宫颈淋巴瘤样病变7例临床病理分析

Lymphomatoid lesion of uterine cervix: a clinicopathological analysis of 7 cases

目的探讨子宫颈淋巴瘤样病变的临床病理特征及诊断和鉴别诊断要点。方法采用光镜、免疫组化、EBER原位杂交和TCR及IgH基因重排等多项技术对7例宫颈淋巴瘤样病变进行病理分析,并结合临床资料进行探讨。结果7例患者中5例为育龄期女性,临床表现为接触性出血或不规则阴道出血6例,伴白带增多2例;1例为体检发现。妇检见宫颈1枚或数枚息肉样新生物,常伴宫颈糜烂。光镜示新生物内弥漫性淋巴组织浸润,见多量免疫母细胞或滤泡中心母细胞样细胞,易见核分裂象。致密的大淋巴细胞间常混杂不等量的小淋巴细胞和浆细胞。免疫组化:CD20常弥漫(+),小淋巴细胞CD3(+),CD30散在或灶性(+),κ与λ阳性无显著差异。6例基因重排未见单克隆条带。6例EBER原位杂交未见阳性表达。随访6例患者均健在。结论子宫颈淋巴瘤样病变是一类伴多量大淋巴细胞且显示活跃核分裂象的淋巴组织高度增生性病变,临床常表现为息肉样新生物,免疫组化及基因重排显示多克隆性表达有助于确诊。

Objective To investigate the clinicopathologic features of lymphomatoid lesion of the uterine cervix and its main points for diagnosis and differential diagnosis. Methods Seven cases of lymphomatoid lesion of the uterine cervix in the archives of the Department of Pathology were examined by light microscopy, immunohistochemical technique, EBER in situ hybridization and TCR and IgH gene rearrangements, and analysed with clinical features as well as follow-up data. Results Five cases of lymphomatoid lesion of the uterine cervix （5/7） were reproductive women （median age of 44.4 yr）. Six patients showed sexual hemorrhage or irregular vaginal bleeding at presentation with leukorrhagia in 2 cases. One case was found by incidental colposcopic examination. All the patients showed one or several polypus of uterine cervix usually with cervical erosion. Histologically, the neoplasm was infiltrated by dense lymphoid cells. Many large immunoblastoid cells and follicular centroblastoid cells were found with mitosis activity. The large lymphoid cells were usually mixed with mature plasmacytes and small lymphocytes. Immunostaining showed that the lymphoid tissue was positive for CD20 （usually diffuse）, CD3 （small lymphocytes）, CD30 （patchy）, and k and λ , chains demonstrated polyclonal expression. TCR and IgH gene rearrangement analysis in 6 cases did not show any positive clonal band. EBER in situ hybridization was negative in 6 cases. Six patients were all alive well with follow-up. Conclusion Lymphomatoid lesion of the uterine cervix is a special kind of lymphoprohferative illness mimicking lymphoma that is usually presented as polypus on gross examination. It should be differentiated from B cell lymphoma of the cervix. Immunohistochemical study and gene rearrangement analysis showing polyclonal proliferation are helpful to the diagnosis in cases with numerous large lymphoid cells with mitotic activity, and follow-up is necessary in these cases.