CAJ | 학술논문

目的：探讨免疫球蛋白重链/T细胞受体（IgH/TCR）基因重排检测联合EB病毒（EBV）原位杂交在淋巴瘤诊断中的应用，分析EBV+-B细胞淋巴瘤的细胞学及基因组学特征、鉴别诊断要点，以缩短诊断时间，减少误诊。方法采用IgH/TCR基因重排与EB原位杂交联合分析诊断EBV+-B细胞淋巴瘤1例，分析其免疫组化特征、EBV原位杂交、基因重排结果。结果 EBV+-B细胞淋巴瘤临床上主要表现为淋巴结增大，常伴骨髓和外周血浸润。淋巴结活检显示其结构破坏，淋巴滤泡减少，淋巴结高度增生性病变，可见轻至中度异型淋巴细胞，淋巴窦扩张，组织细胞增生。免疫组化证实EBV感染的细胞毒性B细胞构成病变主体；EBV原位杂交显示部分淋巴细胞核阳性；基因重排提示IgH、免疫球蛋白轻链（Igκ）基因发生克隆性重排，TCRγ无克隆性重排。结论 EBV+-B细胞淋巴瘤从形态学上难以与伯基特淋巴瘤、慢性淋巴细胞白血病等淋巴瘤区分，早期诊断困难。联合应用IgH/TCR基因重排与EBV原位杂交技术对EBV+-B细胞淋巴瘤的诊断有较高准确性。
목적：탐토면역구단백중련/T세포수체（IgH/TCR）기인중배검측연합EB병독（EBV）원위잡교재림파류진단중적응용，분석EBV+-B세포림파류적세포학급기인조학특정、감별진단요점，이축단진단시간，감소오진。방법채용IgH/TCR기인중배여EB원위잡교연합분석진단EBV+-B세포림파류1례，분석기면역조화특정、EBV원위잡교、기인중배결과。결과 EBV+-B세포림파류림상상주요표현위림파결증대，상반골수화외주혈침윤。림파결활검현시기결구파배，림파려포감소，림파결고도증생성병변，가견경지중도이형림파세포，림파두확장，조직세포증생。면역조화증실EBV감염적세포독성B세포구성병변주체；EBV원위잡교현시부분림파세포핵양성；기인중배제시IgH、면역구단백경련（Igκ）기인발생극륭성중배，TCRγ무극륭성중배。결론 EBV+-B세포림파류종형태학상난이여백기특림파류、만성림파세포백혈병등림파류구분，조기진단곤난。연합응용IgH/TCR기인중배여EBV원위잡교기술대EBV+-B세포림파류적진단유교고준학성。
Objective To investigate the application of immunoglobulin heavy chain/T cell receptor (IgH/TCR) gene re-arrangement and epstein-barr virus(EBV) in situ hybridization in diagnosing lymphoma,analyzing cytological feature and genomic features of EBV+-B cell lymphoma and discriminating the points of diagnosis ,in order to shorten the diagnostic time and avoid misdiagnosis. Methods A total of 1 case with diagnosis of EBV+-B cell lymphoma by IgH/TCR gene rearrangements combined with EB in situ hybridization analysis was performed to analyze its immunohistochemical characteristics ,EBV situ hybridization and results of gene rearrangement. Results The major clinical manifestation of EBV+-B cell lymphoma was lymphadenopathy , which often accompanied by infiltration of the bone marrow and peripheral blood. Lymph node biopsy showed its structural dam-age,lymphoid follicles decreasing,T zone expanding significantly,mild-moderate atypical lymphocyte,lymphatic sinus dilation and histiocytosis. Immunohistochemistry confirmed that cytotoxic B cells infected by EBV constituted the main body;EBV situ hy-bridization showed lymphocyte nuclei positive;gene rearrangement revealed IgH,Igκgene clonal rearrangement,TCRγno clonal rearrangement. Conclusion It is difficult to distinguish EBV+-B-cell lymphoma from burkitt′s lymphoma,chronic lymphocytic leukemia and other lymphomas morphologically with difficult diagnosis in early. Conjoint application of IgH/TCR gene rearrange-ment and EBV in situ hybridization in lymphoma diagnosis has a high diagnostic accuracy.