CAJ | 학술논문

目的提高对正确分析判断免疫组化结果的重要性的认识.方法对3例淋巴瘤误诊病例进行复习,并增加相关抗体标记予以鉴别诊断.结果例1为淋巴结经典霍奇金淋巴瘤,富淋巴细胞型(LRCHL),误诊为滤泡性淋巴瘤与形态学观察遗漏R-S样细胞以及误判免疫组化标志BCL-2、CD20有关,即将BCL-2、CD20阳性的非肿瘤细胞误判为肿瘤细胞；误诊为结节性淋巴细胞为主型霍奇金淋巴瘤与免疫组化标志误判有关,把围绕瘤细胞的背景小淋巴细胞CD20阳性误判为R-S样大细胞CD20阳性,将CD30阳性的肿瘤性大细胞误判为活化性B淋巴细胞.例2为急性髓系白血病,误诊为T淋巴母细胞淋巴瘤(T-LBL),主要由于对瘤细胞表达非特异性抗体TDT、CD7、CD43的意义认识不足.例3为胸腺瘤B1型误诊为T-LBL,主要与抗体CK标记不理想而遗漏了肿瘤性上皮细胞,将表达TDT、CD99的反应性细胞误认为肿瘤细胞,以及对Ki-67表达率的意义认识不足有关.结论淋巴瘤的诊断建立在形态学、免疫组化标志、临床资料和遗传学分析基础上,免疫组化结果的正确分析判断对淋巴瘤确诊至关重要.
목적 제고대정학분석판단면역조화결과적중요성적인식.방법 대3례림파류오진병례진행복습,병증가상관항체표기여이감별진단.결과 례1위림파결경전곽기금림파류,부림파세포형(LRCHL),오진위려포성림파류여형태학관찰유루R-S양세포이급오판면역조화표지BCL-2、CD20유관,즉장BCL-2、CD20양성적비종류세포오판위종류세포；오진위결절성림파세포위주형곽기금림파류여면역조화표지오판유관,파위요류세포적배경소림파세포CD20양성오판위R-S양대세포CD20양성,장CD30양성적종류성대세포오판위활화성B림파세포.례2위급성수계백혈병,오진위T림파모세포림파류(T-LBL),주요유우대류세포표체비특이성항체TDT、CD7、CD43적의의인식불족.례3위흉선류B1형오진위T-LBL,주요여항체CK표기불이상이유루료종류성상피세포,장표체TDT、CD99적반응성세포오인위종류세포,이급대Ki-67표체솔적의의인식불족유관.결론 림파류적진단건립재형태학、면역조화표지、림상자료화유전학분석기출상,면역조화결과적정학분석판단대림파류학진지관중요.
Objective To recognize the importance of analyzing the result of immunohistochemical staining correctly.Method Review of the three misdiagnosed cases lymphoma and exploring the causes of misdiagnosis through reviewing their clinics,histopathology and immunohistochemistry.Results Case 1 of lymphocyte rich classical Hodgkin' s lymphoma (LRCHL) was misdiagnosed as follicular lymphoma (FL) initially,the RS cells were overlooked morphologically and wrongly determined BCL-2 and CD20-positive cells as tumor cells immunohistochemically; also once misdiagnosed as nodular lymphocyte predominant Hodgkin' s lymphoma (NLPHL) because the CD20-negative RS misjudged cells as the positives.Case 2 of AML tumor cells expressed TdT,CD7 and CD43 unspecifically,which misdiagnosed as T-cell lymphoblastic lymphoma (T-LBL). Case 3 of type B1 thymoma was misdiagnosed as T-LBL,because CK wasn' t expressed satisfactorily resulting in neglecting neoplastic epithelial cells,and lymph~ytes in the background were TdT and CD99-positive.Conclusion The diagnosis of lymphoma should be based on morphology,immunohistochemistry,clinics,and genetics.Moreover,the correct judgment of immunohistochemical staining is essential to make right diagnosis.