免疫组化结果误判导致淋巴瘤误诊三例分析

目的 提高对正确分析判断免疫组化结果的重要性的认识.方法 对3例淋巴瘤误诊病例进行复习,并增加相关抗体标记予以鉴别诊断.结果 例1为淋巴结经典霍奇金淋巴瘤,富淋巴细胞型(LRCHL),误诊为滤泡性淋巴瘤与形态学观察遗漏R-S样细胞以及误判免疫组化标志BCL-2、CD20有关,即将BCL-2、CD20阳性的非肿瘤细胞误判为肿瘤细胞;误诊为结节性淋巴细胞为主型霍奇金淋巴瘤与免疫组化标志误判有关,把围绕瘤细胞的背景小淋巴细胞CD20阳性误判为R-S样大细胞CD20阳性,将CD30阳性的肿瘤性大细胞误判为活化性B淋巴细胞.例2为急性髓系白血病,误诊为T淋巴母细胞淋巴瘤(T-LBL),主要由于对瘤细胞表达非特异性抗体TDT、CD7、CD43的意义认识不足.例3为胸腺瘤B1型误诊为T-LBL,主要与抗体CK标记不理想而遗漏了肿瘤性上皮细胞,将表达TDT、CD99的反应性细胞误认为肿瘤细胞,以及对Ki-67表达率的意义认识不足有关.结论 淋巴瘤的诊断建立在形态学、免疫组化标志、临床资料和遗传学分析基础上,免疫组化结果的正确分析判断对淋巴瘤确诊至关重要.

Misdiagnosis of 3 cases lymphoma due to misjudgement of immunohistochemistry

Objective To recognize the importance of analyzing the result of immunohistochemical staining correctly.Method Review of the three misdiagnosed cases lymphoma and exploring the causes of misdiagnosis through reviewing their clinics,histopathology and immunohistochemistry.Results Case 1 of lymphocyte rich classical Hodgkin' s lymphoma (LRCHL) was misdiagnosed as follicular lymphoma (FL) initially,the RS cells were overlooked morphologically and wrongly determined BCL-2 and CD20-positive cells as tumor cells immunohistochemically; also once misdiagnosed as nodular lymphocyte predominant Hodgkin' s lymphoma (NLPHL) because the CD20-negative RS misjudged cells as the positives.Case 2 of AML tumor cells expressed TdT,CD7 and CD43 unspecifically,which misdiagnosed as T-cell lymphoblastic lymphoma (T-LBL). Case 3 of type B1 thymoma was misdiagnosed as T-LBL,because CK wasn' t expressed satisfactorily resulting in neglecting neoplastic epithelial cells,and lymph~ytes in the background were TdT and CD99-positive.Conclusion The diagnosis of lymphoma should be based on morphology,immunohistochemistry,clinics,and genetics.Moreover,the correct judgment of immunohistochemical staining is essential to make right diagnosis.