脾边缘区淋巴瘤的诊断

目的:探讨脾边缘区淋巴瘤的临床特征、诊断及鉴别诊断。方法:回顾性分析华中科技大学同济医学院附属同济医院2019年收治的3例表现为脾大、血细胞减少的CD5 - CD10 - B细胞非霍奇金淋巴瘤患者的临床诊断及鉴别诊断过程，并复习相关文献。 结果:3例均为老年患者，均出现不同程度的脾大和血细胞减少，均在骨髓或淋巴结中发现CD5 - CD10 -单克隆B淋巴细胞。综合患者的临床特征、外周血及骨髓形态、免疫表型和遗传学特征，2例患者诊断为脾边缘区淋巴瘤，1例患者诊断为弥漫大B细胞淋巴瘤。 结论:脾边缘区淋巴瘤的诊断需综合临床特征、外周血及骨髓形态、免疫表型和遗传学特征，与其他CD5 - CD10 -小B细胞淋巴瘤进行仔细鉴别。新一代基因突变高通量检测和表达谱分析有助于不典型疑难病例的精准诊断。

Diagnosis of splenic marginal zone lymphoma

Objective:To explore the clinical features, diagnosis and differential diagnosis of splenic marginal zone lymphoma.Methods:The clinical diagnosis and differential diagnosis processes of 3 cases of CD5 - CD10 - B cell non-Hodgkin lymphoma with splenomegaly and cytopenia who were admitted to Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology in 2019 were retrospectively analyzed, and the relevant literature was reviewed. Results:The 3 cases were all elderly patients with varying degrees of splenomegaly and cytopenia. CD5 - CD10 - monoclonal B lymphocytes were found in the bone marrow or lymph nodes. Based on the patient's clinical characteristics, peripheral blood and bone marrow morphology, immunophenotype and genetic characteristics, 2 patients were diagnosed as splenic marginal zone lymphoma, and 1 patient was diagnosed as diffuse large B-cell lymphoma. Conclusions:The diagnosis of splenic marginal zone lymphoma requires comprehensive analysis of clinical characteristics, peripheral blood and bone marrow morphology, immunophenotype and genetic characteristics. Careful differentiation from other CD5 - CD10 - small B-cell lymphomas is also needed. The next-generation gene mutation high-throughput sequencing and mutational spectrum analysis will help the accurate diagnosis of atypical and difficult cases.