非霍奇金淋巴瘤侵犯骨髓的病理形态及免疫表型特点分析

Pathomorphologic and Immunophenotypic Analysis on Bone Marrow Involvement in Non-Hodgkin Lymphoma

目的:探讨非霍奇金淋巴瘤(NHL)侵犯骨髓的病理形态、免疫表型特点。方法:对骨髓活检标本,石蜡包埋切片,HE染色,光镜观察形态免疫组化进行表型分析。结果:65例中,B细胞淋巴瘤39例,T细胞淋巴瘤26例。形态学上,B细胞淋巴瘤多以混合型、弥漫型侵犯为主,外周T细胞淋巴瘤(PTCL)以间质型、混合型侵犯多见,伴有浆细胞、嗜酸细胞等反应性成分。毛细胞白血病(HCL)呈蜂窝样外观,具有诊断特异性。26例有髓外原发淋巴瘤者,瘤细胞形态与相应骨髓活检形态一致。免疫组化可对大部分淋巴瘤分型。6例小B细胞淋巴瘤不能分型的,2例结合脾脏病理特点确诊,4例仅有骨髓活检标本的,有待进一步检查确定。结论:多数NHL骨髓侵犯具有明确的形态学及免疫表型特点,可以诊断并分型。少数需结合原发部位及其它检查确诊。

Objective： To investigate the characteristics of bone marrow involvement in nonHodgkin＇s lymphoma （NHL） by pathomorphology and immunophenotype. Methods： Routine histologic examination was performed on Hematoxylin- eosin（H-E）-stained sections with paraffin emdedded samples of bone marrow biopsies. Phenotype was conducted by immunohistochemistry method. Results： Of 65 bone marrow trephines, 39 were B and 26 were T cell lymphomas. Morphologically the most frequent patterns of NHL bone marrow involvement were mixed and diffused type in B cell lymphomas and interstitial and mixed type in T cell lymphomas. Hairy cell leukemia （HCL） presented a honeycomb appearance, which was special for diagnosis. The morphology of lymphoma cells in the medullary was consistent with extramedullary sites of 26 cases with primary lymphomas. Most lymphomas could be phenotyped by immunohistochemistry. Among 6 cases of small B cell lymphomas unphenotyped, 2 cases should refer to the spleen pathology, 4 cases with bone marrow biopsy alone need to be further phenotyped by other methods. Conclusions： Most of cases with NHL bone marrow involvement show the pathomorphologic and immunophenotypic characteristics definitely, so it could be diagnosed and phenotyped. Few needs final diagnosis by combination of primary lymphoma and other exams.