宫颈淋巴瘤样病变与淋巴造血组织肿瘤临床病理对比分析#br#

目的探讨宫颈淋巴瘤样病变(LLL)与淋巴造血组织肿瘤的临床病理学特征、诊断及鉴别诊断。方法收集2007年10月至2021年8月北京大学人民医院病理科诊断的LLL20例,髓细胞肉瘤5例,B淋巴母细胞淋巴瘤/白血病1例,非霍奇金淋巴瘤4例。应用光镜观察、免疫组化染色、EBER原位杂交进行分析。结果中位年龄45岁,9例小于40岁。临床表现为阴道出血。宫颈黏膜表层可见炎症细胞及淋巴细胞,灶片状大细胞。CD20、CD3、CD138等部分阳性,Kappa、Lambda无轻链限制性。随访均健在。淋巴造血组织肿瘤中位年龄54.5岁,6例为绝经后。临床表现:阴道出血,宫颈肿物等。可见弥漫增生的淋巴样细胞,髓细胞肉瘤细胞原始,表达MPO、CD43、CD117等。B淋巴母细胞淋巴瘤/白血病细胞原始,表达CD20、PAX5、Td T等。弥漫性大B细胞淋巴瘤表达及黏膜相关淋巴组织边缘区B细胞淋巴瘤表达CD20。5例死亡(50%)。结论宫颈淋巴瘤样病变预后良好,应与淋巴瘤鉴别。临床病史、病理形态和免疫组化对于诊断女性生殖道淋巴造血组织肿瘤具有重要作用。

Analysis of lymphoma-like lesion and tumors of haematopoietic and lymphoid tissue in uterine cervix

Objective?To study the clinicopathologic features, diagnosis and differential diagnosis of lymphoma-like lesion (LLL) and tumors of haematopoietic and lymphoid tissue in uterine cervix. Methods?Twenty cases of LLL, 5 cases of myeloid sarcoma, 1 case of B lymphoblastic lymphoma/leukemia, and 4 cases of non-Hodgkin lymphoma were selected from Peking University People’s Hospital from October 2007 to August 2021. The cases were studied by microscopy, immunohistochemistry and in situ hybridization. Results?The median age was 45, 9 cases were younger than 40 years, most presenting as contact bleeding. Chronic inflammation with diffuse lymphoid proliferation in the surface layer of mucous membrane could be seen in cervical mucosa, expressing B and T cell markers in some cells, without light chain limitation of Kappa and Lambda. All patients were good in following up. In cases of tumors of haematopoietic and lymphoid tissue, the median age was 54.5 years old, and 6 cases were postmenopausal.The patients present as abnormal bleeding and mass， etc. Microscopically, diffuse proliferation of lymphoid cells can be seen. In myeloid sarcoma, the tumor cells differerntiation were primitive, expressing MPO、CD43、CD117, etc. The tumor cells of B lymphoblastic lymphoma/leukemia were small to medium, expressing CD20, PAX5 and TdT, etc. The tumor cells of DLBCL were medium to large, expressing CD20, etc. The tumor cells of mucosa associated lymphoid tissue lymphoma were small to medium, expressing CD20, but not CD5, cyclinD1, CD23, CD10. Five cases were dead (50%). Conclusions?The prognosis of LLL of uterine cervix is good, which should be differentiated from lymphoma. The diagnosis of cervical tumors of haematopoietic and lymphoid tissue relies on clinical history, histiopathology and immunohistochemistry.