淋巴母细胞性淋巴瘤20例临床病理研究

目的 探讨淋巴母细胞性淋巴瘤（LBL）的临床病理特征、诊断及鉴别诊断要点。方法 对20例LBL进行光镜、免疫组化检测，并结合临床病理特征进行分析。结果 患者年龄5～43岁，男15例，女5例，13例纵隔占位者9例伴锁骨上和，或颈部淋巴结肿大，6例以颈部或全身多发性浅表淋巴结肿大起病，1例则表现为胸椎骨的病变。光镜下表现为中等大淋巴样细胞弥漫浸润性生长，瘤细胞胞质少，核染色质细腻，易见核分裂象。免疫组化示TdT、CD3、CD43、CD99（＋），MPO（-）。仅1例呈CD20弥漫（＋）和CD79a（＋）。19例诊断为T-LBL，1例为B-LBL。1例T-LBL同时呈CD79a弥漫弱（＋）。随访13例，4例出现中枢神经侵犯，4例累及骨髓，4例死亡。结论 患者尤其是青少年临床出现纵隔占位伴锁骨和，或颈部淋巴结肿大应首先考虑T-LBL，光镜下瘤细胞中等大，核浆比大，染色质细腻，常呈弥漫浸润性生长，免疫表型TdT阳性可确诊。

Lymphoblastic lymphoma: clinicopathologic study of 20 cases

Objective To investigate the clinicopathologic features of lymphoblastic lymphoma(LBL),as well as its main points for diagnosis and differential diagnosis.Methods Twenty cases of LBL in files of this Department of Pathology were examined by light microscopy and immunohistochemistry,and analyzed with clinical features.Results Twenty cases of LBL occurred in children and adults ranging in age from 5 to 43 years old,with 15 cases in male and 5 cases in female.Thirteen patients were examined a mediastinal mass with supraclavicular and/or cervical lymphoadenopathy involvement(9/13).Six cases showed cervical or multi-lymphoadenopathy at presentation.One case showed the thoracic vertebra bone lesion.Histologically,the lymphoid cells were median-sized,showing a diffuse infiltration.The neoplastic cells had a high nuclear-cytoplastic ratio,with fine chromatin and sometimes convoluted nuclei.Nuclei mitoses were usually high.The tumors were positive for TdT,CD3,CD43,CD99(+) and negative for MPO.Only one case show diffuse positive for CD20 and CD79a.Thus,19 cases were diagnosed as T-LBL,and one case as B-LBL.CD79a was coexpressed with CD3 in one case of T-LBL.4 out of 12 patients with follow-up data were died.Patients also presented with central nervous metastasis(4/12) and bone infiltration(4/12).Conclusion A mediastinal mass with supraclavicular and/or cervical lymphoadenopathy involvement especially in child and young adults favor the diagnosis of T-LBL.The tumor cells show a diffuse infiltration,usually with median size,fine chromatin and high nuclear-cytoplastic ratio.The positivity for TdT in immunostaining can confirm the diagnosis of LBL.