59例老年非何杰金氏淋巴瘤病理分析

本文报道老年非何杰金氏淋巴瘤(NHL)59例并与同期非老年患者138例相比。老年患者占同期NHL总数的29.9％。59例中有结内型43例,结外型16例;低度恶性与中度恶性各12例,高度恶性35例。与非老年组比较,老年组的就诊原因、病变部位、恶性程度、细胞类型和预后等方面无何差别,提示年龄对上述特征无明显影响。     

How Frequent Are Asthma Exacerbations in a Pediatric Primary Care Setting and Do Written Asthma Action Plans Help in Their Management?

Purpose. In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting. Methods. Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit. Results. Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations. Conclusion. Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.     

Depressed host immunity in a case of metachronous primary uterine papillary serous carcinoma and non-Hodgkin''s lymphoma

Metachronous primary malignant tumors of uterine papillary serous carcinoma (UPSC) and non-Hodgkin's lymphoma (NHL) are rare. UPSC is a clinically aggressive and morphologically distinctive variant of endometrial carcinoma. We describe the clinical features of a 63-year-old patient with UPSC that was found 2 years after chemotherapy for malignant lymphoma of neck, stage IV and 5 months after radiation therapy for recurrence. This patient had undergone staging surgery and postoperative radiation for UPSC. One month after completion of radiotherapy, the patient expired due to persistence of the disease. The association between host immunity and UPSC is rarely described in the literature. Immunological profiles of this patient, with compositional changes of natural killer, B, and T cell, dramatically altered the percentage of CD4(+) T cell, CD8(+) T cell, and CD4/CD8 ratio, signifying depressed host immunity. Immunological profile of this patient stressed the issue of depressed host immunity and associated malignancies.     

EBV+ B Lymphoma Cell Lines from Patients with Post-Transplant Lymphoproliferative Disease Are Resistant to TRAIL-Induced Apoptosis

Lymphomas associated with post-transplant lymphoproliferative disease (PTLD) represent a significant complication of immunosuppression in transplant recipients. In immunocompetent individuals, EBV-specific cytotoxic T lymphocytes (CTL) prevent the outgrowth of activated B lymphoblasts through apoptosis induction. Soluble versions of TNF-related apoptosis-inducing ligand/Apo2 ligand (TRAIL) can induce apoptosis in numerous tumor cell types. Given the therapeutic potential of TRAIL, we examined the sensitivity of EBV⁺ spontaneous lymphoblastoid cell lines (SLCL) derived from patients with PTLD to treatment with soluble TRAIL. Despite abundant expression of TRAIL receptors (TRAIL-R), resistance to TRAIL-induced apoptosis was observed in all SLCL examined. This resistance could not be overcome by concomitant treatment with several pharmacological agents. Unlike BJAB positive control cells, for each SLCL tested, cleavage and activation of caspase 8 was inhibited due to failed recruitment of FADD and caspase 8 to TRAIL receptors upon stimulation. Further indicative of a proximal defect, TRAIL receptor aggregation could not be detected on the cell surface of SLCL following ligand engagement. These results suggest that the use of TRAIL for eliminating PTLD-associated tumors may be of limited clinical utility, and illustrate another mechanism by which EBV⁺ B lymphoma cells can evade tumor surveillance at the level of death receptor signaling.     

Intracranial Non-Hodgkin’s MALT lymphoma mimicking a large convexity meningioma

Summary Primary presentation of an intradural Non-Hodgkin’s lymphoma is rare. Recently these B cell lymphomas of mucosa associated lymphoid tissue (MALT) have gained acceptance as an important pathological subtype and are distinguishable from other primary CNS lymphomas that exhibit aggressive behaviour. Over the past decade a number of these lesions have been reported to resemble a meningioma both intra-operatively and radiologically. The authors outline such a case of marginal zone B cell lymphoma that clinically and radiologically resembled a meningioma. This case illustrates the rare occurrence of low grade dural B cell lymphoma and the need to consider this entity in the differential diagnosis of CNS lesions, if appropriate targeted therapy is to be administered.     

原发性脾脏恶性淋巴瘤21例的临床分析

目的 研究原发性脾脏恶性淋巴瘤（SPL）的临床和病理特征与治疗方法。方法 对1975-2000年收治的21例原发性脾脏恶性淋巴瘤患者的临床资料进行回顾性分析。结果 21例均行手术治疗，14例行COP或CHOP方案化疗，7例未行化疗，术后5年生存率分别为35．7％和28．6％。21例均为术后病理确诊，其中B细胞源性20例，T细胞源性1例。按Ahman脾恶性淋巴瘤临床分期，Ⅰ期9例，Ⅱ期7例，Ⅲ期5例，5年生存率分别为55．6％、42．9％、20％。结论 原发性脾脏恶性淋巴瘤的诊断主要依靠B超和CT，病期的早晚影响其预后，手术治疗联合化疗是本病的主要治疗方法。     

Pathological variables determining the prognosis of non-Hodgkin''s lymphomas

The aim of the study was to assess the role of pathological grade, cell proliferation, ploidy, immunophenotype and site in determining the prognosis of non-Hodgkin's lymphomas. Of particular interest was the relative value of grades derived from the Kiel classification as opposed to the National Cancer Institute (NCI) working formulation. The study consisted of 181 cases, treated in a relatively uniform way over an 18-month period spanning 1986. Using life table analysis, both NCI working formulation grade and Kiel grade correlated strongly with survival. However, the differences between grades were entirely due to an excess of early deaths in the high-grade and intermediate-grade categories. In patients surviving greater than 0.1 years (37 days), phenotype, site, ploidy and cell proliferation had no effect on survival. There was no evidence that intermediate-grade tumours, when subdivided into Kiel low- and high-grade types, differed in survival from tumours graded as low- or high-grade by both methods. However, NCI working, formulation high-grade tumours, especially those with a high proliferation rate, formed a group with a very high likelihood of death within 0.1 years.     

Nasopharyngeal and nasal malignant lymphoma: a clinicopathological study of 54 cases

Forty-one cases of nasopharyngeal and 13 cases of nasal malignant lymphoma have been examined histologically and immunohistochemically. All of the cases were non-Hodgkin's lymphoma; one case was of follicular type and the remaining 53 were of diffuse type. Large cell lymphoma comprised 48% of cases and most of the immunoblastic lymphomas showing pleomorphism occurred in the nose. Twenty-seven cases were of T-cell and 21 of B-cell phenotype. The predominance of T-cell lymphoma was due to an increased incidence of these in the nose, the T:B ratio of 3.33:1 contrasting with a 1:1.05 ratio in the nasopharynx. Nasopharyngeal lymphomas seem to show an intermediate incidence between the T-cell predominance in the nose and a B-cell predominance in the oropharynx. Since the large cell type of lymphoma was predominant, the differential diagnosis from undifferentiated carcinoma is important and is facilitated by the use of immunostaining methods.     

脾原发性淋巴瘤超微结构观察与流式细胞分析

目的 探讨诊断电镜（DEM）对脾原发性淋巴瘤的病理分型的超微结构特征。流式细胞术（FCM）测定瘤细胞DNA倍性与恶性程度的关系。方法 应用透射电镜和流式细胞术观察分析41例脾原发性淋巴瘤的超微结构和瘤细胞DNA倍性。结果41例脾原发性淋巴瘤中霍奇金淋巴瘤5例,电镜下R-S细胞呈双叶不规则核和对称致密大核仁,核内常染色质明显,胞质内见中等量线粒体,较长的粗面内质网。非霍奇金B细胞性淋巴瘤21例,裂细胞性5例,细胞核大,核伴有较深的裂沟,胞浆少,胞质见少数肿胀线粒体,无核裂细胞性7例,细胞核规则,呈圆或卵圆型,异染色质多呈条块状,核仁中等大,胞质少,见少量线粒体及长粗面内质网。混合细胞性,瘤细胞大小悬殊,大畸形核较多,核扭曲,不规则深沟及不对称分叶,形成多叶核。非霍奇金T免疫母细胞淋巴瘤11例,瘤细胞较大,核小胞质相对多,胞质透明,核多形性,有的呈圆或卵圆形,核膜薄,有深浅不一的凹陷,可见小核仁。淋巴母细胞性5例,淋巴母曲核性淋巴瘤,细胞为中小形,呈锯齿状核和扭曲状核,异染色质沿核膜聚集,核仁小。毛细胞性淋巴瘤1例,毛细胞的绒毛宽基底,核仁大,胞浆无核糖体板层复合物。组织细胞性淋巴瘤3例,细胞浆丰富,核圆或椭圆形,偶见核膜呈锯齿状或折叠,线粒体和溶酶体丰富,无细胞连接和Birbeck颗粒。FCM     

B细胞淋巴瘤石蜡包埋组织克隆性重链基因重排检测

目的 探讨克隆性重链基因重排检测在B细胞淋巴瘤(B—NHL)诊断中的价值。方法 用半巢式聚合酶链反应(semi—nested PCR)、聚丙烯酰胺凝胶电泳(PAGE)及银染技术，检测经形态学及免疫组织化学确诊的23例B—NHL石蜡包埋组织标本的克隆性免疫球蛋白第三互补决定区(IgHCDR3)重排基因，对照组为7例T细胞淋巴瘤(T—NHL)及6例反应性增生或肉芽肿性淋巴结炎。结果 B—NHL IgHCDR3检出的阳性率87．0％(20／23)，假阳性率7．7％(1／13)，假阴性率13．0％(3／23)。结论 检测克隆性IgHCDR3重排为B—NHL的诊断及鉴别诊断提供有效的辅助手段。