脾边缘带B细胞淋巴瘤的临床及病理组织学特征

目的：提高对脾边缘带淋巴瘤(SMZL)的认识和诊治水平。方法：对1例男性老年(75岁)SMZL患者的外周血、骨髓及脾脏标本，分别采用光镜、相差显微镜、透射电镜、免疫组织化学染色、RHG显带核型分析及PCR技术研究肿瘤细胞的生物学特征。结果：本例患者肿瘤细胞CD20、CD43、bcl—2表达阳性，肿瘤细胞呈结节状浸润脾脏白髓，致套区和边缘带完全被肿瘤细胞取代。骨髓细胞无异常核型。脾脏有单克隆IgH基因重排，骨髓和外周血未见异常淋巴细胞，无单克隆IgH基因重排。结论：对脾进行性肿大不伴浅表淋巴结肿大患者应疑为SMZL；单克隆IgH基因重排有助于SMZL的诊断，需排除滤泡中心淋巴瘤和套区淋巴瘤；脾切除治疗效果好。

The clinical features and histopathological characteristics of splenic marginal zone B cell lymphoma:a case report

Objective:To improve the understanding of splenic marginal zone lymphoma(SMZL) and the level of diagnosis and therapy. Method:We report a case of a 75-year-old man with SMZL. The histopathological characteristics of cells in peripheral blood, bone marrow and spleen were studied with light microscopy, phase contrast microscopy, transmission electron microscopy, immunohistochemical method, RHG chromosome banding technique and PCR for detecting the IgH gene rearrangement. Result:The neoplastic cells of this patient were positive for CD2I) ,CD13 and bcl-2. Histologically,the spleen showed marked nodular expansion of white pulp with frequent merging and coalescence. In these regions, the marginal and mantle zones were replaced by neoplastic cells completely. There were no abnormal karyotype in bone marrow cells. The monoclonal pattern of IgH gene rearrangement was only found in spleen. Abnormal gymphocytic cells were not found in bone marrow and peripherel blood. Conclusion:When patient has progressive splenomegaly without superficial lymph node enlargement, SMZL should be considered. Monoclonal IgH gene rearrangement is an important evidence for the diagnosis. Follicular lympho-ma and mantle cell lymphoma need to be identified. Splenectomy appears to obtain a good clinical response.