EB病毒相关与不相关的肠道T细胞淋巴瘤临床病理研究

目的：探讨EB病毒相关与不相关的肠道T细胞淋巴瘤的临床病理特征、免疫分型和肿瘤细胞属性。方法：运用EBER1／2原位杂交检测EB病毒感染，采用免疫组化检测32例肠肠道原发T细胞淋巴瘤的免疫表型以及LMP－1、TIA－1、bcl-2和CD21的表达。结果：（1）27例（84．4％）为EB病毒相关淋巴瘤，其中11例（40．75）表达LMP－1。（2）32例瘤细胞均表达CD45RO，CD8＋。4例（12．5％），CD4＋8例（25．0％），CD56＋9例（28．1％），17例（53．7％）为CD4－、CD8－、CD56－。TIA－1＋31例（96．9％）。无1例表达bcl2-,CD21。形态上28例为多形性中一大细胞性，单形性中等大细胞性和多形性各2例。临床上多见于青壮年男性，以腹痛、便血、发热、体重下降为主要症状，预后较差（中位生存期1．7月）。（3）EB病毒相关与相关者出现便血和发热以及CD3，CD8、CD56的表达方面差异有显著性。结论：在我国，绝大多数肠道T细胞淋巴瘤为EB病毒相关，具有特殊临床病理表现和免疫表型。其肿瘤细胞源自不同T细胞亚群（包括细胞毒性T细胞）或者NK细胞。

Epstein-Barr virus associated and Epstein Barr virus not-associated intestinal T-cell lymphomas:A clinicopathologic study

Purpose To investigate the clinicopathological and immunohistochemical features of Epstein Barr virus associated and Epstein Barr virus not associated primary intestinal T cell lymphomas(ITCL) and to study their cell origins. Methods In situ hybridization for EBER1/2 and immunohistochemical staining for immunophenotypes, LMP 1,TIA 1,bcl 2 and CD21 were performed in 32 cases. The clinical data were analyzed and all patients were followed up. Results (1) In 27 of the 32 cases, EBER1/2 were detected in the tumor cells, in which 11 presented LMP 1 positive reactions. (2) All 32 cases of ITCL revealed CD45RO positivity,in which 4(12 5%) expressed CD8,8(25 0%)expressed CD4, 9(28 1%)expressed CD56,and 31(96 9%)expressed TIA 1. There were 17(53 7%)cases with CD4-,CD8-,CD56- immunophenotype. None expressed bcl 2 and CD21. 32 ITCL were classified into pleomorphic medium and large cell( n =28), monomorphic medium sized( n =2), pleomorphic small cell( n =2). Clinically, most patients with ITCL were young males with abdominal pain, hematochezia, fever and weight loss. The prognosis of patients with ITCL showed poor (survival median was 1 7 month). (3) The differences between EBV associated and EBV not associated ITCL lay in hematochezia, fever and the expression of CD3, CD8 and CD56. Conclusion Most of Chinese ITCL are EBV associated ones with unusual clinicopathological and immunohistochemical features,which are of different lineages of T cell subtypes, including cytotoxic T cell or NK cell.