淋巴浆细胞性淋巴瘤伴Waldenstrom巨球蛋白血症的临床病理和免疫表型分析

目的 探讨淋巴浆细胞性淋巴瘤伴Waldenstrom巨球蛋白血症的临床病理学特征及预后,了解其免疫表型在病理诊断和鉴别诊断中的作用.方法 根据2008版WHO淋巴造血组织肿瘤分类收集40例淋巴浆细胞性淋巴瘤伴Waldenstrom巨球蛋白血症患者临床及随访资料,对标本进行免疫表型检测(SP法)及PAS、甲苯胺蓝、刚果红特殊染色.结果 患者年龄40～90岁,中位年龄64岁.患者多以疲乏、贫血和出血倾向就诊.淋巴结、脾脏和肝脏肿大比率分别为42.5%、20.0%和12.5%.36例骨髓浸润模式表现为混合型(17例)、弥漫型(15例)和间质型(4例).9例淋巴结,1例结构完全破坏,8例部分破坏,可见扩张的淋巴窦和残存的淋巴滤泡.骨髓组织与淋巴结组织免疫表型结果基本一致.肿瘤性小淋巴细胞表达CD20和CD79a,浆细胞表达CD79a和CD138.所有病例均不表达CD5,仅4例弱表达CD23.生存分析显示不同的骨髓浸润模式、白蛋白值、血小板计数、白细胞计数、血清IgM值对患者生存时间均未见影响.结论 淋巴浆细胞性淋巴瘤伴Waldenstrom巨球蛋白血症为一种少见的好发于老年人的惰性小B细胞淋巴瘤,临床表现多样化.骨髓活检形态学观察、免疫表型分析及临床资料(尤其是血清学检查)对于其临床病理诊断至关重要.     

淋巴浆细胞淋巴瘤/华氏巨球蛋白血症14例临床病理分析

目的探讨淋巴浆细胞淋巴瘤/华氏巨球蛋白血症(lymphoplasmacytic lymphoma/Waldenstr?m’s macroglobulinemia, LPL/WM)的临床病理学特征。方法回顾性分析14例LPL/WM的临床资料、实验室检查、病理学检查及MYD88 L256P基因突变状况。结果 14例LPL/WM中男性11例,女性3例,中位年龄59岁;12例有肝脏或脾脏肿大,11例有淋巴结肿大。13例贫血,13例分泌单克隆IgMκ,1例分泌单克隆IgMλ,14例均有肿瘤性细胞累及骨髓与MYD88 L256P基因突变。淋巴结活检显示淋巴结结构部分存在,均可见开放的淋巴窦。肿瘤性细胞由数量不等的小淋巴细胞、浆样淋巴细胞及浆细胞组成。其中1例在同一淋巴结内可见两类肿瘤性细胞:(1)以浸润淋巴窦为特征的大淋巴细胞;(2)浸润副皮质区和边缘窦的小淋巴细胞、浆样淋巴细胞及浆细胞。免疫表型:11例CD20弥漫阳性,10例限制性表达轻链Kappa,1例限制性表达轻链Lambda;2例CD23阳性,CD10、CD5均阴性,Ki-67增殖指数5%～30%;在同一淋巴结内可见两类肿瘤性细胞:大淋巴细胞中CD20、CD30、MUM1、BCL-2均阳性,Ki-67增殖指数80%;小淋巴细胞中CD20、CD38、CD138、MUM1呈条索状或灶状阳性,Ki-67增殖指数20%。骨髓流式细胞免疫表型:14例小淋巴细胞中CD20、CD19、CD22及sIgM均阳性,2例CD23阳性,CD10及CD5均阴性;浆细胞中CD19、CD138、CD38及CD45均阳性,CD56均阴性。结论 LPL/WM尚无特异性的诊断指标,属于排除性诊断,需与其他小B细胞淋巴瘤尤其是伴浆细胞分化的小B细胞淋巴瘤鉴别。明确诊断需结合其他实验室检查(骨髓细胞形态学、流式免疫表型特征、免疫固定电泳及MYD88 L265P突变检查)。     

颈部淋巴结肿大

淋巴浆细胞淋巴瘤（LPL）是由小B淋巴细胞、浆细胞样淋巴细胞和浆细胞组成的肿瘤,可累及骨髓、淋巴结和脾脏等部位。骨髓穿刺活检多见,淋巴结为首次活检诊断极具挑战性。该文讨论肺癌术后多发淋巴结肿大病例,形态学上滤泡间区大量浆细胞及小淋巴细胞,免疫表型支持B细胞和浆细胞,分子检测B细胞克隆性重排和MYD88突变。LPL形态学...     

DSP30联合IL-2刺激在伴有骨髓侵犯的B细胞非霍奇金淋巴瘤常规染色体核型分析中的应用

目的研究非甲基化胞嘧啶鸟嘌呤二核苷酸寡脱氧核苷酸(CpG-ODN, DSP30)在伴有骨髓浸润的B细胞非霍奇金淋巴瘤(B cell lymphoma, B-NHL)常规染色体检测中的价值。方法搜集116例初诊时伴有骨髓浸润的B-NHL标本, 设实验组应用DSP30联合IL-2刺激细胞增殖并培养72 h后进行染色体制备;对照组常规24 h培养处理并制备染色体, 运用R显带技术对患者骨髓标本进行核型分析。结果 116例B-NHL中慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)47例, 弥漫大B细胞淋巴瘤(DLBCL)19例, 套细胞淋巴瘤(MCL)16例, 滤泡细胞淋巴瘤(FL)13例, 边缘区淋巴瘤(MZL)8例, 伯基特淋巴瘤(BL)7例, 淋巴浆细胞淋巴瘤/华氏巨球蛋白血症(LPL/WM)3例, 毛细胞白血病(HCL)2例, 富于T/组织细胞的大B细胞淋巴瘤1例;对照组116例行常规染色体检测, 18例无分裂相, 染色体成功分析中异常检出率为22.45%(22/98), 而经实验组(DSP30+IL-2)刺激的同期患者, 无分裂相者减少至10例, 异常检出率为59.43%(6...     

一例Lp免疫细胞瘤的细胞学免疫荧光双标记研究

以前,对一组由淋巴细胞、淋巴样细胞、浆细胞样细胞及母细胞(包括淋巴母细胞及免疫母细胞)等多种细胞构成并伴有或不伴巨球蛋白血症的恶性淋巴瘤认识不足,1975年Lennert等将这组淋巴瘤称为淋巴浆细胞/浆细胞样淋巴细胞恶性淋巴瘤(即LpImmunocytoma)。并分为三个亚型:1.淋巴浆细胞型、2.浆细胞样淋巴细胞型、3.多形性型。最近又根据产生M蛋白的类型分     

Waldenstrom''''s巨球蛋白血症血和骨髓中的单克隆B淋巴细胞的特征

Waldenstrom's巨球蛋白血症(WM)特征是单克隆血清免疫球蛋白,在淋巴结、肝和骨髓内有恶性增生的小淋巴细胞、淋巴浆细胞样细胞以及浆细胞。多数病人末梢血和骨髓的淋巴样细胞携带有血清M成份的同型轻链和重链。据这些特点将WM看做是淋巴细胞在其分化为免疫球蛋白分泌性细胞过程中,单克隆B细胞恶性增生。著者在本文报导了巨球蛋白血症血和骨髓中的单克隆B细胞的特征。著者共研究了16例巨球蛋白血症的淋巴细胞,同时对其     

骨髓活检组织淋巴瘤的病理诊断和分型

目的 探讨组织形态改变、免疫组织化学、基因重排在淋巴瘤骨髓侵犯的病理诊断和分型中的作用。材料与方法 对62例甲醛固定、石蜡包埋的骨髓活检组织,分别做了组织学、EnVision法观察和免疫球蛋白重链(IgH)基因和TCRγ基因重排检测。结果 慢性淋巴细胞性白血病／小淋巴细胞淋巴瘤(CLL／SLL)的异型淋巴细胞呈小梁间结节状或散在分布,有时可见假滤泡结构。滤泡型淋巴瘤(FCL)表现为结节性小梁旁或小梁间的浸润,结节内小淋巴样细胞松散聚集。淋巴浆细胞性淋巴瘤(LPL)主要为小梁间弥散浸润,在小而圆的淋巴细胞间可见散在数量不等的浆细胞样淋巴细胞。边缘区淋巴瘤(MZL)则见模糊的或界限不清的小梁间或小梁旁结节,一些细胞胞质透明。套细胞性淋巴瘤(MCL)异型细胞小到中等大小,缺乏副免疫母细胞和假滤泡。毛细胞性淋巴瘤(HCL)瘤细胞胞膜多清晰,胞质丰富透明,常形成荷包蛋样表现。霍奇金病可见大核瘤细胞,核仁明显。T-非霍奇金淋巴瘤(NHL)浸润骨髓主要为小梁间间质性散在或弥漫分布,胞质多透明,核有芋艿样或脑回状改变,DLBL造血细胞间体积大的瘤细胞散在或弥漫分布。CD3对T细胞来源、CD20和CD79对B细胞来源淋巴瘤有鉴别诊断价值,cyclin D1和(SD5阳性对MCL具有诊断性价值,bcl-2和CD10阳性则对FCL具有诊断性意义,而CLL／SLL除了(SD20和CD79阳性外,也可CD5和CD23阳性。HCL的瘤细胞CD25强阳性。CD15、CD30和Fascin也适用于骨髓霍奇金病的诊断。骨髓中CLL／SLL,LPL,MZL及DLBL的IgH重排率(80％、60％、66．7％、70％)及T—NHL的TCRγ重排率(66．7％)较高。结论 综合组织形态改变、免疫组织化学和IgH／TCRγ重排检测,有助于淋巴瘤骨髓侵犯的诊断和分型,有助于发现骨髓中为数不多的淋巴瘤细胞。     

霍奇金淋巴瘤侵犯骨髓的形态学及免疫表型分析

目的探讨霍奇金淋巴瘤侵犯骨髓的形态学、免疫表型特征及诊断与鉴别诊断要点。方法通过骨髓活检组织行HE、免疫组化Eli Vision两步法染色及EBER原位杂交,并结合临床资料进行分析。结果 10例经典型霍奇金淋巴瘤均可见由肿瘤性的大细胞(HRS细胞)及背景细胞和造血细胞形成的实体性或肉芽肿样结构;2例结节性淋巴细胞为主型霍奇金淋巴瘤可见由"爆米花"样细胞及背景细胞和造血细胞形成的实体瘤样结构。骨髓增生明显活跃者8例,造血组织三系增生减低者4例。有病态造血变化者8例表现为粒、红、巨三系分化及成熟异常,原始造血细胞增多。PET/CT示4例有骨质破坏,且伴骨髓纤维化及造血组织细胞三系减低的现象。免疫表型:2例结节性淋巴细胞为主霍奇金淋巴瘤CD20、BCL-6、OCT-2、CD45、EMA及BOB-1均阳性,而CD30、CD15均阴性;10例经典型霍奇金淋巴瘤CD30阳性,6例CD15阳性,9例Pax-5弱阳性,3例OCT-2阳性,3例CD20阳性。对8例混合细胞型经典型霍奇金淋巴瘤行EBER原位杂交检测,其中4例阳性。结论霍奇金淋巴瘤侵犯骨髓时,造血组织有病态造血的变化,尤其是粒细胞形态学的变化易与肿瘤性的大细胞混淆,在免疫表型上CD15亦阳性,需借助Pax-5加以鉴别,因为大多数肿瘤细胞Pax-5弱阳性,而粒细胞不表达Pax-5。骨髓活检可确诊霍奇金淋巴瘤骨髓浸润,对于无淋巴结侵犯或取材受限(如原发于呼吸道、纵隔等)的患者,在PET/CT引导下骨髓穿刺活检不仅可对其直接进行病理诊断,还有望提高淋巴瘤侵犯骨髓的检出率。     

浆细胞肿瘤病理形态的多样性

目的 观察浆细胞肿瘤的病理形态学特点,探讨其组织结构和细胞形态的类型及其鉴别诊断.方法应用HE、免疫组织化学(EliVision法),对46例浆细胞肿瘤的组织形态学及免疫表型进行研究.结果 46例浆细胞肿瘤中,有40例组织结构以弥漫分布为主,3例呈巢状结构而似神经内分泌肿瘤,3例出现硬化的纤维性背景.淀粉样物质沉积、钙化骨化及"血湖"样结构在部分病例中有可能会非常突出而掩盖了肿瘤性浆细胞的特点.细胞形态上,30例由较成熟和欠成熟的浆样细胞组成而较易辨认.6例由类似免疫母细胞的浆母细胞组成.4例肿瘤细胞较小,似小淋巴细胞.2例瘤细胞胞质透亮似透明细胞或印戒细胞.另各有1例分别由异型性明显的间变型细胞、组织细胞样细胞及梭形细胞构成.最后1例细胞形态多样,可出现分叶核、单核及多核型细胞.免疫表型上93.1%(27/29)的病例表达CD79a而仅有5.1%(2/39)的病例表达CD20,87.1%(27/31)的病例表达CD38和83.3%(25/30)表达CD138,96.8%(30/31)的病例表达MUM-1.38例呈免疫球蛋白轻链限制性表达,其中表达λ链27例,表达κ链11例.结论浆细胞肿瘤除了常见的组织形态外,还可出现不典型或少见的组织结构和细胞形态,诊断时应注意与其他类型淋巴瘤如小淋巴细胞淋巴瘤及间变性大细胞淋巴瘤、低分化癌、透明细胞或印戒细胞癌、间叶性肉瘤等进行鉴别,免疫组织化学是必不可少的.     

淋巴结边缘区B细胞淋巴瘤临床病理学特点及BRAF V600E和MYD88 L265P基因突变分析

目的探讨淋巴结边缘区B细胞淋巴瘤(NMZL)临床病理学特点及BRAF V600E和MYD88 L265P基因突变情况。方法收集2009年9月至2021年2月河南省人民医院病理科及北京大学医学部病理学系诊断的NMZL 32例, 分析其临床病理学特点, 聚合酶链反应(PCR)检测BRAF V600E基因及Sanger测序法检测MYD88 L265P基因突变情况。结果患者男性20例, 女性12例, 中位年龄69岁(范围36～82岁), 临床表现为多发淋巴结肿大, 头颈部淋巴结最多见(22/32, 68.8%), 其次为腹股沟(12/32, 37.5%)、腋窝(11/32, 34.4%)、纵隔(5/32, 15.6%)、腹膜后淋巴结(4/32, 12.5%)。患者多处于Ann Arbor分期Ⅰ/Ⅱ期(21例)。形态学表现为弥漫型(24/32, 75.0%)、结节型(5/32, 15.6%)、滤泡间型(2/32, 6.3%)及滤泡周型(1/32, 3.1%)的生长模式, 肿瘤细胞呈单核细胞样、中心细胞样、小淋巴细胞样及不同程度的浆细胞样分化。免疫表型:肿瘤细胞弥漫表达CD20, 部分表达CD43...     

Lymphoplasmacytic lymphoma/Waldenstr?m macroglobulinemia associated with Hodgkin disease. A report of two cases.

Although the clinical course of lymphoplasmacytic lymphoma (LPL)/Waldenstr?m macroglobulinemia (WM) is usually indolent, high-grade non-Hodgkin lymphoma may develop in a small subset of patients. We have not found any patients with LPL/WM associated with Hodgkin disease (HD) described in the literature, prompting us to report 2 cases. In case 1, the patient had LPL/WM involving bone marrow diagnosed 1 week before left supraclavicular lymph node biopsy revealed LPL/WM and classical HD. In case 2, the patient had a 15-year history of LPL/WM before classical HD developed involving bone marrow, liver, and lymph node. Both cases were positive for IgM, monotypic immunoglobulin light chain, and B-cell antigens and were CD3-. The neoplastic Hodgkin cells were CD15+, CD20+ (case 1), CD30+, CD3-, and CD45- and were negative for Epstein-Barr virus RNA. Both patients were treated with chemotherapy for HD. In case 1, clinical response was excellent with no histologic evidence of HD in subsequent biopsy specimens. In case 2, HD was progressive at last follow-up, despite therapy. Patients with LPL/WM, similar to patients with other types of low-grade B-cell lymphoma, can develop HD that may respond to chemotherapy.     

Bone marrow diagnosis in lymphoproliferative disorders: comparison of results obtained from conventional histomorphology and immunohistology

In this study we have investigated 313 bone marrow biopsies from 280 patients with lymphoproliferative disorders. Trephines were sectioned transversely to obtain one cylinder for cryostat sectioning and immunostaining and a second for histomorphological evaluation using a plastic-embedding technique. The results obtained by histomorphological and immunohistological evaluation were compared for their contribution to staging and classification. Using both techniques, bone marrow involvement was seen in 3/43 (7.0%) biopsies from patients with Hodgkin's disease and in 193/270 (71.5%) cases with non-Hodgkin's lymphoma, including multiple myeloma and acute lymphocytic leukaemia. Immunohistology proved superior in detecting minimal mainly interstitial bone marrow infiltration in 15 leukaemia/lymphoma cases. Biopsies showing infiltration with both methods (n = 157) were re-examined for classification of lymphomatous infiltrates. Whereas immunohistology did not provide additional information in cases with Hodgkin's disease and myeloma, this method was crucial for establishing the definitive diagnosis in a number of cases with acute lymphocytic leukaemia and non-Hodgkin's lymphoma. In all of six leukaemia cases, in which no or inadequate material was available for immunophenotyping of cell suspensions, immunohistology clearly defined the subtype. In the 140 cases of non-Hodgkin's lymphoma the majority of cases (76.4%) were identically classified. In some cases, with important prognostic and therapeutic implications, immunohistology alone provided the definitive diagnosis: T-cell lymphoma (n = 2), hairy cell leukaemia (n = 2) and centrocytic non-Hodgkin's lymphoma (n = 3). Bone marrow immunohistology is, therefore, an important supplement for classical lymphoma/leukaemia diagnosis. The differences observed between histomorphology and immunohistology emphasize the importance of lymph node biopsy in lymphoma classification.     

ZAP-70在慢性淋巴细胞白血病/小淋巴细胞淋巴瘤中表达及其与预后的关系

目的 探讨慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)病理学特点及ZAP-70蛋白表达的预后意义.方法 采用免疫组织化学EliVision法,回顾性检测ZAP-70在52例CLL/SLL患者淋巴结和骨髓活检组织中的表达特点,并随访患者.结果 (1)病理学特征:12例淋巴结呈现均一性成熟小淋巴细胞增生,6例可见增殖中心.40例骨髓中瘤细胞形态与淋巴结的相似,但未见增殖中心.浸润模式分为结节型(9例)、间质型(3例)、混合型(9例)、弥漫型(19例)4种,比较非弥漫型和弥漫型存活率,二者差异无统计学意义(Fisher精确检验,P=0.199).(2)ZAP-70表达定位在细胞质和细胞核,21例(40.4%)患者ZAP-70阳性,其中因本病或感染等相关因素死亡11例.31例(59.6%)ZAP-70阴性,包括因本病或感染死亡4例.比较二组生存期,阳性组明显较阴性组短(39个月和59个月,x2=6.991,P=0.008).(3)随访51例患者,死亡21例,其中因本病及感染等相关因素死亡15例.结论 CLL/SLL患者ZAP-70阳性表达提示预后不良.     

ALK-positive anaplastic large cell lymphoma in a patient with chronic lymphocytic leukemia

This article reports the case of a 59-year-old patient with an 8-year history of chronic lymphocytic leukemia (CLL), prostate carcinoma, and squamous cell carcinoma who developed an ALK-positive anaplastic large cell lymphoma (ALCL). Lymph node and bone marrow biopsies showed 2 distinct morphologic populations: (a) the CLL component showing a diffuse monomorphous infiltrate of small lymphocytes with the typical immunophenotype showing positive CD20, CD5, CD23, and κ light chain restriction and (b) the ALCL component showing large anaplastic pleomorphic cells positive for CD30, CD45, ALK, CD45Ro, CD4, and vimentin. Polymerase chain reaction performed on the lymph node for immunoglobulin heavy chain and T-cell receptor γ and β showed gene rearrangements after macrodissection of morphologically distinct populations, indicating confirmed genetically distinct populations. Despite intensive chemotherapy, the patient died. This case represents the rare occurrence of an ALK-positive ALCL developing in a patient with CLL.     

Peripheral T cell lymphoma: value of bone marrow trephine immunophenotyping.

Bone marrow infiltrates taken from 11 patients with peripheral T cell lymphoma were immunophenotyped as T cell lymphoma using monoclonal antibodies on frozen bone marrow trephine biopsy specimens. In nine these were taken at diagnosis and in two after failure of treatment to eradicate lymphoma in the marrow. Patterns of infiltration were as follows: diffuse (n = 4), interstitial (n = 1), nodular (n = 1), focal (n = 5). All cases were CD3 positive and 10 were CD2 positive; five lacked expression of either CD5 or CD7, or both markers. In nine the determination of T cell phenotype depended on analysis of the frozen bone marrow trephine biopsy specimen as there was no other biopsy tissue available for study. In the other two cases there was agreement between the immunophenotypes seen in lymph node and bone marrow infiltrates.     

Chronic lymphocytic leukemia/small lymphocytic lymphoma associated with IgM paraprotein

We studied the clinicopathologic, immunophenotypic, and cytogenetic features of 26 patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) associated with serum IgM paraprotein. The study group (16 men; 10 women; median age, 64 years; range, 40-82 years) represents approximately 2.5% of CLL/SLL cases at our institution. The paraprotein level ranged from 1 to 14 g/L (median, 4 g/L). Neoplasms in bone marrow were composed of small round lymphocytes arranged in nodular (n = 6), diffuse (n = 5), interstitial (n = 5), or mixed (n = 10) patterns. All cases were positive for monotypic surface immunoglobulin light chain, IgM/IgD, CD5, CD19, CD20, and CD23. CD11c (14/20 [70%]), CD79b (11/19 [58%]), FMC-7 (11/26 [42%]), CD22 (8/20 [40%]), and ZAP-70 (6/19 [32%]) were expressed in subsets of cases. Of 17 bone marrow specimens assessed by conventional cytogenetics, 6 were abnormal and 11 were diploid. The overall survival of this group (median follow-up, 24 months) was not significantly different from that for an age-, sex-and stage-matched group of 52 CLL/SLL patients without IgM paraprotein (P = .60). We conclude that CLL/SLL cases with serum IgM paraprotein are similar to other CLL/SLL cases in their clinicopathologic and immunophenotypic features.     

Lymphoma of the breast. A clinicopathologic study of primary and secondary cases

BACKGROUND: Primary lymphomas of the breast are rare, accounting for 1.7% to 2.2% of extranodal lymphomas and 0.38% to 0.7% of all non-Hodgkin lymphomas. Although secondary breast lymphomas are also rare, they represent the largest group of metastatic tumors of the breast. OBJECTIVES: To investigate the clinicopathologic and immunophenotypic characteristics of breast lymphomas, the relative frequency of primary and secondary mammary lymphomas, and in selected cases, the role of gene rearrangement analysis in diagnosis and staging of these lymphomas. RESULTS: We conducted a retrospective review of 22 cases of breast lymphoma diagnosed at William Beaumont Hospital, Royal Oak, Mich, during a 30-year period (1963-1994). Eleven of the 22 cases fulfilled the criteria for primary breast lymphoma; these cases represented 0.6% of all non-Hodgkin lymphomas seen in our hospital. Of the 11 cases, 5 were diffuse large B-cell lymphomas, 2 were follicle center lymphomas, 2 were marginal zone B-cell lymphomas (mucosa-associated lymphoid tissue type), 1 was a lymphoplasmacytoid lymphoma, and 1 was a peripheral B-cell neoplasm, unclassified. Using a panel of immunohistochemical stains (CD45RO, CD45RA, CD43, CD3, CD20, CD30, CD68, and HLA-DR), 8 cases demonstrated unequivocal B-cell phenotype and 3 cases had equivocal or weak staining patterns for B-cell markers. We identified no cases of T-cell lymphoma. Of 7 cases that had bone marrow biopsies for staging, 3 were positive morphologically for bone marrow involvement. Molecular analysis of B- and T-cell gene rearrangement was used to exclude bone marrow involvement in one case with bone marrow lymphoid aggregates and to confirm negativity in a case that was morphologically negative. Of the 11 secondary breast lymphomas, 5 were diffuse large B-cell lymphomas; 1 was diffuse large B-cell, primary mediastinal subtype; and 5 were follicle center lymphomas. CONCLUSIONS: Breast lymphomas represented 1.2% of all non-Hodgkin lymphomas in this study; the frequency of primary and secondary cases was equal. In both groups, right breast lesions were predominant, and the most frequent morphologic type was diffuse large B-cell lymphoma. Gene rearrangement analysis is helpful in selected cases to rule out bone marrow involvement, especially in older patients, in whom lymphoid aggregates are common.     

T-cell lymphoblastic leukemia/lymphoma with t(7;14)(p15;q32) [TCRγ-TCL1A translocation]: a case report and a review of the literature

A 22-year-old man sought medical advice for a swelling in the right side of the neck in December 2011. Histopathological examination of the lymph node biopsy initially suggested reactive lymphadenitis, on account of the only sparse presence of tumor cells. Bone marrow examination was performed in February 2012 revealed findings consistent with a diagnosis of T-cell lymphoblastic leukemia/lymphoma (T-LBL), and the patient was begun on remission induction therapy. The bone marrow showed an immature thymocytic pattern: cytoplasmic CD3⁺, surface CD3^-, CD5⁺, CD4^-, and CD8^-. Re-assessment of the lymph node specimens revealed the same phenotype of the cells in the lymph node as that of the blasts in the bone marrow. In addition, a chromosomal aberration t(7;14)(p15;q32) was noted. The lymph node biopsy specimens were examined by paraffin-embedded tissue section-fluorescence in situ hybridization (PS-FISH), which revealed a fusion signal of T-cell receptor (TCR)γ gene (7p15) with T-cell leukemia/lymphoma 1A (TCL1A) gene (14q32.13). There have been at least 10 reported cases of T-LBL with t(7;14)(p15;q32), including the present case. However, this is the first reported case in which TCRγ-TCL1A translocation was confirmed by FISH.