非霍奇金B细胞淋巴瘤369例病理形态观察 2001年世界卫生组织淋巴组织肿瘤新分类应用体会

Clinicopathologic study of 369 B-cell non- Hodgkin lymphoma cases, with reference to the 2001 World Health Organization classification of lymphoid neoplasms

目的 探讨非霍奇金B细胞淋巴瘤(B -NHL)的病理形态和免疫表型在B -NHL诊断中的价值,评价2001版世界卫生组织(WHO)淋巴瘤分类的可行性。方法 依据2001版WHO淋巴瘤分类,应用HE、免疫组织化学(LSAB法)和原位杂交技术对369例B -NHL重新诊断分型。结果 369例B NHL确定了11个类型,未观察到毛细胞白血病和B 前淋巴细胞白血病, 其中最常见的3个类型依次是:弥漫大B细胞淋巴瘤(189例, 51 .2% ),黏膜相关淋巴组织结外边缘区细胞淋巴瘤(55例,14 .9% ),滤泡淋巴瘤(39例, 10 .6% )。发生于淋巴结者占42. 8% (158例),结外为57. 2% (211例)。单纯HE形态诊断对比形态结合免疫表型的诊断结果,符合率达80%,免疫组织化学可将B -NHL的诊断正确率提高近20%。结论 病理形态是淋巴瘤诊断的基础,免疫表型在诊断和分型中起重要作用,二者与临床特征结合可使绝大多数淋巴瘤得到明确诊断。2001版WHO淋巴瘤分类具有较强的实用性。

Objective To describe the relative frequency, morphologic features, immunopheno type and clinical data of different types of B-cell non-Hodgkin lymphoma (B-N HL) and to evaluate the practical application of the 2001 World Health Organizat ion (WHO) classification of lymphoid neoplasms. Methods 369 documented cases of B-NHL were further subtyped according to the 2001 WHO classification of lymphoid neoplasms, on the basis of hematoxylin and eosin staining, immunohistochemistry and in-situ hybridization techniques. Results Amongst the 369 cases of B-NHL studied, 353 cases could be further c lassified into 11 subtypes. Diffuse large B-cell lymphoma, extranodal marginal zone lymphoma and follicular lymphoma were the commonest subtypes, accounting f or 51.2%(189 cases), 14.9% (55 cases) and 10.6% (39 cases) of all cases resp ectively.Tumors in lymph nodes were seen in 158 cases (42.8%) and in extra node in 211 cases (57.2%). B-cell prolymphocytic leukemia and hairy cell leukemia were not identified. When comparing the diagnosis based on morphologic examinat ion alone with the diagnosis based on both morphology and immunophenotype, there was a 80% concordance rate. Immunohistochemical study was helpful in reaching the correct diagnosis in many cases and could improve the overall diagnostic acc uracy by about 20%. Conclusions Amongst cases of B-NHL, diffuse large B-cell lymphoma is the common est subtype, followed by MALToma and follicular lymphoma. While morphologic exa mination forms the basis for lymphoma diagnosis, immunohistochemical study also plays an important role in further subtyping. A combination of both modalities are sufficient for arriving at an accurate diagnosis in most cases of B-NHL, in keeping with the recommendation of the 2001 WHO classification of lymphoid neop lasms.