摘要
目的分析γδ型肝脾T细胞淋巴瘤(HSTCL)的血细胞形态学特点。方法本研究为回顾性研究,搜集2009至2014年河北燕达陆道培医院收治的4例γδ型HSTCL患者的临床资料,最初外院形态学均误诊为急性白血病(AL)或骨髓增生异常综合征(MDS)。对治疗后未缓解患者的骨髓涂片和血涂片进行形态学和细胞化学染色,并与本院的流式细胞术免疫分型、染色体、TCR基因重排检测结果进行比较。结果4例患者骨髓涂片肿瘤细胞比例为7.6%~40.0%;仅有2例患者外周血涂片肿瘤细胞比例分别为9%和10%,γδ型HSTCL肿瘤细胞的瑞氏染色形态有很高相似度:细胞中等大小,胞浆较丰富;大部分细胞核仁1个,大而明显;形态似白血病性原始细胞,尤其是原始单核细胞;但是细胞核染色质呈粗颗粒状,比原始单核细胞致密;与原始粒细胞和原始淋巴细胞相比,HSTCL细胞较大,形状相对不规则,胞浆较丰富,核型不规则更加明显。细胞化学染色具有鉴别诊断意义:HSTCL肿瘤细胞的非特异性酯酶(NSE)染色阴性或者点状弱阳性,且不被氟化钠抑制;糖原(PAS)染色阴性或者呈粗颗粒状阳性,髓过氧化物酶(MPO)均阴性。结论γδ型HSTCL细胞具有独特的成熟淋巴细胞肿瘤形态学特征。瑞氏染色质量和未做完整的细胞化学染色、缺乏此罕见疾病的形态学识别、部分病例伴随AL或MDS表现,极易误认为白血病性原始细胞,可能是导致HSTCLγδ型误诊的主要原因。
Objective To analyze the cell morphological features of hepatosplenic T-cell lymphoma(HSTCL)gamma-delta(γδ)type,differentiate from acute leukaemia(AL).Methods This was a retrospective study.The clinical data of four cases of HSTCLγδtype who were treated in Hebei Yanda Ludaopei Hospital from 2009 to 2014 were collected.Their initial morphology diagnoses in other hospitals were all acute leukemia or myelodysplastic syndrome(MDS).Morphological analysis and cytochemical stains to their bone marrow(BM)aspiration and peripheral blood(PB)smears were completed when they had no response to previous chemotherapies,and the morphological reports were compared with results of immunophenotyping,chromosome,and T cell receptor(TCR)gene rearrangement.Results The percentages of malignant cells in four patients′BM aspirations were 7.6%-40.0%,and in two patients′PB was 9%and 10%,respectively.The morphology of four cases had a very high similarity in Wright′s stain.Predominantly medium-sized cells were seen,with rich cytoplasm and frequently one big conspicuous nucleolus.The malignant cells resembled blasts,especially monoblasts,but with coarse granular chromatin,more compact than that in monoblasts.When comparing to malignant myeloblast and lymphoblasts,HSTCL cells were larger and more irregular in cell shape,with more abundant cytoplasm and prominent nuclear irregularity.The cytochemistric stain played an important role in differential diagnosis.HSTCL malignant cells showed non-specific esterase(NSE)negative or focal punctate activity which couldn′t be inhibited by sodium fluoride.Periodic acid-Schiff(PAS)stain was negative or positive with a form of coarse granules.The myeloperioxdase(MPO)stain was negative.Conclusion Malignant cells of HSTCLγδtype have very distinct morphological features of mature lymphocytic neoplasm.The quality of Wright′s stain,being short of complete cytochemical stains,lacking of awareness of this disease,and acute leukemia or MDS like appearance in some cases,result in the possibility of di
作者
伍平
孙慧鹏
万凌君
周春雨
王彤
刘红星
王卉
Wu Ping;Sun Huipeng;Wan Lingjun;Zhou Chunyu;Wang Tong;Liu Hongxing;Wang Hui(Clinical Laboratory,Hebei Yanda Ludaopei Hospital,Sanhe 065201,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第23期1805-1811,共7页
National Medical Journal of China
关键词
淋巴瘤
T淋巴细胞
误诊
Lymphoma
T-Lymphocytes
Diagnostic errors
