弥漫性大B细胞淋巴瘤临床病理分析

目的 探讨弥漫性大B细胞淋巴瘤(DLBCL)的临床病理学及免疫学表型特征.方法 收集我院1998年3月至2008年12月间48例弥漫性大B细胞淋巴瘤患者,进行组织形态学观察和免疫表型测定.结果 48例发病年龄26～78岁,以中老年人男性为主,主要发生于颈淋巴结、锁骨上、腹股沟及腋窝及鼻、咽、肠、睾丸、扁桃体等;37例中心母细胞型,9例免疫母细胞型,2例间变大细胞型;48例DLBCL中CD20肿瘤细胞均阳性,均不表达CD3和CyclinD1.结论 弥漫性大B细胞淋巴瘤的诊断需将临床特征、组织形态及免疫学表型有机结合起来,才能提高确诊率.     

弥漫性大B细胞淋巴瘤临床病理分析

目的 探讨弥漫性大B细胞淋巴瘤(DLBCL)的临床病理学及免疫学表型特征.方法 收集我院1998年3月至2008年12月间48例弥漫性大B细胞淋巴瘤患者,进行组织形态学观察和免疫表型测定.结果 48例发病年龄26～78岁,以中老年人男性为主,主要发生于颈淋巴结、锁骨上、腹股沟及腋窝及鼻、咽、肠、睾丸、扁桃体等;37例中心母细胞型,9例免疫母细胞型,2例间变大细胞型;48例DLBCL中CD20肿瘤细胞均阳性,均不表达CD3和CyclinD1.结论 弥漫性大B细胞淋巴瘤的诊断需将临床特征、组织形态及免疫学表型有机结合起来,才能提高确诊率.     

肺原发性血管内大B细胞淋巴瘤1例并文献复习

血管内大B细胞淋巴瘤(intravascular large B-cell lymphoma,IVLBCL)是一种罕见的非霍奇金淋巴瘤,由Pfleger和Tappeiger于1959年首次报道,以往又称之为系统性增殖性血管内皮瘤病或嗜血管性(血管内)淋巴瘤,2001年WHO淋巴瘤组织学分类将其明确归类为结外弥漫性大B细...     

淋巴结内边缘区B细胞淋巴瘤的病理诊断与分析

目的:观察并探讨淋巴结内边缘区B细胞淋巴瘤(NMZL)的形态特点、免疫表型特征、诊断及鉴别诊断.方法:对10例淋巴结的NMZL进行光镜观察,免疫组织化学染色,并随访.结果:10例就诊时均精神状况良好.6例得到随访,大多(5/6)临床分期较高(Ⅱ或Ⅲ期).细胞的形态以中心细胞样细胞为主,少数可以单核细胞样细胞为主或小淋巴...     

胃肠道粘膜相关淋巴组织型结外边缘区B细胞淋巴瘤的病理分析

目的 加深对粘膜相关淋巴组织（MALT）型淋巴瘤的认识。方法 复阅胃肠道MALT型淋巴瘤30例，在HE诊断基础上做HP染色和免疫组化LCA、CD20、κ、λ、CK标记。结果 胃16例，肠14例。临床主要表现为腹胀腹痛，黑便或血便，腹部包块。病理改变以边缘区B细胞（中心细胞样细胞）为主，13例出现变异大细胞，3例以变异大细胞为主。25例有淋巴上皮（LEL)病变，18例有淋巴滤泡结构，21例见浆细胞浸润。17例HP阳性，30例CD20阳性。结论 胃肠道MALT型淋巴瘤与HP感染关系密切。低度恶性的MALT型淋巴可向中度恶性或高度恶性淋巴瘤转化。     

46例上呼吸道非何杰金淋巴瘤临床病理及免疫组化观察

上呼吸道淋巴瘤为上呼吸道较常见的恶性肿瘤,发生于该部位的淋巴瘤,往往有其特殊的临床表现.我们收集了从1992年到2000年46例上呼吸道淋巴瘤病例,进行临床病理特点及免疫表型分析,为临床诊断和治疗提供可靠依据.     

脾窦岸细胞血管瘤临床病理探讨

目的探讨脾窦岸细胞血管瘤（LCA）的临床表现、病理学形态、免疫表型特征、诊断与鉴别诊断,从而提高对该肿瘤的认识。方法对1例脾窦岸细胞血管瘤进行临床与病理形态学、免疫组化分析并复习相关文献。结果临床表现脾大、脾功能亢进、贫血及血小板减少。CT示脾实质内多个大小不等的类圆形低度变区,光镜下病变位于红髓内,界限清楚,相互融合成腔隙可形成彼此沟通成血管床,血管床囊性扩张,腔内岸细胞核无明显异型性。免疫组化vimentin（＋）、F8（＋）、SMA（＋）、CD31（＋）、CD68（＋）、CDl63（＋）、Lysozyme（＋）、S-100（-）、CD34（-）、CK（-）、Ki-67〈5％、D2—40（-）。结论LCA是一种罕见的脾血管源性肿瘤,病理学形态改变,免疫组化标记及影像学检查有助于诊断,结合文献报道,该肿瘤常伴发其他脏器的恶性肿瘤,对此类患者应密切随访,以除外肿瘤复发及转变恶性肿瘤的可能。     

脾脏大B细胞淋巴瘤1例

患者男，７７岁。上腹疼痛不适数年，发现左上腹包块１５d。检查：左肋缘下１cm处可触及包块，表面呈结节状，质硬。B超、CT检查示脾脏实质性占位。实验室检查，周围血象及骨髓象正常。临床诊断为脾脏肿瘤而行手术切除。病理检查：一侧脾脏，大小１４cm×１４cm×８cm，表面结节状，切开见多个大小不等的结节（图１），大者８．５cm×８cm，小者１cm×１cm，切面灰白色，有坏死。镜下观察：脾正常结构消失，肿瘤细胞弥漫排列，体积较大，胞浆丰富，淡伊红染，核呈圆形、卵圆形，外形较规则，染色质呈凝块状，部分可见核仁，嗜酸性或嗜碱性…     

Lennert氏淋巴瘤病理形态及免疫组化研究

Lenncrt 氏淋巴瘤较少见,Catherine 报告仅占恶性淋巴瘤的3.1%。本文就4例Lennert 氏淋巴瘤的病理形态及免疫组化研究,报告如下。病例与方法临床资料:4例均为男性,年龄7～70岁,平均32岁。病程(出现症状至病理确诊)14～18月,平均57月。4例均表现为颈部或全身淋巴结肿大,小者直径2～3cm,大者13×6×6cm 大小。患者常有不规则发热。1例既往有脾肿大。1例x 线检查示纵膈增宽,纵膈淋巴结肿大。1例骨髓穿刺未见异常。随访:3例经联合化疗后分别已存活20、55及96个月,1例仅用转移因子治疗已存活84个月。本文收集4例Lonnert 氏淋巴瘤,其淋巴结活检标本采用10%甲醛固定,石蜡切片,HE染色,光镜观察。并对石蜡切片采用PAP 法和ABC 法进行免疫标记。用DAB 显色。所用的抗人体免疫球蛋白IgG、IgA、IgM、K 及λ购自上海生物制品研究所,所用的MOAB B_1、T_1、T_4、T_8及αAT 购自DAKO 公司。     

27例黏膜相关淋巴组织结外边缘带B细胞淋巴瘤的病理研究

目的:观察并探讨黏膜相关淋巴组织结外边缘带B细胞淋巴瘤(简称MALT淋巴瘤)的组织学形态、免疫表型特征、鉴别诊断。方法:对27例发生在不同器官的MALT淋巴瘤进行光镜观察,免疫组织化学染色。结果:27例就诊时均精神状况良好,以发现器官占位或消化、呼吸系统不适为由就诊。MALT淋巴瘤呈弥漫的淋巴组织增生改变,常常出现弥漫的或模糊结节的生长方式,细胞的形态以中心细胞样细胞、单核细胞样细胞、小淋巴细胞样细胞为主,可以伴有浆样细胞和/或浆细胞。肿瘤细胞增殖指数范围5%~40%。19例滤泡树突细胞(FDC)网以萎缩变小为主,8例FDC网不同程度增生。结论:MALT淋巴瘤属于低度恶性淋巴瘤,肿瘤细胞生长方式独特,细胞形态多以生发中心细胞样细胞为主。需要与滤泡性淋巴瘤、小淋巴细胞性淋巴瘤、套细胞淋巴瘤,淋巴浆细胞淋巴瘤相鉴别,临床预后好。     

Subglottic tracheal stenosis as primary manifestation of a marginal zone B-cell lymphoma of the larynx

BACKGROUND: More than 90% of laryngeal tumors are squamous cell carcinomas. Primary hematopoetic neoplasms of the larynx are rare, being mainly extramedullary plasmocytoma and non-Hodgkin's lymphoma (NHL). These are mainly located in the supraglottic and glottic area, with only a few reported in the subglottic region. CASE REPORT: We report on a 58-year-old man, who presented at our clinic with severe dyspnea. On microlaryngoscopy, a subglottic stenosis at the level of the cricoid cartilage was found. The biopsy revealed the diagnosis of a MALT-type lymphoma (marginal zone B-cell lymphoma). The tracheostomy was followed by locoregional radiotherapy. CONCLUSION: This is the first report of a subglottic MALT-type lymphoma causing a tracheal stenosis. The preferred treatment is locoregional radiotherapy including the draining lymph nodes.     

原发性睾丸恶性淋巴瘤的临床病理和免疫组化研究

目的：研究原发性睾丸恶性淋巴瘤的临床病理及免疫表型特点,方法对7例原发性丸恶性淋巴瘤进行组织形态学观察和免疫组化标记,结果 原发性睾丸恶性淋巴瘤临床多见于老年,表现为病变睾丸不同程度冲大,组织学类型多为弥漫型B细胞性恶性淋巴瘤,结论 原发性睾丸恶性淋巴瘤是具有特征性的病变,确诊依赖于组织学观察,免疫组化标记对鉴别诊断非常重要。     

Autoimmune phenomena in untreated and treated marginal zone lymphoma

Introduction: Current literature suggests an association between various autoimmune conditions and marginal zone lymphoma (MZL). However, these autoimmune conditions have not been comprehensively systematized to date. As a result, their clinical implications remain largely unknown.

Areas covered: The authors provide a comprehensive review of the existing literature on various autoimmune abnormalities documented in the course of MZL, as well as on autoimmune alterations induced by certain MZL therapies.

Expert opinion: The course of MZL is accompanied by a variety of hematologic and non-hematologic autoimmune disorders. Whereas some of them could be secondary and related to the course of the MZL, others may be primary and might even favor the development of MZL itself. In addition, authentic autoimmune conditions have been documented with the use of rituximab as a single agent and the nucleoside analogs. Therefore, we believe caution should be exerted with the use of these agents in MZL patients with evidence of autoimmune disorders, as exacerbation of autoimmune phenomena can be anticipated. While the heterogeneity of the MZL subtypes represents an inherent limitation, integration of emerging information from immunology research laboratories and clinical practice could translate into improved outcomes of this disease spectrum.     

Autoimmune phenomena in untreated and treated marginal zone lymphoma

INTRODUCTION: Current literature suggests an association between various autoimmune conditions and marginal zone lymphoma (MZL). However, these autoimmune conditions have not been comprehensively systematized to date. As a result, their clinical implications remain largely unknown. AREAS COVERED: The authors provide a comprehensive review of the existing literature on various autoimmune abnormalities documented in the course of MZL, as well as on autoimmune alterations induced by certain MZL therapies. EXPERT OPINION: The course of MZL is accompanied by a variety of hematologic and non-hematologic autoimmune disorders. Whereas some of them could be secondary and related to the course of the MZL, others may be primary and might even favor the development of MZL itself. In addition, authentic autoimmune conditions have been documented with the use of rituximab as a single agent and the nucleoside analogs. Therefore, we believe caution should be exerted with the use of these agents in MZL patients with evidence of autoimmune disorders, as exacerbation of autoimmune phenomena can be anticipated. While the heterogeneity of the MZL subtypes represents an inherent limitation, integration of emerging information from immunology research laboratories and clinical practice could translate into improved outcomes of this disease spectrum.     

Treatment of gastric marginal zone lymphoma of MALT type

Importance of the field: Gastric marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT type) represent approximately half of all cases of lymphomas arising in the stomach. They have been strongly associated with chronic Helicobacter pylori (H. pylori) gastritis. Treatment aimed at eradicating this infection results in lymphoma remissions in the majority of patients (approximately 80%) and this represents a unique case of anticancer treatment based on the eradication of the causing factor.

Areas covered in this review: The effects of H. pylori eradication in suppressing the growth of this lymphoma with particular emphasis on the long-term disease control results are presented in this review. Trials of different treatment modalities for patients not responding to antibiotics are also covered.

What the reader will gain: Understanding of the effects of H. pylori eradication on suppressing the growth of gastric MALT lymphoma. Readers will learn how to distinguish between clinical, histological and molecular remission of the lymphoma and will learn alternative treatments for patients with H. pylori-negative disease and for cases not responding to eradication.

Take home message: Gastic MALT lymphoma has an indolent course and most patients can achieve durable disease control after only anti-H. pylori therapy. For patients not responding to antibiotics, randomized trials are needed to define the best treatment modality.     

Auto-immune neutropenia associated with metformin in a patient with splenic marginal zone lymphoma

A 75-year-old man with splenic marginal zone lymphoma had been treated by fludarabine. The 3 first courses were very well tolerated, with no cytopenia. To treat diabetes mellitus, metformin was added at day 6 after the beginning of the fourth course of fludarabine treatment. He had previously been briefly treated with metformin a few months before. Four days later, at day 10, haemogram revealed severe neutropenia (neutrophils: 0.7 g/l). Neutrophil count continued to decrease reaching 0.283 g/l at day 17. A bone marrow aspirate was performed and showed very active granulopoiesis with maturation arrest at the promyelocyte stage. Metformin was discontinued on day 22 (16 days after reintroduction) and neutropenia promptly reversed during next week with 1.9 g/l (day 29). Direct and indirect granulocyte immunofluorescence test were used to detect anti-neutrophil autoantibodies. The antibodies were related to metformin and were detectable by granulocyte agglutination test and the monoclonal antibody-specific immobilization of granulocyte antigens assay. A possible explanation is the fludarabine-metformin combination, since fludarabine could deplete regulator T-lymphocytes and lead to the emergence of metformin-induced anti-neutrophil antibodies.     

46例胃肠道原发性淋巴瘤的临床病理分析

目的：探讨胃肠道原发性淋巴瘤的临床病理特征。方法：按WHO(2000年)诊断标准，对46例胃肠道原发淋巴瘤进行临床、病理组织形态观察、免疫组织化学标记，并结合文献复习。结果：46例胃肠道原发淋巴瘤，男：女=1.8：1，发病年龄4-77岁，以消化道症状和腹部包块为主诉。好发部位：胃15例，小肠23例，大肠8例。组织学类型：46例均为非霍奇金淋巴瘤（NHL）,B细胞性淋巴瘤38例占82.6％，其中粘膜相关淋巴组织型边缘区B细胞淋巴瘤(MALT-type)19例，弥漫性大B细胞性淋巴瘤（DLBCT）15例，滤泡性淋巴瘤（FL）1例，套细胞淋巴瘤（MCL）1例，Burkitt样淋巴瘤2例，T细胞淋巴瘤8例占17.4％。不同组织学类型的淋巴瘤其免疫表型和临床表现不同。结论：胃肠道原发性淋巴瘤具有其独特的临床病理特征，准确的组织学分型和临床分期对治疗具有重要指导意义。     

Pharmacotherapy of large B-cell lymphoma

Background: Constituting approximately 30% of lymphoid malignancies, diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults worldwide. The clinical and biologic heterogeneity that exists in DLBCL suggests that this entity might actually be comprised of several distinct neoplasms that could require different therapeutic approaches. DLBCL was considered incurable until combination chemotherapy became available. Objective: Current treatment strategies for the treatment of untreated and relapsed advanced-stage DLBCL are reviewed; novel treatments for DLBCL are discussed. Methods: Relevant literature was identified using the PubMed search engine and by reviewing abstracts from major conference proceedings. Results/conclusion: Recently, novel therapeutic strategies, including the incorporation of immunotherapy to combination chemotherapy, have improved outcome for patients with DLBCL with cure rates exceeding 50%, especially in younger patients.