摘要
目的探讨血管免疫母细胞性T细胞淋巴瘤伴霍奇金样细胞的临床表现、病理诊断与鉴别诊断。方法对6例血管免疫母细胞性T细胞淋巴瘤伴霍奇金样细胞进行形态学观察、免疫组织化学EliVision法及EB病毒编码的小RNA（EBER）原位杂交技术分析，并复习文献。结果形态学特点为淋巴结结构破坏，多形性淋巴细胞浸润，在嗜酸性粒细胞、组织细胞、浆细胞的炎症背景下，散在数量不等的大细胞，间质小血管增生明显。部分大细胞形态似RS细胞，单核、多核，嗜酸性核仁明显。免疫组织化学染色显示：CD3、CD5广泛阳性，CD10、bcl-6部分细胞阳性，CD20灶状及散在阳性，CD21显示增多、紊乱的树状突细胞网（FDC）围绕血管生长。其中霍奇金样大细胞CD20阳性或弱阳性，PAX-5弱阳性或阳性，CD30灶性强弱不等阳性或强阳性，CD15阴性，MUM-1强阳性或阳性，Ki-67阳性。EBER特点为大、中、小细胞散在阳性或簇状阳性，其中霍奇金样细胞阳性。结论血管免疫母细胞性T细胞淋巴瘤伴霍奇金样细胞是侵袭性淋巴瘤，形态学与经典型霍奇金淋巴瘤存在交叉，EBER、免疫表型较相似，容易误诊，需结合临床表现、组织学形态、免疫表型、EBER乃至基因重排综合分析、诊断。
Objective To study the clinicopathologic features and pathologic diagnosis and differential diagnosis of angioimmunoblastic T-cell lymphoma with HRS-like cells. Methods Six cases of angioimmunoblastic T-cell lymphoma with HRS-like cells were examined histologically and immunohistoehemically （EliVision method ） and in-situ hybridization for Epstein-Barr virus-encoded RNA （EBER）, and the literature was reviewed. Results The cytologic and microscopic features of these imprints and lymph node samples showed a heterogeneous population of hematolymphoid cells, including small to intermediate lymphoid cells, immunoblasts, plasma cells, dendritic cells, and eosinophils, as well as small vessels that were surrounded by some of the abnormal cells. The neoplastic T-cells expressed CD3 and CD5 and partly positive for CD10 and bcl-6, CD21 showed expanded and irregular follicular dendritic cell （FDC） meshworks that surrounding the high HEV. The HRS-like cells were positive for MUM-1 and Ki-67, variable intensity positive for CD30, CD20, and PAX-5, but negative for CD15. EBV-positive cells included HRS-like cells and small to large-sized neoplastic T-cells, which formed small clusters or scattering in the background of the disease. Conclusions The clinical course of angioimmunoblastic T-cell lymphoma with HRS-like cells is aggressive. Which present with histomorphology overlap with classical Hodgkin lymphoma（ CHL）, similar to CHL in EBER and immunophenotype, however, it is easy to misdiagnosis as HL. Thus, angioimmunoblastic T-cell lymphoma pathology diagnosis should comprehensive analysis of different kinds of materials, including clinical features, and histological structure, and EBER, and immunophenotype, and gene rearrangement.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2015年第8期553-558,共6页
Chinese Journal of Pathology
基金
国家自然科学基金（81272633）
