宫颈粘膜相关淋巴瘤及假性淋巴瘤临床病理和免疫组化研究

Clinicopathology and immunohistochemistry study of cervical mucosa associated lymphoid tissue lymphoma and cervical psuedolymphoma

目的：探讨宫颈粘膜相关淋巴瘤（ＣＭＡＬＴ－ｏｍａ）及假性淋巴瘤（ＣＰＬ）的诊断标准、鉴别诊断及发病机理。方法：ＣＭＡＬＴ－ｏｍａ及ＣＰＬ各５例，活检或手术标本做石蜡切片及免疫组化（ＡＢＣ法）染色。结果：ＣＭＡＬＴ－ｏｍａ出现“淋巴上皮病变”及单克隆增殖，２例为Ｔ小多形细胞性，３例为Ｂ细胞性（ＣＣＬ和淋巴浆细胞型）。ＣＰＬ均有多克隆性的多种炎细胞浸润。结论：大多数ＭＡＬＴ－ｏｍａ为低度恶性并有“回归”现象。因此，手术为首选治疗方法。如果肿瘤侵犯邻近脏器或转移至淋巴结，应加用化疗或放疗。ＣＰＬ应予以有效的抗菌治疗，否则，有转变成ＭＡＬＴ－ｏｍａ的可能。自身免疫性疾病及感染，可导致机体产生获得性ＭＡＬＴ，并在持续性刺激下发展为ＣＰＬ，进而转变为ＣＭＡＬＴ－ｏｍａ。

Purpose The diagnostic standard and differentiation diagnosis and mechanism are studied in cervical mucosa associated lymphoid tissue lymphoma (CMALT oma) and cervical pseudolymphoma (CPL). Methods General paraffin embedded section and immunohistochemical method (ABC method) were taken in biopsy or surgical specimens of five CMALT oma and five CPL. Results CMALT omas appeared “lymphoepithelial lesions” and monoclonal hyperplasia in which two cases were pleomorphic T cell lymphomas and the others were B cell lymphomas (CCL type and lymphoplasmacyte type). Five cases of CPL had polyclonal and several kinds of inflammatory cells infiltration. Conclusions Most of the MALT omas are low grade malignant tumors and have “homing back”. Therefore, operation is the first choice. If there were tumor cells invading proximal organs or metastasizing to lymph nodes, the chemiotherapy and/or radiotherapy should be taken after operation. The efficient antibiotic therapy should be given in CPL. Otherwise, CPL might become MALT. Acquired MALT may develope as a reaction to autoimmune disease and infection. Hyper immune reaction and MALT hyperplasia under the stimulation might result in CPL and develop CMALT oma.