应用2008版WHO造血和淋巴组织肿瘤分类对4例母细胞性NK细胞淋巴瘤重新评估

目的 探讨2008版WHO淋巴造血系统分类对母细胞性NK细胞淋巴瘤的重新分类和命名,观察此类淋巴瘤的组织形态、免疫表型分型及临床特点,并探讨其起源.方法 对符合2001版WHO造血和淋巴系统肿瘤分类(WHO分类)中母细胞性NK细胞淋巴瘤标准的4例,结合临床特点,观察其组织学形态、行免疫组织化学EliVision法染色,按2008版WHO分类进行重新分类.结果 4例的组织形态均呈母细胞性NK细胞淋巴瘤改变,CD56阳性,不表达T、B细胞和髓系标记,EBER原位杂交4例均阴性,均符合2001版WHO分类中NK母细胞性淋巴瘤的诊断标准.按2008版WHO分类,3例原发于皮肤,表达CD56、CD4和CD123,应诊断为母细胞性浆细胞样树突细胞肿瘤;1例发生于淋巴结,CD56和CD4阳性,CD123阴性,也无皮肤病变,只能暂时纳入来源不确定的白血病-NK细胞淋巴母细胞白血病/淋巴瘤.结论 2001版WHO分类中所谓的母细胞性NK细胞淋巴瘤实际上是一组异源性肿瘤,具有不同的免疫表型和临床特点,对此类肿瘤的细化分类和准确命名是2008版WHO淋巴瘤分类的一大进步.

Retrospective analysis of 4 cases of the so-called blastic NK-cell lymphoma, with reference to the 2008 WHO classification of tumours of haematopoietic and lymphoid tissues

Objective To study the clinical and pathologic features of 4 cases of the so-called blastic natural killer (NK)-cell lymphoma, with reference to the 2008 WHO classification of tumours of haematopoietic and lymphoid tissues. Methods The clinical, pathologic and immunohistochemical findings (EliVision method) of 4 cases of blastic NK-cell lymphoma (previously diagnosed according to the 2001WHO classification) were retrospectively analyzed and reclassified with a special reference to the 2008 WHOclassification. Results The 4 cases of hematologic malignancy studied were characterized by the presence of medium-sized blastic lymphoma cells, CD56 expression, and absence of lineage-specific B-cell, T-cell and myeloid cell markers. According to the 2001 WHO classification, they fell into the category of blastic NKcell lymphoma. Three of the cases presented with primary cutaneous lesions and expression of CD56, CD4and CD123. They are likely derived from the plasmacytoid dendritic cells rather than NK cells. They were then, according to the 2008 WHO classification, reclassified as the blastic plasmacytoid dendritic cell neoplasm. The remaining case showed lymph node involvement, positive for CD56 and CD4, negative for CD123, and not accompanied with the cutaneous lesions. This case was provisionally classified as a ambiguous lineage leukemia-NK cell lymphoblastic leukemia/lymphoma. Conclusions The so-called blastic NK-cell lymphomas in the 2001 WHO classification are rare and represent a heterogeneous group of lymphoproliferative disorders, with different clinical, pathologic and immunohistochemical features. It's suggested to have a precise category when applying the 2008 WHO classification to this kind of lesion.