富于T淋巴细胞/组织细胞的大B细胞淋巴瘤临床病理分析

目的探讨富于T淋巴细胞/组织细胞的大B细胞淋巴瘤(THRLBCL)的组织病理学特征、免疫表型、临床特点。方法回顾性分析郑州大学第二附属医院病理科和河南省肿瘤医院病理科2013年5月至2018年9月确诊的12例THRLBCL患者的临床病理资料,并辅以免疫组化及原位杂交的方法进行分析。结果 12例THRLBCL患者年龄22~74岁,中位年龄58.5岁。男女比例7:5。临床首发症状主要为发热和淋巴结肿大。临床分期主要为Ⅲ~Ⅳ期(75%)。6例累及骨髓,5例累及脾脏,2例累及肝脏。病理检查组织均为淋巴结组织,镜下可见异形大B细胞散布于丰富的小T淋巴细胞和多少不一的组织细胞背景中。肿瘤性大B细胞CD20、BCL6、PAX5阳性,CD30、CD15阴性。背景细胞中的T淋巴细胞CD3、CD5阳性,组织细胞CD68、CD163阳性。EBER原位杂交示EB病毒阴性。结论 THRLBCL组织学形态背景富于T淋巴细胞和组织细胞,肿瘤细胞阳性表达CD20、BCL6、PAX5,阴性表达CD30、CD15,背景T淋巴细胞阳性表达CD3、CD5,组织细胞阳性表达CD68、CD163。该肿瘤应与结节型淋巴细胞为主型霍奇金淋巴瘤、经典型富于淋巴细胞型霍奇金淋巴瘤及T淋巴细胞淋巴瘤相鉴别。其发病与EB病毒感染无关。

Clinicopathological Analysis of T Cell/Histiocyte|Rich Large B Cell Lymphoma

Objective To explore the histopathological features,immunophenotype,clinical features of T cell/histiocyte-rich large B cell lymphoma(THRLBCL).Methods The clinical and pathological data of 12 cases of THRLBCL were analyzed retrospectively which diagnosed and treated in the second affiliated hospital of Zhengzhou university and Henan cancer hospital from May 2013 to September 2018.Immunohistochemistry and in situ hybridization were used to analyze the cases.Results The ages of patients were from 22 to 74 years old,with a median age of 58.5 years old.MaleGA6FAfemale ratio was 7GA6FA5.The initial symptoms were fever and lymph node enlargement.The major clinical stage was stageⅢ-Ⅳ(75%).Six patients were involved in bone marrow,5 patients were involved in spleen and 2 patients were involved in liver.All the tissues examined were lymph nodes.Histologically,large atypical B cells were scattered in a rich background of small T lymphocytes and a varied background of tissue cells.Tumoral B cells:CD20 positive,BCL6 positive,PAX5 positive,CD30 negative,CD15 negative.Background cells:T cells:CD3 positive,CD5 positive;tissue cells:CD68 positive,CD163 positive.EBER in situ hybridization was negative.Conclusion The histological background of THRLBCL is rich in T lymphocytes and tissue cells.Tumor cells express BCL6,CD20,PAX5,but CD30,CD15 are negative.Background T cells express CD3,CD5,background tissue cells express CD68,CD163.THRLBCL must be fully identified with nodular lymphocyte-dominated Hodgkin lymphoma,typical lymphocytic Hodgkin lymphoma and T cell lymphomas.There is no correlation between THRLBCL and EB virus infection.