淋巴瘤病理诊断新进展

2008年第4 版WHO淋巴瘤分类对于淋巴瘤的临床诊治、基础研究起到巨大的推动作用。新的修订版即将出版,虽然分类的基本结构未改变,但对于淋巴瘤发生极早期阶段的一些病变的诊断和处理方式、某些类型的诊断标准以及与临床诊疗密切相关的分子、遗传学等方面均做出扩充、更新和细化,并提出一些新的概念。本文对这些更新选择性进行综述和介绍,为国内淋巴瘤精准医疗提供最新的信息。      

2016年版WHO淋巴瘤分类新进展及其应用

淋巴瘤分类从早期到2016年版世界卫生组织（WHO）分类经历了一系列变化。2016年版WHO淋巴瘤分类旨在提供最新的淋巴瘤诊断类型、更准确的诊断标准以及生物学与临床的相关性,从而推动淋巴瘤领域的基础研究,促进未来的治疗进展,为患者提供更好的服务。     

肺黏膜相关淋巴瘤的诊断与鉴别诊断

目的 探讨肺黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALToma）的临床、影像、病理学特征和可靠的诊断依据,并与形态非常相似的3种肺良性淋巴组织增生性病变相鉴别.方法 分析3例肺MALToma患者的病史、影像学、病理组织学等检查,与淋巴细胞性间质性肺炎、淋巴细胞性炎性假瘤、滤泡性支气管炎鉴别.结果 肺MALToma临床表现和影像学缺乏特异性,与肺癌不易鉴别.病理示边缘区淋巴细胞增生、围绕生发中心并相互融合,侵入支气管上皮形成“淋巴上皮病变”,侵入滤泡生发中心形成“滤泡植入”.结论 肺MALToma是一种少见的低度恶性肿瘤,临床症状和影像学无特异性,确诊需依据病理组织学.与其他肺淋巴组织增生性病变的主要鉴别点在于边缘带的范围大小、有无融合、有无“滤泡植入”、有无“淋巴上皮病变”、滤泡之间的细胞类型等.     

黏膜相关性肺淋巴瘤的CT表现

肺淋巴瘤根据发病部位和病因不同可分为原发性、继发性及免疫缺陷相关性三类。原发性肺淋巴瘤仅表现为肺的淋巴浸润,而不伴有其他部位的淋巴结病变,临床极为罕见。我们收集8例经穿刺活检和手术病理检查证实的原发性肺淋巴瘤病例,结合文献资料,进行回顾性分析,现报告如下。     

第27届国际病理学术会议关于淋巴瘤的最新分类

 世界卫生组织（WHO）淋巴造血系统肿瘤分类第4版2008年9月问世,2008年10月希腊雅典第27届国际病理学术会议上,参与该分类的一些作者,就该分类的一些新变化做了专题报告。新分类基于欧美修订分类和2001年第3版分类,130多名病理专家参与,采纳了临床血液病专家和肿瘤专家对第3版的建议,根据形态学、免疫学、细胞遗传学、分子生物学和临床特点作了一些修订和补充,所以每种类型都是生物学与临床相结合的疾病实体。目前60多个疾病实体已被确认, 为临床提供了统一的术语和诊断标准。     

学习肿瘤的WHO分类，转变观念，提高肿瘤诊断和治疗的水平

半个世纪以来，尤其是近20多年，肿瘤学的基础和临床研究取得了巨大进展。肿瘤分子生物学研究从基因和分子水平阐明肿瘤的发生发展规律，揭示了肿瘤细胞与正常细胞之间的差异，认识到大多数肿瘤是体细胞突变导致后天获得的遗传性疾病，对癌症本质是一种遗传性疾病（Cancer is a genetic disease）的认识已渗入到临床肿瘤学的各个方面，在肿瘤的分类、诊断和治疗中许多观念发生了重大变化。世界卫生组织在新世纪初出版的肿瘤WHO分类系列丛书，     

从头颈外科学到头颈肿瘤学——肿瘤综合治疗的学科保证

[编者按]科学研究贵在创新,这是科技工作追求的境界.然而,创新不可能一蹴而就,更非空中楼阁,而是由长期实践经验积淀做基础的.所以,前人经验的传承实为后人创新的必要借鉴.为此,本刊遵循百家争鸣的方针,特邀请毕牛从事科学探索并卓有贡献的老专家,就自己的实践感悟,包括学术思想、研究思路、方法经验、成败得失等,撰写一批具有独到见解和反思精神的文章,陆续发表在本栏内,以飨读者,希望对科研临床工作能有所启迪.     

Importance of the time interval between surgery and postoperative radiation therapy in the combined management of head & neck cancer

Twenty-two patients with advanced carcinomas of various head and neck sites were treated with surgical resection followed by elective postoperative radiation therapy. No patient had gross residual or recurrent disease at the time radiation therapy was started. The time interval from surgery to the start of radiation therapy varied from two and one half weeks to sixteen weeks; the median was seven weeks. Doses of radiation varied from 4500 rad to 5400 rad in five to five and one half weeks.One patient was lost to follow-up. Of the remaining twenty-one patients ten were alive with no evidence of disease (NED) at two to four years (48 %). We observed that 7 of 10 (70 %) of patients whose radiation therapy was started within seven weeks after surgery, were alive free of disease; however, only 3 of 11 (27 %) of those in whom there was a delay of seven weeks or more survived free of disease. Furthermore, in the former group there were virtually no local or regional recurrences, regardless of the stage of the disease, while in the latter group the incidence of local or regional recurrences was 64 %.These data suggest that delay in the start of postoperative radiation therapy, even in the absense of gross recurrent tumor, might adversely affect the results of combined surgical and radiotherapeutic management of head and neck cancers.     

Unilateral big hockey stick incision for neck dissection in head and neck carcinoma

Objective: To investigate for the feasibility and advantages performed by the unilateral big hockey stick incision (BHSI) in head and neck carcinoma. Methods:Neck dissection by using the unilateral big hockey stick incision (BHSI) was performed on 93 patients with head and neck carcinoma. Results: The big hockey stick incision has a cosmetic scar and not scar contraction and is barely visible and easily covered in hair and clothing; sufficient exposure of the operation field; a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to having preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.     

2016年版WHO淋巴肿瘤分类概述

2016年WHO淋巴肿瘤的修订版问世,内容较2008年版有些变化.文章结合过去8年内的一些临床、病理、遗传学和分子生物学的进展,阐明了一些非常早期的淋巴增生性病变的诊断和临床处理,修饰了一些淋巴瘤的诊断标准,深化了遗传学/分子生物学在多种淋巴瘤诊治中的意义.新的分类中也加入了少数临时的淋巴瘤类型.     

2008年版世界卫生组织造血与淋巴组织肿瘤分类中与EB病毒相关的淋巴瘤概述

EB病毒（EBV）是一种普遍存在的γ-疱疹病毒,全世界90％的成年人存在无症状感染.EBV与经典型霍奇金淋巴瘤、某些类型的B细胞淋巴瘤、T细胞/NK细胞淋巴瘤密切相关.研究表明,EBV潜伏感染的基因表达产物对淋巴瘤的发生起到了启动和（或）促进作用,并为EBV相关淋巴瘤免疫治疗提供了依据.文章主要就2008年版世界卫生组织造血与淋巴组织肿瘤分类中与 EBV相关淋巴瘤的类型作一综述.     

HIGH DOSE FRACTION RADIOTHERAPY FOR MUCOSAL MALIGNANT MELANOMA OF THE HEAD AND NECK

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Clinical utility of fine-needle aspiration for diagnosis of head and neck lymphoma

Background

Although fine-needle aspiration (FNA) is currently used for the diagnosis of lymphoma, its diagnostic utility in patients with head and neck (HN) lymphoma is unclear. We therefore assessed the utility of initial clinical and FNA diagnoses for HN lymphoma in a clinician's perspective.

Methods

We conducted a retrospective study of total 109 patients with HN lymphoma underwent both FNA and tissue diagnoses from January 2000 through December 2005. The diagnostic sensitivity of FNA was compared with that of histopathology. FNA diagnosis was based on cytomorphology alone in 69 patients and on immunophenotyping plus morphology in 40.

Results

On clinical diagnosis, lymphoma was suspected in 54 patients, nonlymphoma/metastatic malignancy in 31, and benign disease in 24. FNA diagnosed lymphoma in 41 patients; suspicious of lymphoma in 23; atypical lymphoma in 20; benign disease in 19; and was nondiagnostic in 6 patients. Diagnostic accuracy of FNA was not significantly improved by repeat core needle biopsy and immunophenotyping. Delay from FNA to tissue diagnosis was significant in the benign FNA-diagnostic group, with a mean 49 days.

Conclusions

The clinical and FNA diagnoses of HN lymphoma may be incomplete and include the potential pitfall of significant diagnostic delay.     

2015版犠犎犗肺肿瘤组织学分类解读

对第4版（2015年）WHO 肺肿瘤分类与第3版（2004年）肿瘤分类进行比较,并复习相关文献。2015版肿瘤分类作了大量的改动,对肺肿瘤的分类做了一些修改,新增了6个病种,即 NUT 中线癌、肌上皮肿瘤、伴有 EWSR1-CREB1基因易位的肺黏液样肉瘤、血管内大 B 细胞淋巴瘤、Erdheim-Chester 病和脑膜瘤非特异型;更新了肺癌的分子病理和免疫组织化学等内容,强调了肺癌相关基因的检测与靶向治疗。对一些肿瘤作了重新命名,如硬化性血管瘤命名为硬化性肺泡细胞瘤,使用贴壁型腺癌代替原先的细支气管肺泡癌。     

WHO胸部肿瘤分类（第5版）中肺肿瘤部分解读

国际癌症研究机构（International Agency for Research on Cancer,IARC）于2021年5月出版了《WHO胸部肿瘤分类（第5版）》。与2015年出版的《WHO胸部肿瘤分类（第4版）》相比,《WHO胸部肿瘤分类（第5版）》变更了主要章节的框架,新增和调整了部分疾病的命名和分类,并充实了流行病学、病因学、组织病理学和分子遗传学等相关内容。现就《WHO胸部肿瘤分类（第5版）》中肺肿瘤分类变化较大的内容予以简要介绍。