CD5+小B细胞淋巴瘤的骨髓病理学特点

目的：探讨CD5+小B细胞淋巴瘤(small B cell lymphoma，SBL)的骨髓病理学特点。方法：回顾性分析了2003年1月至2015年5月深圳市人民医院病理科92例CD5+SBL侵犯骨髓患者的病理档案资料，92例均行骨髓活检(bone marrow biopsy，BMB)标本的形态学及免疫组织化学染色检查、流式细胞学检测和IgH/CCND1的荧光原位杂交(fluorescence in situ hybridization，FISH)检测。结果：慢性淋巴细胞白血病/小淋巴细胞性淋巴瘤(chronic lymphocytic leukemia/small lymphocytic lymphoma，CLL/SLL)56例(60.9%)，套细胞淋巴瘤(mantle cell lymphoma，MCL)23例(25.0%)，其他类型13例(14.1%)，包括滤泡性淋巴瘤(follicular lymphoma，FL)5例，淋巴浆细胞性淋巴瘤(lymphoplasmacytic lymphoma，LPL)4例，脾脏边缘区淋巴瘤(splenic marginal zone lymphoma，SMZL)4例。侵犯骨髓的方式以弥漫型最多见(28例)，其次为混合型(25例)，结节型(19例)及间质型(18例)侵犯较少，窦内型最少见(2例)。免疫表型检测示所有病例流式细胞学检测均表达CD19，CD20和CD5。免疫表型积分系统显示所有CLL/SLL患者为4~5分，MCL和其他类型患者均≤3分。13例其他类型的SBL中，5例FL均表达CD10；3例FL，1例LPL，3例SMZL表达CD23。CLL/SLL与MCL在CD23，sIgM，FMC7，CD11C，CD22表达率上差异均有统计学意义(P<0.01)。免疫组织化学检测结果显示MCL均表达cyclin D1。FISH检测所有MCL均为IgH/CCND1阳性。结论：CD5+ SBL包括多种淋巴瘤类型，侵犯骨髓时呈多种分布方式。流式细胞学的免疫表型检测对于CD5+ SBL，尤其是CLL/SLL的诊断和鉴别尤为重要。

Pathologic characteristics of bone marrow for #br# CD5 positive small B cell lymphoma

Objective: To study the pathologic characteristics of bone marrow for CD5 positive small B cell lymphoma (SBL).Methods: The pathologic profiles of 92 patients with CD5 positive SBL were retrospectively analyzed. The morphologic and immunophenotypic features were analyzed by flow cytometry and immunohistochemistry. IgH/CCND1 was examined by fluorescence in situ hybridization (FISH).Results: A total of 92 patients with CD5 positive SBL were enrolled in this study, including 56 (60.9%) chronic lymphocytic leukemia /small lymphocytic lymphoma (CLL/SLL), 23 (25.0%) mantle cell lymphoma (MCL) and 13 other SBL (14.1%). Among the 13 other cases, 5, 4 and 4 cases were follicular lymphoma (FL), lymphoplasmacytic lymphoma (LPL) and splenic marginal zone lymphoma (SMZL), respectively. The frequency of patterns for bone marrow infiltration was as follow: diffuse pattern (19/92), mixed pattern (15/92), nodular pattern (9/92), interstitial pattern (8/92), and intrasinusodial pattern (2/92). All patients expressed CD19, CD20 and CD5. According to the immunophenotypic score system, all the CLL patients had 4–5 scores, while SMCL and other SBL patients had less than 3 scores. For the other SBL patients, 5 FL expressed CD10, while 3 FL, 1 LPL and 3 SMZL expressed CD23. There was a significant difference in the expression of CD23, sIgM, FMC7, CD11C and CD22 between the CLL and MCL groups (P<0.01). All 23 MCL patients expressed cyclin D1 and showed IgH/CCND1 gene translocation by FISH detection.Conclusion: CD5 positive SBL includes a variety of types of lymphoma. Patterns of bone marrow for CD5 positive SBL are diversity. Immunophenotypic analysis by flow cytometry is essential in the diagnosis and differential diagnosis of CD5 positive SBL, especially for CLL.