316例淋巴组织肿瘤骨髓细胞形态学的WHO分型观察

目的：观察淋巴系肿瘤在骨髓细胞形态学中的表现,探讨WHO分型有关问题。方法：采用WHO分型方法,对316例伴有骨髓细胞形态学表现异常的淋巴组织肿瘤进行分析。结果：前体B、T淋巴母细胞急性白血病(ALL)占46．6％,外周B淋巴组织肿瘤中慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL／SLL)占18．4％,多发性骨髓瘤(MM)占14．6％,其他恶性淋巴瘤细胞骨髓浸润亦较多见,占12．2％,浸润程度不一。其余比例较少的疾病为Burkitt淋巴瘤／白血病、毛细胞白血病(HCL)、幼稚淋巴细胞白血病(PLL)、浆细胞白血病(PCL)、伴有绒毛淋巴细胞的脾淋巴瘤(SLVL)。B淋巴系肿瘤病例较T淋巴组织肿瘤明显增多。结论：WHO分型以细胞形态学和免疫分型为基础,确定主要分化类型和分化程度,并结合细胞遗传学异常以及特殊的病因学和临床特点综合分类,可能是目前国际上最为合理的分类法。     

COANP方案合用国产rhG—CSF治疗淋巴肉瘤细胞白血病

淋巴肉瘤细胞白血病（LCL）又称淋巴瘤细胞白血病，是恶性淋巴瘤（主要是非霍奇金氏淋巴瘤）病程后期，恶性肿瘤细胞播散至骨髓及血液所致的白血病，国内外对此类白血病尚无疗效肯定的化疗方案，我科于1996年4月起用COANP方案配合国产rhG-CSF（重组人粒细胞集落刺激因子）共治疗LCL中层得26例，均取得较好疗效，报道如下。     

骨髓细胞学检查对恶性淋巴瘤病理诊断、临床分期及预后价值

[目的]探讨骨髓细胞学检查对恶性淋巴瘤病理诊断和临床分期的价值.[方法]总结回顾101例恶性淋巴瘤患者的骨髓细胞学检查和临床分期结果.[结果]霍奇金淋巴瘤(HL)24例;非霍奇金淋巴瘤(NHL)77例.NHL分型:B细胞型49例,T细胞型26例和NK细胞型2例.恶性淋巴瘤的骨髓侵犯(BMI)32例(31.68%),其中恶性淋巴瘤性白血病(MLL)8例.HL的淋巴细胞削减型和混合细胞型;NHL的小淋巴细胞淋巴瘤,前B淋巴母细胞淋巴瘤和T淋巴母细胞淋巴瘤BMI多见.10例无明显浅表淋巴结肿大的NHL患者经骨髓活检确诊为BMI,分期则由原Ⅱ、Ⅲ期升为Ⅳ期.恶性淋巴瘤发展至MLL的间期＜3.5年,生存期＜28个月,预后不良.[结论]骨髓细胞学检查对恶性淋巴瘤的诊断和临床分期有重要价值,尤其对无淋巴结病理证据的患者可提供诊断依据,伴有BMI患者为临床晚期,可能进展为白血病.     

NK/T细胞淋巴瘤细胞凋亡和增殖的特征及意义

目的 探讨NK/T 细胞淋巴瘤细胞凋亡和增殖的特征及意义。方法 应用TdT 介导的dUTP 缺口末端标记(TUNEL）技术和免疫组织化学链霉素抗生物素-过氧化酶连接法（SP 法）检测25 例NK/T 细胞淋巴瘤组织和10 例反应性增生淋巴组织中的细胞凋亡、增殖细胞核抗原（PCNA）表达水平。结果 25 例NK/T 细胞淋巴瘤组织中细胞凋亡指数（AI）平均为（1.92±0.86) %,细胞增殖指数（PI）平均为（41.48±5.10) % ; 10 例反应性增生淋巴组织AI 平均为（6.70±1.89) % , PI 平均为（20.10±2.77) % ;与反应性增生淋巴组织相比,NK/T 细胞淋巴瘤组织中AI 显著减少（t=10.80,P＜0.01) , PI 显著增大(t= 12.39,P＜0.01）。NK/T 细胞淋巴瘤组织中AI与PI 呈显著性正相关（r= 0.69,P＜0.01）。结论 NK/T 细胞淋巴瘤组织中细胞凋亡减少,细胞增殖活跃,细胞凋亡与增殖的失衡在NK/T 细胞淋巴瘤的发生发展中可能起重要作用。     

恶性淋巴瘤1126例临床特点分析

 目的　分析恶性淋巴瘤患者住院的临床特点。方法　从该院病案数据库提取2005年1月至2009年12月住院恶性淋巴瘤患者的资料,剔除未能明确病理分型及重复入院的病例,从年龄、性别、病理类型、肿瘤起病部位及分期等方面进行分析、总结。结果　住院的恶性淋巴瘤患者1126例,男女比例为1.94∶1。霍奇金淋巴瘤（HL）患者年龄集中在20～40岁,以混合细胞型（64.16 %）、结节硬化型（29.48 %）为主。非霍奇金淋巴瘤（NHL）患者年龄以50~70岁为多,发病率位于前10位的为弥漫大B细胞淋巴瘤（53.31 %）、结外NK／T细胞淋巴瘤（7.35 %）、套细胞淋巴瘤（6.40 %）、B细胞慢性淋巴细胞白血病／小淋巴细胞淋巴瘤（4.30 %）、间变性大细胞淋巴瘤（4.09 %）、前T细胞淋巴母细胞白血病／淋巴瘤（3.88 %）、外周T细胞淋巴瘤（非特指）（3.46 %）、血管免疫母细胞型淋巴瘤（3.04 %）、滤泡性淋巴瘤（2.94 %）、伯基特淋巴瘤（2.52 %）。两者起病部位均以颈部淋巴结常见。结论　HL和NHL发病存在性别、年龄、病理类型、起病部位等差异。     

急性白血病伴CD56阳性的临床意义

目的：探讨CD56在急性白血病中的表达及其临床意义。方法：就近2年来应用流式细胞仪检测了CD56的92例急性白血患者中发现的CD56阳性病例,分析细胞形态学、免疫表型和临床特点。结果：92例急性白血病中15例（16．3％）表达CD56,其中1例急性前髓系／NK细胞白血病（Myeloid/NK cell precursor acute leukemia),1例原始NK细胞白血病（Blastic NK cell leukemia),1例NK样T细胞淋巴瘤／白血病（NK－like T-cell lymphoma/leukemia),12例急性髓细胞白血病伴NK细胞抗原表达或急性髓系／NK细胞白血病。结论：伴CD56阳性急性白血病,其细胞形态学、免疫表型及临床表现各有特点,见于M2、M5、L2,髓外浸润多见,多预后不良。     

2008年版"世界卫生组织造血及淋巴组织肿瘤分类"指要

 2008年第4版"世界卫生组织造血及淋巴组织肿瘤分类"把该类肿瘤分列为12个项目,对分子生物学进展结合较多,基因、染色体改变均加入分类中。慢性骨髓增生性疾病改为骨髓增生性肿瘤,并将肥大细胞增多症（mastocytosis）归于此栏中。新增了伴有嗜酸细胞增多的髓系及淋巴细胞系恶性肿瘤及异常的PDDFRA、PDDFRB或FGFR1基因一栏。在骨髓增生异常综合征／骨髓增生性肿瘤（MDS／MPN）一栏中增加了伴环形铁粒幼细胞再生障碍性贫血并显著的血小板增多（RARS-T）（可能为一单独性疾病）。在骨髓增生异常综合征（MDS）一栏中分为一系或多系增生异常伴有一系或多系血细胞减少,并增添了儿童MDS。在急性髓系白血病及其有关前体细胞恶性肿瘤中,把髓系肉瘤（myeloid sarcoma）单独分类;新增加了唐氏综合征（Down syndrome）伴有的髓系增生疾病;新增加了母细胞性浆细胞样树突细胞肿瘤（blastic plasmacytoid dendretic cell neoplasm）。把系列不明的白血病（acute leukemia of ambiguous lineage）单列为一个项目,含6种白血病。在前体淋巴系肿瘤中分为B系及T系,淋巴母细胞性白血病／淋巴母细胞性淋巴瘤,其区别点在于骨髓中淋巴母细胞＞25 %,则诊断为淋巴细胞白血病[和急性髓系白血病（AML）不同,不设下限为20 %]。成熟B淋巴细胞系肿瘤分为39种,包括慢性淋巴细胞白血病、骨髓瘤、重链病、Burkitt淋巴瘤等,但不包括移植后淋巴细胞增生性疾病（PTLD）。成熟T淋巴细胞系和NK细胞系肿瘤栏目下列举了22种成熟T淋巴细胞系和NK细胞系恶性肿瘤。霍奇金淋巴瘤栏目下列举了6种霍奇金淋巴瘤。组织细胞和树突状细胞恶性肿瘤包括7种恶性肿瘤及播散性幼年型黄肉芽肿。移植后淋巴细胞增生性疾病（PTLD）被单独分类在一个栏目中,又分为５种类型。     

COANP 方案合用国产 rhG-CSF 治疗淋巴肉瘤细胞白血病

淋巴肉瘤细胞白血病(ＬＣＬ)又称淋巴瘤细胞白血病,是恶性淋巴瘤(主要是非霍奇金氏淋巴瘤)病程后期,恶性肿瘤细胞播散至骨髓及血液所致的白血病,国内外对此类白血病尚无疗效肯定的化疗方案。我科于1996年4月起用ＣＯＡＮＰ方案配合国产ｒｈＧＣＳＦ(重组人粒细胞集落刺激因子)共治疗ＬＣＬ患者26例,均取得较好疗效,报道如下。1　临床资料1.1　一般资料住院恶性淋巴瘤患者,有病理诊断及骨髓和外周血细胞学检查。其中男16例;女10例;年龄16～67岁,中位年龄46岁。初治4例,复治患者22例,ＫＰＳ评分60以上。病理组织学分型:低度恶性4例,中度恶性15…     

复发难治性NK/T细胞淋巴瘤疗效及预后相关因素

目的 分析复发难治性NK/T细胞淋巴瘤患者的有效治疗方法和预后相关因素.方法 回顾性分析1999年1月至2007年6月中山大学肿瘤医院收治的复发及难治的NK/T细胞淋巴瘤24例,并进行单因素和多因素分析.结果 截至末次随访时间2007年6月,中位随访期7(1.5～38)个月,共生存5例,复发后中位生存期(MST)7(1.5～38)个月,预计1、2、3年总生存(OS)率分别为33.3%、4.2%、4.2%.多因素分析结果提示,复发后骨髓受累、复发后PS与全身性复发NK/T细胞淋巴瘤患者复发后OS率密切相关,是独立预后指标.2例接受自体外周血干细胞移植(AHSCT)患者无瘤生存期分别是19、38个月.结论复发后骨髓受累情况、PS是复发难治性NK/T细胞淋巴瘤独立预后因素,复发难治性NK/T细胞淋巴瘤患者预后较差,MST短,化疗敏感患者采用AHSCT,可能提高其生存.     

咽淋巴环非霍奇金淋巴瘤的影像学特征及临床意义

背景与目的:咽淋巴环是非霍奇金淋巴瘤(non-HodgkinslymphomaNHL)常见的结外侵犯部位,早期临床及影像学表现均与该部位常见的鳞状上皮癌相似,常引起误诊。为了提高对本病影像特点的认识,本文拟分析有关资料,探讨咽淋巴环NHL的影像学特点及临床意义。方法:回顾性分析149例经病理确诊的咽淋巴环NHL的CT和MRI表现。结果:病理分型:B细胞来源占65.8%,T和NK/T细胞占34.2%。病变部位:发生于扁桃体的最多见,其次为鼻咽扁桃体等多部位受累。CT和MRI表现:(1)病变形态为肿块型81例、浸润性36例、溃疡型7例及混和型25例,其中肿块型以B细胞NHL多见,浸润型以NK/T细胞多见。(2)肿块型多表现为CT密度和MRI信号均匀。(3)病变以局限在咽粘膜间隙多见,咽旁间隙等深层结构及颅底骨质侵犯少。(4)总的颈淋巴结受累率52.3%,其中B细胞65.3%,和NK/T细胞27.5%,后者明显低于前者(P<0.05)。结论:多部位多中心起源、大肿块、咽壁弥漫浸润性增厚、颅底及深层结构侵犯少是咽淋巴环NHL典型的影像学特征;不同的免疫表型又有一定的特点。CT和MRI在咽淋巴环NHL的诊断、临床分期有重要的参考价值。     

伴PET/CT骨髓弥漫性糖代谢增高的淋巴瘤患者骨髓浸润情况及相关因素分析

背景与目的：正电子发射计算机断层显像技术(positron emission tomography-computed tomography,PET/CT)在淋巴瘤的诊断、治疗和随访中发挥着越来越重要的作用。该研究旨在探索PET/CT显示骨髓弥漫性糖代谢异常增高的淋巴瘤患者骨髓有无浸润、淋巴瘤病理类型以及其他临床特点。方法：回顾性分析复旦大学附属中山医院62例经病理确诊为淋巴瘤且PET/CT显示骨髓弥漫性糖代谢增高患者的临床资料、病理以及PET/CT详细数据,并行统计学分析。结果：PET/CT显示有骨髓弥漫性糖代谢异常增高的患者,其淋巴瘤病理类型分布与国内所报道各亚型淋巴瘤发病比例基本一致;侵袭性与惰性淋巴瘤之间［标准摄取值(standard uptake value,SUV)分别为8.43与5.38,P=0.048］、有或无B症状之间(SUV分别为8.30与5.72,P=0.033)、有或无骨髓浸润之间(SUV分别为8.78与6.96,P=0.020),SUV的差异均有统计学意义。32例(51.6%)患者经骨髓活检病理证实骨髓受累。骨髓受累者其淋巴瘤病理类型的分布上与未受累者差异有统计学意义(P=0.001);骨髓受累者套细胞淋巴瘤、结内边缘区B细胞淋巴瘤、伯基特淋巴瘤和间变大细胞淋巴瘤者比例较高,而骨髓未受累者弥漫大B细胞淋巴瘤、外周T细胞淋巴瘤、肠病相关性T细胞淋巴瘤和NK/T细胞淋巴瘤(鼻型)者比例较高。PET/CT骨摄取假阳性可能与发热、贫血等有关。结论：PET/CT骨髓弥漫性糖代谢异常增高虽然对临床诊疗有一定的提示,但应结合PET/CT骨糖代谢异常增高的特点、患者的临床因素及病理亚型综合分析,以减少误诊与漏诊,更精确地指导分期及治疗。     

Magnetic resonance imaging of bone marrow versus bone marrow biopsy in malignant lymphoma

Bone marrow involvement is a frequent finding in malignant lymphoma. Bone marrow biopsy of the posterior iliac crest is routinely performed for staging. Abnormal magnetic resonance imaging (MRI) signals of bone marrow was also reported to be indicative of bone marrow involvement. This study included 60 patients with malignant lymphoma. Unilateral bone marrow biopsy of the posterior iliac crest was performed. MRI of lumbar spine was studied within 24 hours of bone marrow biopsy. 22 healthy controls were used for the detection of MRI objectivity during visual evaluation. In 83% of patients (50/60), biopsy and MRI results agreed completely. In two patients, histologic sections failed to show any evidence of bone marrow involvement despite abnormal MRI signals suggestive of involvement. In three patients, MRI was completely normal despite biopsy proven bone marrow infiltration. False negativity (3/60) and false positivity (2/60) rates were very low. Negative biopsy findings with positive or equivocal MRI results should not exclude bone marrow involvement and needs further evaluation with bilateral or guided biopsy. Thus, we conclude that MRI of bone marrow is a fairly sensitive, noninvasive modality and might be of potential value in detecting bone marrow infiltration in malignant lymphoid neoplasms which can be utilized as a useful adjunct to standard staging procedures.     

112例淋巴系统恶性肿瘤骨髓免疫表型分析

背景与目的:淋巴细胞白血病和淋巴瘤骨髓侵犯的诊断以细胞形态学为基础,而免疫分型可通过获得肿瘤细胞分化和发育阶段的信息使淋巴系统恶性肿瘤的诊断更为准确,为临床合理治疗和预后判断提供重要的科学依据.本研究应用多参数流式细胞术(flow cytometry,FCM)探讨淋巴细胞白血病和非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)骨髓侵犯的免疫表型特点.方法:收集112例病理确诊NHL并伴骨髓侵犯和淋巴细胞白血病患者的骨髓标本.应用FCM检测肿瘤细胞的免疫表型.结果:45例前驱B淋巴母细胞白血病/淋巴瘤(precursor B lymphoblastic lymphoma/leukemia,B-ALL/LBL)主要表达CD19、CD10、TdT、CD34、HLA-DR和CD20;32例前驱T淋巴母细胞白血病/淋巴瘤(precursor T lymphoblastic lymphoma/leukemia,T-ALL/LBL)主要表达胞内CD3(cytoplasmic CD3,CyCD3)、CD7、CD5、TdT、膜表面CD3(surface CD3,sCD3)和HLA-DR.77例前驱淋巴细胞肿瘤中,28例(36%)有髓系抗原CD13、CD33的表达;9例(20%)B-ALL/LBL病例有CD20与CD34共同表达,28例(87.5%)T-ALL/LBL病例有CyCD3与TdT共同表达.成熟淋巴细胞肿瘤35例,其中17例慢性淋巴细胞白血病/小淋巴细胞淋巴瘤主要表达CD19、CD20、CD5和HLA-DR,并有CD19与CD5共同表达.4例弥漫大B细胞性淋巴瘤主要表达CD19、CD20、CD10和HLA-DR.3例伯基特淋巴瘤主要表达CD19、CD10、CD20、SIgM.1例套细胞淋巴瘤表达CD5、CD19、CD20、HLA-DR.5例外周T细胞淋巴瘤(PTCL)主要表达sCD3、CD5、CD7、CD4或CD8.1例间变性大细胞淋巴瘤主要表达sCD3、HLA-DR.4例NK/T细胞肿瘤表达CD56、HLA-DR,也表达CD7或CD4或CD8.成熟淋巴细胞肿瘤不表达早期抗原如CD34、TdT.成熟淋巴细胞肿瘤可伴有髓系抗原CD13、CD33的表达.结论:淋巴系统恶性肿瘤侵犯骨髓采用形态学结合FCM免疫学分型可获得T、B细胞来源、肿瘤细胞分化阶段和异常抗原表达等参数,有助于临床诊断和微小残留病灶的检测.     

FDG-PET in T-cell and NK-cell neoplasms.

BACKGROUND: A growing number of studies demonstrate the utility of (18)fluoro-2-deoxyglucose positron emission tomography (FDG-PET) in the management of malignant lymphoma. The results of FDG-PET, however, have not been studied extensively for T-cell and natural killer (NK)-cell neoplasms. PATIENTS AND METHODS: We retrospectively evaluated pretreatment FDG-PET scans in 41 patients with T/NK-cell neoplasms diagnosed according to the World Health Organization (WHO) classification. Histological subtypes frequently included were peripheral T-cell lymphoma, unspecified (PTCLu, n = 11), extranodal NK/T-cell lymphoma, nasal type (ENKL, n = 8), primary cutaneous anaplastic large cell lymphoma (C-ALCL, n = 5), and angioimmunoblastic T-cell lymphoma (AILT, n = 4). RESULTS: FDG-PET detected a lymphoma lesion in at least one site in 36 out of 41 patients. The positive rate was equally high in most histological subtypes except for cutaneous lymphomas: PTCLu 91%, ENKL 100%, C-ALCL 60%, AILT 100%. All the patients without an FDG-avid lesion had lesions restricted to skin. Among patients who had cutaneous lesions, only 50% had FDG-avid cutaneous lesions, all of which were tumorous. The positive rate of FDG-PET for bone marrow involvement was only 20%. CONCLUSION: T/NK-cell neoplasms incorporated in this study were generally FDG-avid except for cutaneous lesions and bone marrow involvement.     

B细胞淋巴瘤患者骨髓IgH基因克隆性重排检测的临床意义

目的 探讨半巢式聚合酶链反应(PCR)检测B细胞淋巴瘤患者骨髓中IgH基因克隆性重排的可行性,并初步评价其临床价值.方法 选用FR2、FR3A引物,采用半巢式PCR方法检测105例B细胞淋巴瘤患者骨髓中IgH基因的单克隆性重排,与骨髓穿刺细胞形态学检测结果进行比较,并评价PCR检测结果与临床病理特征的关系.结果 105例B细胞淋巴瘤患者中,IgH基因克隆性重排PCR检测48例(45.7%)阳性,而骨髓细胞形态学只检测出22例(21.0%),两者差异有统计学意义(P<0.05),符合率为71.4%(75/105).弥漫大B细胞性淋巴瘤(DLBCL)、滤泡性淋巴瘤(FL)及小淋巴细胞性淋巴瘤(SLL)初治患者PCR检测阳性率分别为30.8%、25.0%和100.0%.PCR检测结果与Ann Arbor分期有关,早期B细胞淋巴瘤患者lgH基因克隆性重排PCR检出阳性率低于晚期患者(P=0.02).PCR检测阳性和阴性患者的近期疗效差异无统计学意义(P>0.05),但CR率(23.3%和46.3%)差异有统计学意义(P=0.019).结论 IgH基因克隆性重排PCR检测可能是判断B细胞淋巴瘤患者骨髓异常的有效方法,较骨髓细胞形态学敏感;Ann Arbor分期晚的患者PCR检测阳性率高于分期早的患者;PCR检测阳性者治疗后获得CR的机会低于阴性者.     

Bone marrow involvement by non-Hodgkin's lymphoma: the clinical significance of morphologic discordance between the lymph node and bone marrow. Nebraska Lymphoma Study Group.

Bone marrow specimens from 317 patients with non-Hodgkin's lymphoma (NHL) obtained at initial staging were evaluated for the presence of lymphoma or benign lymphoid aggregates. Thirty-two percent (102 patients) had lymphoma in their bone marrow, and 9% had benign lymphoid aggregates. Bone marrow lymphoma was present in 39% of low-grade, 36% of intermediate-grade, and 18% of high-grade lymphomas. The bone marrow was involved in 25% of patients with diffuse large-cell or immunoblastic NHL (ie, diffuse histiocytic lymphoma of Rappaport). Bone marrow involvement did not affect survival of patients with low-grade NHL, but survival was significantly shorter (P = .03) for patients with intermediate- and high-grade NHL with bone marrow involvement. Bone marrow involvement was equally common in B-cell and T-cell NHL (31% v 32%). However, patients with T-cell NHL and bone marrow involvement had shorter survival than B-cell NHL with marrow involvement (P = .02) or T-cell NHL without marrow involvement (P = .05). A high incidence of morphologic discordance between lymph node and bone marrow was observed (ie, 40%), always with a more aggressive subtype in the lymph node than in the bone marrow. Presence of large-cell lymphoma in the bone marrow predicted for short survival. Survival for patients with small-cell lymphoma in their bone marrow did not differ significantly from patients with negative bone marrows. We conclude that bone marrow involvement in large-cell NHL, especially in those of T-cell origin, portends a poor prognosis. However, the subgroup of patients with an aggressive histologic subtype of NHL in a lymph node biopsy and small-cell NHL in the bone marrow do not have a poorer outlook than those without bone marrow involvement.     

Distribution and prognosis of WHO lymphoma subtypes in Taiwan reveals a low incidence of germinal-center derived tumors

To assess the distribution of lymphomas in Taiwan according to the WHO (World Health Organization) classification, 175 recently diagnosed cases of malignant lymphomas were studied and the clinicopathologic data were analyzed. B-cell lymphomas accounted for 57.1% of cases, T-cell lymphomas 38.9%, and Hodgkin's lymphoma 4%. Extranodal lymphomas predominated (55.4%). The most common subtype of B-cell lymphoma was diffuse large B-cell lymphoma (33.1%). All tumor types believed to be derived from germinal center (GC) B-cells including follicular lymphoma (4.6%), Burkitt lymphoma (1.7%), Hodgkin lymphoma (4.0%), and GC-like diffuse large B-cell lymphoma (as defined by combined expression of bcl-6 and CD10) were rather uncommon as compared to frequencies seen in series from Western countries. The common T-cell lymphomas included nasal and extranasal NK/T cell lymphoma (7.4%), mycosis fungoides (7.4%), and unspecified peripheral T-cell lymphoma (6.9%). Adult T-cell leukemia/lymphoma was very uncommon and accounts for only 0.6%. The proportional increase in T-cell lymphomas that were unrelated to type I human T-cell lymphotropic virus (HTLV-1) may be linked to differential Epstein-Barr virus (EBV) oncogenesis. The survival data revealed that mantle cell lymphoma, NK/T-cell lymphoma, unspecified peripheral T-cell lymphoma, and subcutaneous panniculitis-like T-cell lymphoma had an aggressive course. Our results confirm the utility of the WHO classification scheme for prognostic stratification and further highlight the distinctive distribution pattern of malignant lymphoma in Taiwan including the higher relative incidence of T cell lymphomas and the rarity of germinal center-derived B-cell tumors.     

恶性淋巴瘤骨髓受累的免疫表型特征

目的:探讨淋巴瘤骨髓受累的免疫表型特征。方法:采用流式细胞仪CD45/SSC设门方法对34例恶性淋巴瘤患者的骨髓标本进行检测,以骨髓涂片细胞学检查作阳性对照。收集骨髓受累患者的CD分子表达数据。结果:①对34例恶性淋巴瘤患者的骨髓应用流式细胞仪进行检测,发现23例阳性,阳性率67.65%(23/34),95%可信区间(51.92%,83.37%)。②该23例阳性患者中,非霍奇金淋巴瘤(NHL)19例,霍奇金淋巴瘤(HL)4例。NHL患者中B细胞来源免疫荧光单克隆抗体标记抗原出现频率最高的为CD19,CD20;T细胞来源标记抗原出现频率最高的为CD7。而在HL患者中出现频率最高的为CD9。结论:采用流式细胞仪CD45/SSC设门方法,发现非霍奇金淋巴瘤骨髓受累患者免疫表型特征为:B细胞来源:CD19、CD20;T细胞来源:CD7。霍奇金淋巴瘤为:CD9。     

Diagnostic difficulties of pure intrasinusoidal bone marrow infiltration of non-Hodgkin's lymphoma: a report of eight cases from India

Bone marrow involvement in non-Hodgkin's lymphoma is prognostically important for appropriate management. Intrasinusoidal pattern of bone marrow infiltration is poorly identified on trephine biopsies. We analyzed the clinical, hematological and histopathological spectrum of eight cases of non-Hodgkin's lymphoma showing pure intrasinusoidal bone marrow infiltration. Fever, cytopenias and blasts in circulation were the indications for bone marrow aspiration and trephine biopsies. Flow cytometry on bone marrow and immunohistochemistry on trephine sections were done. There were five cases of T-cell hepatosplenic non-Hodgkin's lymphoma (three γδ T-cell lymphoma) and three B-cell non-Hodgkin's lymphoma (two intravascular large B-cell lymphoma and one splenic marginal zone lymphoma). Except the cases with intravascular large B-cell lymphoma, all showed variable splenomegaly without lymphadenopathy. Immunohistochemistry highlighted intrasinusoidal infiltration, which was difficult to discern on hematoxylin and eosin. This brief analysis highlights that pure intrasinusoidal infiltration of extranodal non-Hodgkin's lymphoma requires a high degree of diagnostic suspicion and can be seen in various lymphomas.