鼻咽部良性淋巴组织增生209例临床病理分析

目的总结鼻咽部良性淋巴组织增生（NBLA）的临床病理特点、诊断及鉴别诊断要点，提高对NBLA的认识和病理诊断水平。方法观察209例NBLA的临床及组织病理学，用免疫组化EnVision法检测60例病变组织中浸润的淋巴细胞、雌激素（ER）和孕激素（PR）的表达情况，用原位杂交方法对16例病变组织进行了EBER原位检测。结果镜下可将NBLA分为滤泡型（188／209）及弥漫型（21／209）；黏膜固有层浅层可见浆细胞灶状或带状浸润占56％（117／209），淋巴上皮样病变占99％（207／209），血管壁浸润占34．9％（73／209）。免疫组化：滤泡型CD79a和CD20阳性细胞集中于套区及生发中心，CD10阳性细胞位于生发中心，bcl-2阳性细胞主要位于套区，CD3、CD45RO阳性细胞主要分布于弥散淋巴组织。弥漫型CD79a和CD20阳性细胞与CD3和CD45RO阳性细胞混杂分布，bcl-2阳性细胞弥漫分布，CD10（-）。淋巴上皮样病变内浸润的淋巴细胞主要是CIY20和CD79a（＋），浸润血管壁的淋巴细胞以CD3和CD45RO（＋）为主。17例（17／60）个别细胞ER弱（＋），PR均（-）。16例EBER均（-）。结论NBLA镜下可分为滤泡型和弥漫型，弥漫型应注意与多种B细胞淋巴瘤鉴别，其发病与病变部位的ER、PR及EB病毒感染无关。

Nasopharyneal benign lymphadenosis: a clinicopathologic analysis of 209 cases

Objective To summarize the clinicopathologic features and differential diagnosis of nasopharyneal benign lymphadenosis (NBLA), and to improve its diagnostic level. Methods 209 cases of NBLA were analyzed with their clinical findings and histopathology. EnVision immunohistochemical staining was performed in 60 cases to detect lymphocytic markers, ER and PR, and in situ hybridization of EBER used in 16 cases. Results The two histological types of NBLA were distinguished: follicle type (188/209)and diffuse type (21/209). Plasma cells were found focal or sheet-like infiltration at superficial proper layer in 117 cases. 207 cases had lymphoepithelia-like lesion and 73 cases had vessel wall infiltration phenomenon. Immunohistochemically, follicle type showed mantle zone and germinal center were mainly positive for CD79a and CD20. The follicle centre cells expressed CD10. bcl-2 was mainly expressed in mantle zone. Diffuse lymphoid tissue was mainly positive for CD3 and CD45RO. Diffuse type showed the cells expressed CD79a, CD20, CD3 and CD45RO. CD10 was negative and bcl-2 was diffusely positive. Lymphocytes among the lymphoepithelial-like lesion was mainly B-cell and the infiltrating vessel wall was mainly T-cell. Individual cells had weak immunoreactivity to ER and all cases were negative for PR. The tests for EBER were negative. Conclusion NBLA has follicle type and diffuse type, and diffuse type should be distinguished from B cell lymphoma. Accurate diagnosis of NBLA requires correlation of medical record, histological features and immunostaining results. Its pathogenesis is not correlated with ER, PR and EB virus infection.