中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2013年
4期
222-226
,共5页
淋巴瘤%B淋巴细胞%树突细胞,滤泡%Ki-67抗原
淋巴瘤%B淋巴細胞%樹突細胞,濾泡%Ki-67抗原
림파류%B림파세포%수돌세포,려포%Ki-67항원
Lymphoma%B-lymphocytes%Dendritic cells,follicular%Ki-67 antigen
目的 观察在不同类型小B细胞淋巴瘤(SBL)中滤泡树突细胞(FDC)网架的破坏情况和FDC分布特征,结合Ki-67阳性指数高低和分布方式存在的差异,探讨其在SBL鉴别诊断中的价值.方法 回顾性研究北京大学肿瘤医院2008年11月至2012年6月间诊断的68例SBL,观察CD21及CD23免疫组织化学染色显示的FDC网架破坏情况、分布形式及Ki-67阳性指数及分布形式.使用统计学软件分析其与不同SBL类型的关系.结果 68例患者年龄28 ～ 85岁,平均55.2岁；男女比1.2∶1,发病部位为淋巴结内55例(80.9％),结外13例(19.1％).复习并依据2008 WHO造血与淋巴组织肿瘤分类标准确诊病理诊断:低级别滤泡性淋巴瘤(FL,1级和2级)22例,边缘区淋巴瘤(MZL) 19例,套细胞淋巴瘤(MCL) 17例,以及慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)10例.在FL中CD21及CD23标记的FDC网架是以中心破坏为主,发生比例占90.9％(20/22).而在MZL中则以FDC网架周边结构破坏为主,为14/19；在CLL/SLL则表现为散在个别FDC或者无FDC网架；对于MCL,有7/17的病例表现为散在个别FDC或者无FDC网架,另有7/17的MCL出现了FDC的不规则网状增生.FDC网架按照破坏及分布情况在不同的淋巴瘤分型中差异具有统计学意义(P＜0.01).Ki-67显示的肿瘤细胞增殖活性在4种不同SBL间差异也具有统计学意义(P＜0.05),增殖活性从高到低依次为:MCL、FL、SLL、MZL.Ki-67在FL病例可以看到滤泡中心散在表达且极向消失,MZL病例中可见残余生发中心外的肿瘤较为一致散在表达,而且两者均普遍低于残留非肿瘤性生发中心的阳性指数；在MCL中可见较为一致的分布,但个体间阳性指数差异较大(5％～90％)；在CLL/SLL病例中肿瘤的“增殖中心”Ki-67呈灶状增高.结论 通过常规使用CD21和CD23免疫组织化学染色,显示FDC网架的破坏情况,并联合Ki-67显示细胞的增殖活性,观察两者分布形式,对于明确区分各种类型的SBL具有鉴别意义.
目的 觀察在不同類型小B細胞淋巴瘤(SBL)中濾泡樹突細胞(FDC)網架的破壞情況和FDC分佈特徵,結閤Ki-67暘性指數高低和分佈方式存在的差異,探討其在SBL鑒彆診斷中的價值.方法 迴顧性研究北京大學腫瘤醫院2008年11月至2012年6月間診斷的68例SBL,觀察CD21及CD23免疫組織化學染色顯示的FDC網架破壞情況、分佈形式及Ki-67暘性指數及分佈形式.使用統計學軟件分析其與不同SBL類型的關繫.結果 68例患者年齡28 ～ 85歲,平均55.2歲；男女比1.2∶1,髮病部位為淋巴結內55例(80.9％),結外13例(19.1％).複習併依據2008 WHO造血與淋巴組織腫瘤分類標準確診病理診斷:低級彆濾泡性淋巴瘤(FL,1級和2級)22例,邊緣區淋巴瘤(MZL) 19例,套細胞淋巴瘤(MCL) 17例,以及慢性淋巴細胞白血病/小淋巴細胞淋巴瘤(CLL/SLL)10例.在FL中CD21及CD23標記的FDC網架是以中心破壞為主,髮生比例佔90.9％(20/22).而在MZL中則以FDC網架週邊結構破壞為主,為14/19；在CLL/SLL則錶現為散在箇彆FDC或者無FDC網架；對于MCL,有7/17的病例錶現為散在箇彆FDC或者無FDC網架,另有7/17的MCL齣現瞭FDC的不規則網狀增生.FDC網架按照破壞及分佈情況在不同的淋巴瘤分型中差異具有統計學意義(P＜0.01).Ki-67顯示的腫瘤細胞增殖活性在4種不同SBL間差異也具有統計學意義(P＜0.05),增殖活性從高到低依次為:MCL、FL、SLL、MZL.Ki-67在FL病例可以看到濾泡中心散在錶達且極嚮消失,MZL病例中可見殘餘生髮中心外的腫瘤較為一緻散在錶達,而且兩者均普遍低于殘留非腫瘤性生髮中心的暘性指數；在MCL中可見較為一緻的分佈,但箇體間暘性指數差異較大(5％～90％)；在CLL/SLL病例中腫瘤的“增殖中心”Ki-67呈竈狀增高.結論 通過常規使用CD21和CD23免疫組織化學染色,顯示FDC網架的破壞情況,併聯閤Ki-67顯示細胞的增殖活性,觀察兩者分佈形式,對于明確區分各種類型的SBL具有鑒彆意義.
목적 관찰재불동류형소B세포림파류(SBL)중려포수돌세포(FDC)망가적파배정황화FDC분포특정,결합Ki-67양성지수고저화분포방식존재적차이,탐토기재SBL감별진단중적개치.방법 회고성연구북경대학종류의원2008년11월지2012년6월간진단적68례SBL,관찰CD21급CD23면역조직화학염색현시적FDC망가파배정황、분포형식급Ki-67양성지수급분포형식.사용통계학연건분석기여불동SBL류형적관계.결과 68례환자년령28 ～ 85세,평균55.2세；남녀비1.2∶1,발병부위위림파결내55례(80.9％),결외13례(19.1％).복습병의거2008 WHO조혈여림파조직종류분류표준학진병리진단:저급별려포성림파류(FL,1급화2급)22례,변연구림파류(MZL) 19례,투세포림파류(MCL) 17례,이급만성림파세포백혈병/소림파세포림파류(CLL/SLL)10례.재FL중CD21급CD23표기적FDC망가시이중심파배위주,발생비례점90.9％(20/22).이재MZL중칙이FDC망가주변결구파배위주,위14/19；재CLL/SLL칙표현위산재개별FDC혹자무FDC망가；대우MCL,유7/17적병례표현위산재개별FDC혹자무FDC망가,령유7/17적MCL출현료FDC적불규칙망상증생.FDC망가안조파배급분포정황재불동적림파류분형중차이구유통계학의의(P＜0.01).Ki-67현시적종류세포증식활성재4충불동SBL간차이야구유통계학의의(P＜0.05),증식활성종고도저의차위:MCL、FL、SLL、MZL.Ki-67재FL병례가이간도려포중심산재표체차겁향소실,MZL병례중가견잔여생발중심외적종류교위일치산재표체,이차량자균보편저우잔류비종류성생발중심적양성지수；재MCL중가견교위일치적분포,단개체간양성지수차이교대(5％～90％)；재CLL/SLL병례중종류적“증식중심”Ki-67정조상증고.결론 통과상규사용CD21화CD23면역조직화학염색,현시FDC망가적파배정황,병연합Ki-67현시세포적증식활성,관찰량자분포형식,대우명학구분각충류형적SBL구유감별의의.
Objective To identify the immunohistochemical patterns of follicular dendritic cell (FDC) meshwork and Ki-67 labeling index in small B-cell lymphomas (SBLs) and their significance in differential diagnosis.Methods Sixty-eight cases of SBLs were included collected from November 2008 to June 2012.The patterns of FDCs and Ki-67 expression were studied on paraffin sections by CD21,CD23 and Ki-67 immunohistochemistry.The characteristic staining patterns of FDCs and Ki-67 expression among different SBLs were analyzed statistically.Results The age of SBL patients ranged from 28 to 85 years with a mean of 55.2 years.The male to female ratio was 1.2 ∶ 1.Fifty-five cases involved only lymph nodes (80.9％),and the remaining cases involved multiple extra-nodal sites.Histological classification of the cases was made according to the 2008 WHO lymphoma classification criteria:22 were low-grade follicular lymphomas (FLs,including grade 1 and grade 2),19 marginal zone lymphomas (MZLs),17 mantle cell lymphomas (MCLs),and 10 chronic lymphocytic leukemia/small lymphocytic lymphomas (CLL/SLLs).FDC meshwork limited to the central part of neoplastic follicles was characteristic for FL(90.9％,20/22).The germinal center FDC meshwork was destroyed primarily at periphery in MZL (14/19).The absence or scattered FDC clusters were typical of SLL/ CLL.Irregular FDC was seen in 7/17 of MCL,while 7/17 MCL displayed FDC pattern similar to that of CLL/SLLs.The pattern of FDCs was a significantly diagnostic feature in distinguishing the four types of SBLs (P ＜ 0.01).Ki-67 was also a statistically significant parameter(P＜0.05) with decreasing labeling index as the following:MCL,FL,SLL and MZL.Ki-67showed scattered pattern in germinal centers with loss of polarity in FLs.MZL presented uniformly scattered positive pattern in interfollicullar areas.Ki-67 staining was uniform in MCL,but its labeling index varied from 5％ to 90％.The Ki-67 index was higher in the morphological "proliferation center" of all CLL/SLLs.Conclusion Immunohistochemieal staining patterns of FDC meshworks and Ki-67 labeling index offer a significant discriminatory power in the differential diagnoses among SBLs.
