宫颈淋巴瘤样病变与宫颈淋巴瘤的鉴别

Distinction between lymphoma-like lesions and lymphoma of uterine cervix:a clinicopathologic study of 26 cases

目的探讨宫颈淋巴瘤样病变和宫颈淋巴瘤的临床病理特点及免疫球蛋白重链(IgH)基因重排在两者鉴别诊断上的价值。方法对10例宫颈淋巴瘤样病变和16例宫颈淋巴瘤进行临床资料分析和组织病理学观察,以免疫组织化学(EnVision法)检测 B、T 淋巴细胞标记物和免疫球蛋白轻链(κ,λ)的表达,并应用半套式聚合酶链反应方法检测了4例淋巴瘤样病变和4例淋巴瘤中 IgH基因重排的情况。结果宫颈淋巴瘤样病变患者年龄24～54岁(中位年龄43岁),临床多表现为宫颈糜烂或息肉,镜下观察可见表浅分布的、局灶或弥漫性免疫母细胞样大细胞浸润,伴淋巴细胞转化成熟现象和多型性炎性细胞浸润(多量成熟浆细胞、嗜酸性粒细胞、中性粒细胞)。宫颈淋巴瘤患者年龄28～78岁(中位年龄58岁),临床表现为宫颈肿块或弥漫性宫颈肥大,镜下观察示12例弥漫性大 B 细胞淋巴瘤和4例滤泡性淋巴瘤,二者组织学形态分别以弥漫分布、形态单一的肿瘤性大淋巴细胞浸润和肿瘤性滤泡形成为特点,病灶中少有多型性炎性细胞浸润,也不出现淋巴细胞转化成熟现象。宫颈淋巴瘤样病变中,免疫母细胞样大细胞κ和λ染色结果欠满意。4例宫颈淋巴瘤病例和2例宫颈淋巴瘤样病变中检出单克隆性 IgH 基因重排。结论宫颈淋巴瘤样病变和淋巴瘤主要依据不同的临床和病理形态特点相互区分。IgH 基因重排检测对于二者鉴别有帮助,但需注意部分良性病变也有单克隆性淋巴细胞增生。

Objective To study the clinicopathologic features and differential diagnosis of lymphoma-like lesions and lymphoma of uterine cervix. Methods Clinical data and hematoxylin and eosinstained slides of 10 cases of lymphoma-like lesion and 16 cases of lymphoma of uterine cervix were reviewed. Immunohistochemical study for B- and T-cell markers and light chains （ κ,λ） were performed on paraffin sections. The rearrangement status of immunoglobulin heavy chain （IgH） gene was analyzed with seminested polymerase chain reaction in 4 cases lymphoma-like lesion and 4 cases of lymphoma of uterine cervix. Results The age of patients with lymphoma-like lesion ranged from 24 to 54 years （ medium = 43 years）. The lesion generally presented with cervical erosion or polyp. Microscopically, it is characterized by focal or diffuse superficial infiltration of immunoblast-like large B cells intermingled with a polymorphic population of inflammatory cells, including plasma cells, eosinophils and neutrophils. Maturation of the transformed large B cells was also noticed. On the other hand, the age of the patients with lymphoma of uterine cervix varied from 28 to 78 years （ medium = 58 years ）. Cervical mass or diffuse enlargement of cervix were the commonest clinical findings. The cases included 12 examples of diffuse large B-cell lymphoma and 4 examples of follicular lymphoma. The former was characterized by a diffuse monomorphic population of large atypical lymphoid cells, while neoplastic follicles were identified in the latter. Neither polymorphic inflammatory infiltrates nor maturation phenomenon was found. The immunostaining for κ and λ light chains was inconclusive. Molecular study showed clonal rearrangement of IgH gene in all cases of cervical lymphoma, as well as 2 cases of lymphoma-like lesion. Conclusions The distinction between lymphoma-like lesion and lymphoma of uterine cervix depends primarily on the clinical and histopathologic features. Assay for rearrangement of IgH gene may be helpful in differential diagnosis, though monoclonality can be detected in some benign lesions as well.