

分 类 号：R73[医药卫生—肿瘤]