淋巴组织反应性增生与非何杰金病中网状纤维分…

对８０例淋巴组织反应性增生与１０４例非何杰金淋巴瘤的组织切片，进行了网状纤维的比较观察，初步提出二者的不同网状纤维分布类型：ＲＨ组，窦隙疏网型，滤泡窦隙疏网型。ＮＨＬ组，滤泡型中分空环密集型，空环无效疏网型，弥漫型中分疏网型，密网型，网格型，交错网格型，混合型。网状纤维分布型在这两类病变中主要区别在于ＲＨ为正常分布型的扰乱；而ＮＨＬ则为新生的分布，且可能与肿瘤细胞类型，恶性程度等相关，上述分型有助     

原癌基因bcl-6在淋巴组织增生性疾病中表达及意义

目的 :了解原癌基因bcl 6在一组淋巴组织增生性疾病中表达情况 ,探讨弥漫性大B细胞淋巴瘤的发病机制和bcl 6表达在鉴别诊断中的意义。方法 :观察 112例淋巴组织增生性疾病的组织病理学形态及分型和检测bcl 6表达。结果 :9例淋巴结反应性增生的生发中心细胞、12例滤泡性淋巴瘤和 16例中心细胞中心母细胞淋巴瘤的肿瘤细胞均可表达bcl 6 ,表达强度多为弱阳性 ,阳性率和阳性强度差别无统计学意义 (P >0 0 5 ) ;6 0例弥漫性大B细胞淋巴瘤表达阳性率 95 % ,表达强度为中等阳性或强阳性 ,与前一组相比差别有统计学意义 (P <0 0 1) ;5例套细胞淋巴瘤 ,6例典型霍奇金淋巴瘤及 4例外周T细胞淋巴瘤均不表达bcl 6。结论 :弥漫性大B细胞淋巴瘤显著表达bcl 6 ,表达强度高于淋巴结反应性增生、滤泡性淋巴瘤和中心细胞中心母细胞淋巴瘤 ,bcl 6的过度表达可能与其发病有关。bcl 6的表达对反应性增生和滤泡性淋巴瘤的鉴别诊断无意义 ,但对滤泡性淋巴瘤和弥漫性大B细胞淋巴瘤的鉴别有辅助作用。     

移植后淋巴组织增生性疾病

移植后淋巴组织增生性疾病（post—transplant lymphoproliferative disorder,PTLD）是发生于实质器官和干细胞移植受体的一组疾病,常发生于移植后1年内,但也可发生于移植后的5～10年。PTLD的特点是组织形态多样,常伴坏死,B细胞表型为主,累及淋巴结外及EBV感染。PTLD发病机制明显不同于发生于普通人群的淋巴瘤。PTLD在长期免疫抑制及EBV感染的情况下发生,可继发多种基因变异,基因变异对PTLD向淋巴瘤转化起重要作用。     

胸腺原发黏膜相关淋巴组织淋巴瘤及淋巴上皮性涎腺炎样胸腺增生的临床病理分析

目的探讨胸腺原发黏膜相关淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤和淋巴上皮性涎腺炎(lymphoepithelial sialadenitis,LESA)样胸腺增生的临床病理学特征、两者相关性及鉴别诊断。方法分析3例胸腺MALT淋巴瘤和1例LESA样胸腺增生的临床病理学和免疫表型特征,并复习相关文献。结果 3例胸腺MALT淋巴瘤,其中2例伴Sj9gren综合征;镜下胸腺正常结构损毁,增生的淋巴滤泡间可见肿瘤性淋巴样细胞浸润伴明显的淋巴上皮病变,以中心细胞样和单核样B细胞形态为主。瘤细胞表达CD20、PAX-5和BCL-2,其中1例伴显著浆细胞分化者Lambda轻链限制性表达。3例胸腺MALT淋巴瘤免疫球蛋白(immunoglobulin,Ig)基因检测均示单克隆性重排。LESA样胸腺增生镜下胸腺分叶状结构大体尚存,可见包含增生滤泡的丰富淋巴细胞浸润,胸腺上皮增生伴显著淋巴上皮病变,未见有单核样B细胞形态。免疫组化染色示增生淋巴组织由B和T细胞混合;Ig基因重排检测示多克隆性增生。结论 LESA样胸腺增生和胸腺MALT淋巴瘤均是胸腺少见的淋巴增生性病变,两者具有相似的组织学和免疫表型特征;结合基因重排技术详细分析两者的鉴别要点,有助于鉴别。     

鼻咽淋巴组织增生及其与癌症关系的形态学观察和随访研究

Forty-three cases of nasopharyngeal lymphoid hyperplasia (NPLH) were studied morphologically and had been followed-up for a period of 7.5 years in a high-incidence city of nasopharyngeal carcinoma (NPC). The authors suggest that NPLH might be recognized as a disease entity in adults. Basing on the sites and gross appearances of the hyperplastic lymphoid tissue, two types of NPLH, namely, adenoids and nodular might be distinguished. The histopathological changes of NPLH are described in detail and its relation to the development of NPC is discussed. According to the data of this study, the authors' opinion is that NPLH is not a precancerous condition.     

血管淋巴组织增生伴嗜酸细胞浸润与Kimura病

报道７例血管淋巴组织增生伴嗜酸细胞浸润和Ｋｉｍｕｒａ病，结果显示：两者为同一种疾病的不同阶段，前者以小淋巴和小扭核细胞浸润，为多克隆性；后者出现中扭核细胞，为单克隆性，复发病例则随病情的发展从小扭核细胞向中扭核过渡，亦为单克隆性，结果提示，本病有从良性向恶性发展的趋势，上皮样和组织细胞样血管增生是本病特征之一。     

X连锁淋巴组织增生征基因的克隆

Ｘ连锁淋巴细胞增生征（ＸＬＰ）基因已分别被两个研究小组定位克隆，分别命名为ＳＨ２Ｄ１Ａ和ＳＡＰ，证实该基因有四个外显子，编码一种１２８个氨基到的蛋白质，其中含有一个ＳＨ２区，它能特异地结合了信号蛋白磷酸化的酪氨酸处，该基因的突变是发生ＸＬＰ的原因。     

X连锁淋巴组织增生征基因的克隆

X连锁淋巴细胞增生征（XLP）基因已分别被两个研究小组定位克隆，分别命名为SH2D1A和SAP。证实该基因有四个外显子，编码一种128个氨基酸的蛋白质，其中含有一个SH2区，它能特异地结合于信号蛋白磷酸化的酪氨酸处，该基因的突变是发生XLP纷原因。     

淋巴组织增生性病变中β Ⅲ-微管蛋白的表达及意义

目的 探讨βⅢ-微管蛋白(βⅢ-tubulin,TUBB3)在反应性增生淋巴结和淋巴瘤中的表达,分析TUBB3在淋巴瘤诊断与鉴别诊断中的价值。方法 采用免疫组化EnVision法检测20例反应性增生淋巴结和126例非霍奇金淋巴瘤(包括88例B细胞性淋巴瘤和38例T细胞性和NK细胞性淋巴瘤)中TUBB3的表达,并复习相关文献。结果 反应性增生淋巴结中,TUBB3高度局限于淋巴滤泡生发中心内。小淋巴细胞性淋巴瘤(small lymphocytic lymphoma,SLL)和结外黏膜相关性淋巴组织边缘区淋巴瘤(extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue,MALToma)中,除了残留的淋巴滤泡表达TUBB3外,肿瘤细胞均不表达TUBB3。5例套细胞淋巴瘤(mantle cell lymphoma,MCL)中,1例表达TUBB3。24例低级别滤泡性淋巴瘤(follicular lymphoma,FL)中,8例表达TUBB3。39例弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)中,15例表达TUBB3,TUBB3在生发中心样(germinal center B-like,GCB)型中的表达高于非生发中心样(non-germinal central B-like,non-GCB)型,但差异无统计学意义(P0.05)。15例外周T细胞性淋巴瘤(非特指型)中,TUBB3阳性3例;15例NK/T细胞性淋巴瘤、3例间变性大细胞性淋巴瘤(anaplastic large cell lymphoma,ALCL)和5例血管免疫母细胞性T细胞性淋巴瘤(angioimmunoblastic T-cell lymphoma,AITL)均不表达TUBB3。TUBB3在DLBCL中的阳性率高于成熟性小B细胞性淋巴瘤(P0.05)。TUBB3在B细胞性淋巴瘤中的阳性率明显高于其在NK细胞/T细胞性淋巴瘤中的阳性率(P 0.05)。结论TUBB3高度局限于反应性增生淋巴结的淋巴滤泡生发中心内,有助于低级别FL、SLL和MALToma的鉴别诊断。     

Efficacy of rituximab plus chemotherapy in follicular lymphoma depends on Ki-67 expression

Rituximab is widely used for the treatment of B-cell non-Hodgkin's lymphoma (NHL), and encouraging results have been obtained. However, some CD20-positive NHL show minimal response to rituximab, indicating that the treatment effect depends on the presence or absence of an unidentified factor. We analyzed the relationship between the effect of rituximab plus chemotherapy and expression of Ki-67, p53 and bcl-2 and several clinical variables in cases of B-NHL, particularly follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). Forty-four patients were included in the present study, and the overall treatment response rate was 68%. Twelve of 30 patients (40%) achieved a complete response, five (16%) reached an unconfirmed complete response and 13 (43%) achieved a partial response. A high serum lactate dehydrogenase level and International Prognostic Index of high or high intermediate risk were associated with a decreased response in the case of FL. Immunohistochemical assays were performed in 18 FL patients (55%) and 15 DLBCL patients (45%). Significant correlation was found between an inferior response to treatment and high Ki-67 expression in the cases of FL (P = 0.006). p53 and bcl-2 expression did not correlate significantly with the response rate. The cell cycle appears to be an important factor in the efficacy of rituximab treatment. Ki-67 expression might be a predictor of efficacy of rituximab plus chemotherapy.     

Benign and malignant lymphoid lesions of the stomach. A histological reappraisal in the light of the Kiel classification for non-Hodgkin''s lymphomas

Twenty-two cases of lymphoid tumours of the stomach were reviewed by application of the Kiel classification for non-Hodgkin's malignant lymphomas. Four cases of pseudolymphomas were found, one of which had been previously misdiagnosed as malignant lymphoma. The remaining cases were all malignant tumours with B-cell lymphoma features. These were divided into seven low grade lymphomas (three immunocytomas and four centroblastic/centrocytic) and II high grade lymphomas (six centroblastic and five immunoblastic lymphomas). No cases of Hodgkin's disease or lymphoblastic lymphoma were observed. The Kiel nomenclature was not only easy to apply, but also helped to differentiate pseudolymphoma from malignant lymphoma. Both the pseudolymphomas and the malignant lymphomas were consistently associated with follicular gastritis. This lesion, while intrinsically non specific, was sometimes accompanied by suggestions of transition between itself and the lymphoma, a fact which at least raises the possibility of a transformation of the former into the latter.     

Expression of epidermal and nerve growth factor receptors in human thymus and thymomas

We have investigated the immunohistochemical expression of p53 protein in 96 cases of non-Hodgkin's lymphoma using a panel of five antibodies. Positive neoplastic cells were found in 30 (31.2%) cases, which could be divided into two groups according to their patterns of reactivity with the different antibodies; i.e. those positive with both polyclonal and monoclonal antibodies, and those which were stained only by monoclonal antibodies PAb1801 and/or PAb240. Positivity was nuclear in all but six cases in which cytoplasmic staining was found. In view of the hypothesis recently raised that p53 protein induces apoptosis we have compared our results with parallel staining for bcl-2 protein since bcl-2 is believed to be important, at least in lymphomas, in suppression of apoptosis. Staining for bcl-2 protein was performed on 83 cases and it was shown that p53-positive cases accounted for 10 out of 17 (59%) of the bcl-2 -negative lymphomas but only for 15 out of the 66 (23%) bcl-2 -positive cases, suggesting a possible relationship between the expression of these two proteins. Thus, our data show that p53 protein is abnormally expressed in a substantial proportion of non-Hodgkin's lymphomas and bears a significant inverse relationship to bcl-2 protein expression. However the molecular basis of this expression remains to be elucidated.     

丝裂素激活蛋白激酶在良性前列腺增生中的表达及临床意义

目的对比研究丝裂素激活蛋白激酶(MAPKs)在增生与正常前列腺组织中的表达,探讨良性前列腺增生发病的分子生物学机制。方法采用W estern B lot及免疫组织化学方法,检测增生及正常前列腺组织中ERK、JNK和p38MAPK的表达情况。结果与正常前列腺组织相比,增生组织ERK的平均灰度值(wh ite~b lack,0~255)和阳性细胞百分率明显升高,JNK和p38MAPK的检测结果则与之相反。ERK染色主要位于细胞核和细胞质内,在增生组织上皮细胞及基质细胞的染色阳性率均高于正常前列腺组织。结论ERK在良性前列腺增生组织中过表达,从而导致细胞增生指数增加,JNK和p38MAPK低表达导致凋亡减少,促进疾病的发生和发展。     

Malignant lymphomas and undifferentiated small cell carcinoma of the thyroid: a clinicopathological review in the light of the Kiel classification for malignant lymphomas

The paper reports a re-evaluation--based on the Kiel classification for non-Hodgkin lymphomas--of a group of cases initially diagnosed as undifferentiated small cell carcinomas or primary lymphomas of the thyroid. Twelve such cases were found among the 155 cases of primary malignant tumours of the thyroid recorded at the Institut Jules Bordet between 1955 and 1975. The review of the clinical charts and the histology showed that all the cases were in fact malignant lymphomas fitting easily into one of the groups described in the Kiel classification. These findings support the growing opinion that undifferentiated small cell carcinoma of the thyroid does not exist as a distinctive clinicopathological entity. Furthermore, the Kiel classification proved to be an excellent prognostic indicator, since all the cases classified as highly malignant were indeed fatal, whereas the surviving cases--three of which had shown tumoral extension beyond the thyroid capsule--fell into the group of low malignancy. Lastly, this study acknowledges the frequently observed association of malignant lymphoma of the thyroid with stigmata of Hashimoto's disease, and thus supports the concept that the continuous antigenic stimulation observed in the latter could trigger the development of a malignant lymphoma.     

Fine-needle aspiration biopsy in diagnosis of follicular lymphoma: cytomorphologic and immunohistochemical analysis

Follicular lymphoma is a relatively uncommon type of non-Hodgkin's lymphoma (NHL) thought to derive from follicular center cells. There are limitations to fine-needle aspiration in the diagnosis of follicular NHL, and very few studies are available on it. We describe here the cytomorphologic features of eight biopsy-proven cases of follicular NHLs and five biopsy-proven cases of intermediate-grade NHLs. Five cases of reactive lymphoid hyperplasia (RLH) diagnosed on cytology were also studied cytomorphologically. Image morphometry was done in follicular and intermediate-grade NHLs, immunocytochemistry was done in follicular and intermediate-grade NHLs, and immunocytochemistry for bcl-2 expression was studied in five cases of follicular NHLs. The aspirate smears of follicular NHL showed the presence of higher grades, many to abundant (++ to +++) monomorphic lymphoid aggregates, with an increased number of mast cells. Lymphohistiocytic tangles and tingeable body macrophages were not observed in any of the cases. Cytomorphologically, all the cases of intermediate-grade NHL showed a predominantly monomorphic population of lymphoid cells with absent or few grades (+) of lymphoid aggregates. Image morphometric data analysis of each cell parameter for follicular and intermediate-grade NHLs were found to be statistically insignificant (P > 0.05) and hence of little help in diagnosis of follicular vs. low-grade NHLs. Immunocytochemistry for bcl-2 expression in follicular NHL showed variable results, ranging from 0-90% (expressed as bcl-2 index). Certain characteristic cytomorphological features such as the presence of monomorphic lymphoid cell aggregates and an increased number of mast cells are soft indicators for the diagnosis of follicular NHL on aspiration smears. Immunocytochemistry for bcl-2 expression may be of help in cases with clinical and cytological suspicion of lymphoma. Image morphometry has a small role in this regard.     

荧光原位杂交检测石蜡包埋间变性大细胞淋巴瘤病例中ALK基因转位及其意义

目的　比较荧光原位杂交 (fluorescence in situ hybridization,FISH)和免疫组织化学在检测间变性大细胞淋巴瘤 (anaplastic large cell lymphoma,AL CL )中间变性淋巴瘤激酶 (anaplastic lymphomakinase,AL K)基因转位及其融合蛋白中的作用 ,并探讨 FISH在石蜡包埋组织中的应用。方法　采用双色FISH和免疫组织化学检测 2 2例石蜡包埋 AL CL病例中 AL K基因转位及其融合蛋白。结果　通过调整组织切片的酶消化时间等优化措施 ,成功地在石蜡切片上进行了双色 FISH实验 ;FISH和免疫组织化学均在 6 0 % (12 /2 0 )系统性 AL CL中检测到 AL K基因转位或融合蛋白 ,在 2例皮肤原发 AL CL中未检测到基因转位或融合蛋白 ,两种方法的符合率为 10 0 %。结论　 (1)在检测 AL CL中有无 AL K基因转位时 ,AL K蛋白免疫组化由于其简单、快捷、价廉成为一般情况下的首选方法 ;在具备 FISH条件时 ,也可以将 FISH作为首选 ;(2 )通过优化实验条件 ,可以在石蜡包埋组织上成功地进行 FISH实验。     

流式细胞术分析淋巴瘤穿刺液免疫表型的临床意义

目的 :探讨非霍奇金氏淋巴瘤 (NHL)病理特点、免疫表型及与慢性淋巴腺炎和增生性淋巴腺炎 (RH)免疫表型的不同表达。方法 :对 2 0 6例淋巴结肿大患者进行淋巴结穿刺 ,取穿刺液进行染色镜检 ,作出初步诊断。而后采用流式细胞仪(FCM)检测各患者淋巴结穿刺液中淋巴细胞免疫表型。结果 :①经形态学检查慢性淋巴腺炎患者 95例 ;增生性淋巴腺炎患者4 0例 ;NHL患者 71例。② 71例NHL中B NHL 5 3例 ,占 74 6 4 % ;T NHL 12例 ,占 16 90 % ;CD3阳性 15例 ,占 2 1 13% ;CD4阳性6例 ,占 8 4 5 % ;CD34阳性 30例 ,占 4 2 2 5 %。③NHL各抗原表达结果与增生性淋巴腺炎、慢性淋巴腺炎各抗原表达结果均有显著差异 (P <0 0 5 )。结论 :免疫表型检查有助于确定绝大多数NHL病例、肿瘤增生细胞的T或B性质及克隆性 ,免疫表型检查可作为NHL鉴别诊断的辅助指标。     

An immunohistochemical study of non-Hodgkin''s lymphomas: correlation of morphological appearances and immunophenotype in 148 cases

An unselected series of 148 cases of non-Hodgkin's lymphoma has been studied by immunohistological methods. In each case, the morphological features displayed in paraffin sections were correlated with the immunophenotype, determined using a panel of monoclonal antibodies. Of the lymphomas 82% were B-cell type, 28% of follicle centre cell origin, 17% lymphocytic or immunocytic and 30% of large cell type. All the B-cell tumours expressed pan-B antigen, and nearly all HLA-DR. In most, light chain monoclonality was demonstrable. Nearly all had moderate to large numbers of T-cells of both subtypes interspersed amongst the B-lymphocytes. Follicle centre cell tumours expressed surface IgM and IgD and had numerous dendritic reticulum cells. Lymphocytic and immunocytic lymphoma expressed IgM but less IgD, and had fewer or no dendritic reticulum cells. Large cell lymphoma expressed either no immunoglobulin or only IgM, and contained ragged dendritic reticulum cells, giving the appearance of 'burnt-out' follicles. T-cell lymphomas usually showed a clear preponderance of either helper or suppressor subtype. Additionally, they contained residual B-cells and sometimes germinal centres. Only 3% of this series were 'non-B, non-T', and only one case HLA-DR negative, so the 'null' or 'unclassifiable' group is very small when information from antibody markers is available.