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广东省2008年1月病理读片会(二)

 


更新时间:2008-01-24 12:05:45  出片单位:广州金域医学检验中心病理诊断部

 

 

病例1 (病理号0749054)
病 史:患者男,52岁,发现右腋窝肿块一个月。全身其它处淋巴结、肝、脾未见异常。
大体所见:灰红多结节组织一堆,总体积7×6×4.5cm,结节直径0.8~2.0cm,包膜完整,切面灰红质脆。
临床诊断:淋巴瘤?


请讨论


病理特点:
⑴ 正常淋巴结结构完全破坏;
⑵ 新生中心细胞与中心母细胞样淋巴细胞弥漫克隆性增生;
⑶ 另有许多上皮样组织细胞成不规则团状散在。

免疫组化:
瘤细胞
阳性:CD20、CD79a、bcl-2
阴性:CD10、CD38、CD3、CD45Ro、CD30、cyclinD1、TdT;
上皮样细胞:CD68(+)、CK(-);CD21、CD23显示片状的FDC;

病理诊断:
(腋窝淋巴结)弥漫性大B细胞淋巴瘤,伴上皮样组织细胞反应(DLBCL—ER)

讨论:本例为DLBCL伴上皮样组织细胞反应,十分少见。国内未见报告,而国外已有50例报告。简介如下:
Centroblastic and centroblastic/centrocytic lymphoma associated with a prominent epithelioid granulomatous response: a clinicopathologic study of 50 cases. (Kojima M et al ,Mod pathol 2002;15(7):750-8)

Background
Diffuse large B-cell lymphoma is a heterogeneous category of lymphoma
Large B-cell lymphoma is sometimes accompanied by a reactive component comprising small lymphocytes, plasma cells, eosinophils, and histiocytes
Centroblastic
Immunoblastic
T-cell/histiocyte rich
Anaplastic
Centroblastic or centroblastic/centrocytic lymphomas with a prominent epithelioid response.

DLBCL-ER?????

MATERIALS AND METHODS

Reviewed 50 patients with LBCL-ER and 167 other (DLBCL) and 94 follicular lymphomas (FL)

RESULTS
Comparied with DLBCL:
LBCL-ER showed a higher age distribution (median 71, P =.03),
A female predominance (M:F = 18:32, P =.001)
Less frequent involvement of extranodal sites >1(P=.004
A bulky mass of the affected lymph nodes in 54% of cases.

Compared with FL:
Older age (P =.0006)
More associated with the aggressive clinical factors such as serum LDH level and International Prognostic Index score

Histological Findings (Low magnification)
Histological features of centroblastic (n=46) or centroblastic/centrocytic lymphomas (n=4) with a prominent epithelioid response.

Nine lesions(18%; displayed a partial follicular growth pattern, and the other 41 (82%) showed a diffuse growth pattern.

At low magnification, thick trabecular fibrosis compartmentalized the lymph node parenchyma in 39 cases, producing a vague nodular pattern even in the diffuse lymphomas

Histological Findings (high magnification)

The majority of the tumor cells had round nuclei with fine nuclear chromatin and two to four small nucleoli,

A small number of immunoblasts,immunoblast-like cells, and medium-sized cells with cleaved nuclei were also seen

A few multilobulated centroblasts and multinucleated cells somewhat resembling Reed-Sternberg cells were observed in two cases

Histological Findings
low-power field of an affected node. Geographic epithelioid granulomatous response occupied 90% of the lymph node. (Case 5).Hematoxylin and eosin (HE), 10 x

Histological Findings
B, low-power field of an affected lymph node. Tubercular fibrosis compartmentalized the parenchyma producing a vague nodular pattern. Note the epithelioid cell accumulation in large and poorly demarcated masses (Case 5). HE 10

Histological Findings
C, high-power field of the affected lymph node. The tumor cells had large round or indented nuclei with small- to medium-sized nucleoli (Case 13). HE 100

D, high-power field of the affected lymph node. Note the binucleated cells. Epithelioid cells are diffusely infiltrating. (Case 24). HE 100 .