容易误诊为淋巴瘤的淋巴管内良性淋巴细胞聚集

目的 探讨淋巴管内淋巴细胞聚集的性质,总结其诊断与鉴别诊断要点.方法结合临床资料,对4例淋巴管内淋巴细胞聚集标本进行形态学观察及采用免疫组织化学EliVision两步法染色,并进行随访.结果 4例发生的部位分别是扁桃体2例、咽弓部1例,阑尾1例.病程为1周至3个月,随访3～84个月均未见复发.除阑尾外其他部位的大体形态均呈息肉状.组织学以膨胀、充满小淋巴细胞的淋巴管为主要特点,淋巴管周围伴有明显纤维化;免疫表型为淋巴管内聚集的细胞以T细胞为主.结论淋巴管内淋巴细胞聚集是一种良性淋巴组织病变,慢性炎性改变、纤维化可能导致局部淋巴管受压、淋巴细胞潴留;组织形态类似于脉管内淋巴瘤,呈现单一的T细胞免疫表型,但细胞异型性不明显,且表现为孤立性病变,无明显恶性临床表现.这些特征有助于鉴别诊断.

Intralymphatic accumulation of lymphocytes mimicking intravascular lymphomatosis

Objective To study the significance and differential diagnosis of intralymphatic accumulation of lymphocytes. Methods The clinical and pathologic features of 4 cases of intralymphatic accumulation of lymphocytes were reviewed retrospectively. Immunohistochemical study was carried out and follow-up data were analyzed. Results The sites of involvement included tonsil (2 cases ), pharynx ( 1 case) and appendix ( 1 case). The duration of disease ranged from 1 week to 3 months. Follow up of the patients (from 3 to 84 months) showed no evidence of disease recurrence. Gross examination of the tissues(except in the case of appendiceal involvement) showed polypoid changes. Histologically, the lymphatic channels were filled up with small lymphocytes and associated with fibrosis in the vicinity.Immunohistochemical study revealed a T-cell phenotype of the intralymphatic lymphoid cells. Conclusions The aocumulation of lymphocytes in lymphatic channels is associated with a benign clinical course. This phenomenon may be due to retention of lymphocytes secondary to the perilymphatic chronic inflammation and fibrosis. Although the lesion simulates intravascular lymphomatosis morphologically and shows a uniform T-cell phenotype, the lymphoid cells lack obvious cellular pleomorphism and mitotic activity. The solitary nature of the lesion, when coupled with the indolent clinical behavior, is also helpful in the differential diagnosis.