间变性大细胞淋巴瘤20例临床病理学特征探讨

目的探讨间变性大细胞淋巴瘤的临床病理学特征及诊断、鉴别诊断要点。方法对20例间变性大细胞淋巴瘤进行临床病理分析及免疫组化研究,并进行文献复习。结果 20例间变性大细胞淋巴瘤的发病年龄为4～78岁,其中11例发生于颈部淋巴结,表现为多发淋巴结肿大,有或无压痛,伴发热、体重下降、部分有淋巴结融合,镜下普通型12例,占60%,淋巴结结构破坏,瘤细胞多形性、不规则或卵圆形、梭形,胞浆丰富、嗜酸,核空网状,核膜粗,可见1～3个不等的嗜双色核仁、中位或靠边分布,核分裂易见,可见顿挫型病理性核分裂;免疫组化示肿瘤细胞CD30(20例均阳性)、ALK(5例阳性)、CD5(18例阳性)、CD7(12例阳性)、CD138(8例阳性)、Ki-67(60%～85%阳性)、CD3(19例阳性)、CD45RO(19例阳性)、TIA-1(18例阳性)、Vim(20例均阳性)、mum-1(10例阳性)、CD2(11例阳性)、CD8(10例阳性)、CD68(1例阳性)、Bcl-2(6例阳性)、Bcl-6(12例阳性)。结论间变性大细胞淋巴瘤比较少见,其诊断和鉴别诊断需结合组织病理学、免疫组化、基因重排、临床及实验室检查。

Clinicopathological features of 20 cases of anaplastic large cell lymphoma

Objective To investigate the clinicopathological features,diagnostic and differential diagnosis points of anaplastic large cell lymphoma.Methods Clinical pathological analysis and immunohistochemical study of 20 cases of anaplastic large cell lymphoma and literature review were performed.Results The onset age of 20 cases of anaplastic large cell lymphoma was 4 to 78 years old,11 cases of which occurred cervical lymph nodes,showing multiple lymphadenopathy with or without tenderness,combined with fever,weight loss,and partial lymph node fusion.And 12 cases were common under the microscope,accounting for 60%,which showed the destroyed structure of lymph nodes,the pleomorphic,irregular or oval,fusiform tumor cells,cytoplasm rich,acidophilic,nuclear empty network,nuclear membrane thick,visible 1-3 dioxin nucleus,median or marginal distribution.And the nuclear division was easy to see,and abortive pathological mitosis was visible.Immunohistochemistry showed tumor cells CD30(20 cases with positive),ALK(5 cases with positive),CD5(18 cases with positive),CD7(12 cases with positive),CD138(8 cases with positive),Ki-67(60%~85%positive),CD3(19 cases with positive),CD45RO(19 cases with positive),TIA-1(18 cases with positive),Vim(20 cases with positive),mum-1(10 cases with positive),CD2(11 cases with positive),CD8(10 cases with positive),CD68(1 case with positive),Bcl-2(6 cases with positive),Bcl-6(12 cases with positive).Conclusion Anaplastic large cell lymphoma is rare.Its diagnosis and differential diagnosis need to be combined with histopathology,immunohistochemistry,gene rearrangement,clinical and laboratory examination.