脑原发性淋巴瘤临床病理及免疫组化研究

「目的」收集１７例中枢神经系统原发性淋巴瘤，对其临床病理特点及免疫组化染色特征进行探讨。「方法」标本采用常规石蜡切片、ＨＥ染色及ＳＰ法免疫组化染色，光镜观察。「结果」１７例患者中男性１２例，女性５例；中位年龄５０岁。１７例中肿瘤位于顶叶５例，额叶４例，颞叶和基底节区各３例，小脑２例。１６例肿瘤细胞呈弥漫围绕血管分布，仅１例在肿瘤内可见部分滤泡形成。１７例肿瘤细胞均为ＬＣＡ阳性表达，其中１６例Ｌ２６     

原发性中枢神经系统恶性淋巴瘤的临床病理及免疫表型

目的 观察原发性中枢神经系统淋巴瘤(PCNSL)的免疫表型及其临床病理特征。方法 应用免疫组织化学方法，检测单克隆抗体LCA、L26、CD79、UCHL-1、CD3、CD30、CD68、免疫球蛋白κ及λ轻链、S-100蛋白及GFAP在14例PCNSL中的表达情况，并观察其临床病理特点。结果 PCNSL的肿瘤组织形态与淋巴结内淋巴瘤基本一致，但无淋巴滤泡形成。瘤细胞有明显围绕血管现象，呈“袖套”样分布。免疫组化标记所有病例LCA、L26及CD79阳性，5例λ轻链阳性，其余抗体标记阴性。结论 PCNSL均来源于B细胞，瘤细胞分布疏密不均，围绕血管浸润，免疫组化检测LCA阳性、GFAP阴性可作为PCNSL的诊断、鉴别诊断依据。     

胃原发性恶性淋巴瘤临床病理及免疫组化研究

作者应用细胞学、组织学及免疫组织化学标记技术研究了１２例胃原发性恶性淋巴瘤。结果表明其中无核裂细胞型４例，核裂细胞型３例，淋巴浆细胞样型５例。免疫组化标记证实１２例均系Ｂ细胞性淋巴瘤。本文讨论了原发性恶性淋巴瘤的诊断和鉴别诊断。     

骨原发性淋巴瘤5例临床及病理分析

骨原发性淋巴瘤临床罕见，约占骨恶性肿瘤的5％，占结外非霍奇金淋巴瘤的4％～6％。临床易误诊为骨肉瘤。现将本院病理科诊断为5例骨原发性淋巴瘤临床病理特点报告如下。     

脑原发性淋巴瘤临床病理及免疫组化研究

[目的]收集17例中枢神经系统原发性淋巴瘤 ,对其临床病理特点及免疫组化染色特征进行探讨。[方法]标本采用常规石蜡切片、HE染色及SP法免疫组化染色 ,光镜观察。[结果]17例患者中男性12例 ,女性5例 ;中位年龄50岁。17例中肿瘤位于顶叶5例 ,额叶4例 ,颞叶和基底节区各3例 ,小脑2例。16例肿瘤细胞呈弥漫围绕血管分布 ,仅1例在肿瘤内可见部分滤泡形成。17例肿瘤细胞均为LCA阳性表达 ,其中16例L26阳性 ,1例UCLH1阳性。[结论]PCNSL好发于50岁左右男性患者 ,以顶、额叶多见。镜下见肿瘤细胞多呈弥漫围绕血管分布。免疫组化染色证明肿瘤多为B细胞性淋巴瘤 ,T细胞性淋巴瘤较罕见     

脾脏原发性恶性肿瘤临床病理及免疫组化研究

目的：分析脾脏原发性恶性肿瘤的临床病理特点和免疫组化表达特征，为该肿瘤病理诊断和治疗提供依据。方法：采用常规石蜡切片，H-E染色和免疫组化S-P法标记LCA、L26阳性以确定诊断。结果：580例手术切除脾脏标本中恶性肿瘤10例，男6例，女4例；年龄16-65岁，平均43岁，7例恶性淋巴瘤，海绵状血管瘤恶变，恶性血管瘤和纤维肉瘤各1例，病变完全局限于脾内和仅累及肺门淋巴结，组织学以淋巴细胞性淋巴瘤预后较好。恶性血管瘤，纤维肉瘤预后较差。结论：原发性脾脏恶性肿瘤是一种临床上少见的肿瘤，根据组织学特点，结合免疫组化染色，可以作出明确的病理诊断。治疗应首选脾切除和放疗加化疗。     

中枢神经系统原发性恶性淋巴瘤──附24例临床光镜、电镜及免疫组化研究

本文报告２４例原发于中枢神经系统的恶性淋巴瘤（ＭＬＣＮＳ）。以光镜、电镜和免疫组化进行观察，所得结果与临床资料、随访等对比分析，发现该瘤早、中期瘤细胞围血管分布，并沿Ｖｉｒｃｈｏｗ－Ｒｏｂｉｎ（ＶＲ）间隙扩展；晚期病变弥漫，但不均匀，无滤泡形成，瘤细胞彼此不粘聚。免疫标记及电镜检查，多数为Ｂ细胞起源，少数为组织细胞起源。临床以颅内压增高症状为主，病程多较短。ＣＴ示单灶，少数为多灶病变，呈高密、等密或疏密混合块影，周围可见轻度水肿带，常拟诊为胶质瘤或转移瘤而手术。随访结果表明，该瘤预后差，多于短期内死亡，且较颅外相同的组织学类型更差。另就病因、起源及病理鉴别诊断作了讨论。     

121例肠道原发性淋巴瘤临床病理分析

目的研究肠道原发性淋巴瘤的临床病理特点和预后。方法复习121例肠道原发性淋巴瘤临床资料、大体所见、HE切片、免疫组化染色,按2008年WHO造血与淋巴组织肿瘤分类重新进行分类,并用Kaplan-Meier法进行生存分析。结果121例肠道原发性淋巴瘤发病年龄从7～81岁,平均年龄52.7岁,中位年龄55岁。男性88例,女性33例,男女比例8∶3。发病部位分别为大肠（结、直肠）62例（51.2%）,小肠（空、回肠）47例（38.8%）,十二指肠7例（5.8%）,多发部位4例（3.3%）,阑尾1例（0.8%）。临床上以腹痛、腹胀（72.9%）、下消化道出血（22.0%）、发热（10.2%）、腹部包块（8.5%）、腹泻（8.5%）、消瘦（5.1%）等为首发症状。大体上表现为隆起型（37.3%）、溃疡型（33.9%）和浸润型（28.8%）。组织学类型分别为弥漫性大B细胞淋巴瘤,非特殊类型68例（56.2%）,MALT淋巴瘤18例（14.9%）,外周T细胞淋巴瘤,非特殊类型13例（10.7%）,肠病相关T细胞淋巴瘤7例（5.8%）,结外NK/T细胞淋巴瘤,鼻型4例（3.3%）,套细胞淋巴瘤和滤泡性淋巴瘤各3例（2.5%）,ALK阴性的间变性大细胞淋巴瘤2例（1.7%）,慢性淋巴细胞性白血病/小淋巴细胞性淋巴瘤、Burkitt淋巴瘤和不能分类的B细胞淋巴瘤各1例（0.8%）。59例外检病例中共随访39例（66.1%）,随访时间1-102月,平均随访时间19.7月,目前死亡15例。20例失访（未回信或拒绝告知）。结论肠道原发性淋巴瘤以中老年男性多见,最常累及的部位是大肠（结、直肠）,临床表现以腹痛、腹胀多见;最常见的组织学类型是弥漫性大B细胞淋巴瘤,非特殊类型。肠道原发性T细胞淋巴瘤的预后比B细胞淋巴瘤差。     

卵巢原发性恶性淋巴瘤临床病理研究

探讨卵巢原发性恶性淋巴瘤的诊断及鉴别诊断。用免疫组织化学及组织病病理学方法观察３９例具有小圆形细胞为主要特征的卵巢恶性肿瘤。     

A New Xenograft Model of Primary Central Nervous System Lymphoma

The management of primary lymphoma of the central nervous system (PCNSL) remains controversial and patients' outcome dismal. In order to investigate new selective therapeutic strategies in a controlled system, a reproducible model of PCNSL in nude rats was developed and characterized. Human B lymphoma cells (BL2) were implanted in the brain frontal area in New Zealand nude rats through a silastic device sealed to the skull. Fifteen and 30 days post-implantation, animals were sacrificed. An autopsy was performed. Representative brain sections were cut and examined for the presence of lymphoma. Immunohistochemistry was performed for proliferation (MIB1-Ki67), a B-cell marker (L26-CD20), a T-cell marker (UCHL1-CD45RO).The analysis of the brains showed tumor growth in 88% of the rats. No mortality was observed. At autopsy no extracerebral, spinal or cerebellar metastasis were found. Microscopically the brain tumors appeared non-encapsulated, highly vascularized, with a characteristic perivascular and diffuse lymphomatous spread in the parenchyma. Immunohistochemistry showed a marked positivity of the tumor cells for L26. Tumor cells were negative for UCHL1. Mean proliferation rate was 30%. The device was well tolerated and caused no local infection. Controlled studies on PCNSL in animal models are lacking. This PCNSL model in nude rats reproduces the histology and location of human CNS lymphoma. Tumor dimensions are within the resolution limits of CT and MRI and therefore suitable for stereotactic therapy. This model provides a tool to test new chemo and radiotherapeutical strategies in a controlled fashion.     

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai,India

Background: The aim of this study was to analyze the clinicopathological and immunohistochemical featuresof primary central nervous system lymphoma (PCNSL) cases occurring in Indian patients and also study theutility of the crush smear preparation in intraoperative diagnosis. Materials and Methods: The immune status,clinical, radiological details, immunohistochemical profile, histopathological findings and cytological features insmear preparation of 32 cases of PCNSL were analyzed. Patients with systemic NHL and skull-base lymphomaswere excluded. Results: The mean age of our patients was 52 years with a male: female ratio 1:1. A periventricularlocation was found in 62.5% of patients. None of our PCNSL cases were associated with AIDS. All cases exceptone were diffuse large B-cell lymphomas. Intraoperative diagnosis using crush smears allowed correct predictionin 93% of cases. Conclusions: Our study shows that PCNSL is seen predominantly in immunocompetent patientsin India .The age of presentation is relatively young as compared to the West. Our study also stresses the utilityof crush smear preparation in establishing an intraoperative diagnosis.     

Radiotherapy in the Treatment of Primary Central Nervous System Lymphoma (PCNSL)

The use of radiotherapy alone to treat primary central nervous system lymphoma (PCNSL) does not produce the high local control and survival rates that it does in limited extranodal non-Hodgkin's lymphoma outside the central nervous system (CNS). Even with doses of whole brain radiation therapy (WBRT) to 40+20Gy boost, the Radiation Therapy Oncology Group (RTOG) reported a local control rate of 39%. Seventy-nine percent of recurrences were in the 60Gy region. The median survival was 11.6 months. This response to local radiotherapy is quite different from the response of non-CNS Diffuse Large Cell Lymphoma where doses of 30–40 and >40Gy have a 75–90% local control rate. Neither systemic lymphoma nor PCNSL have a classic radiotherapy dose response. For PCNSL there appears to be a threshold dose that ranges in the literature between 30 and 50Gy with a median of 40Gy. Therefore, when radiotherapy is combined with chemotherapy that crosses the BBB, WBRT and/or boost doses may be able to be decreased, especially in patients achieving a complete response. Promising data from the Centre Leon Berard suggest that this is possible. When such chemotherapy was combined with intrathecal chemotherapy and 20Gy WBRT, they obtained a 56% actuarial 5 year survival rate. Confirmation of single institution reports of favorable results such as these are needed. Cooperative group and intergroup trials are needed to define optimal therapy.     

脾脏原发性恶性肿瘤临床病理及免疫组化研究

目的 :分析脾脏原发性恶性肿瘤的临床病理特点和免疫组化表达特征 ,为该肿瘤病理诊断和治疗提供依据。方法 :采用常规石蜡切片 ,H E染色和免疫组化S P法标记LCA、L2 6阳性以确定诊断。结果 :5 80例手术切除脾脏标本中恶性肿瘤 10例 ,男 6例 ,女 4例 ;年龄 16～ 6 5岁 ,平均 4 3岁。 7例恶性淋巴瘤 ,海绵状血管瘤恶变、恶性血管瘤和纤维肉瘤各 1例。病变完全局限于脾内和仅累及肺门淋巴结 ,组织学以淋巴细胞性淋巴瘤预后较好。恶性血管瘤、纤维肉瘤预后较差。结论 :原发性脾脏恶性肿瘤是一种临床上少见的肿瘤。根据组织学特点 ,结合免疫组化染色 ,可以作出明确的病理诊断。治疗应首选脾切除和放疗加化疗