弥漫性大B细胞淋巴瘤侵犯骨髓的病理学观察

Pathologic observation of diffuse large B cell lymphoma bone marrow involvement

目的探讨弥漫性大B细胞淋巴瘤（DLBCL）侵犯骨髓的病理学特点、诊断与鉴别诊断。方法对24例DLBCL侵犯骨髓的骨髓活检HE染色切片进行形态学观察，20例免疫组化（IHC）法进行免疫表型分析。将其中10例髓外部位原发的NHL患者的骨髓与髓外部位瘤细胞的形态学进行对比观察。结果DLBCL侵犯骨髓的方式依次为：弥漫型14例，间质型6例，混合型2例，结节型1例，窦内型1例。侵犯程度为重度15例，中度4例，轻度5例。瘤细胞形态学类型为中心母细胞型21例，免疫母细胞型3例。瘤细胞表达CD20、CD45RN、Pax5等一种或多种B细胞的标记。不表达CD3、CD4580、CD5、CD10、TdT、CyclinD1、CD38、CD68、MPO。10例髓外原发淋巴瘤患者的骨髓与其髓外部位瘤细胞形态一致。结论DLBCL侵犯骨髓多具有特殊的骨髓病理学特点。少数轻度、间质型浸润以及混有较多小淋巴细胞者，免疫组化有助于鉴别诊断。骨髓活检对于DLBCL侵犯骨髓的诊断具有重要意义。

Objective To explore the bone marrow pathology ,diagnosis and differential diagnosis of diffuse large B cell lymphoma （DLBCL） bone marrow involvement（BMI）. Methods Morphologie observation was peffornled on bone marrow biopsies （BMB） stained with Hematoxylin-eosin（HE） from 24 patients with DLBCL BMI. Immunohistoehemistry （IHC） for immunophenotyping was conducted on 20 patients. The morphology of lymphoma cells in the medullary and extramedu]lary was compared for 10 cases with primary lymphoma. Results Patterns of DLBCL BMI were presented by： diffuse（14 cases）, interstitial（6 cases）, mixed （2 case）, nodular （1 ease） and intrasinusoidal （1 case） types. The extent of BMI included severe（15 cases）, moderate（4 cases） and mild （5 cases）. The common morphological variants was eentroblastie （21 cases） and the remainder was immunoblastie （3 cases）. IHC showed the lymphoma cells expressing one or more B cell markers, including CD~ CD45~ and Pax5. They were negative for CD3, CD45Rts CDs, CDl0, TdT, Cyclin D1, CD3s, CD6s and MPO.The morphology of lymphoma cells in the medullary was concordant with extramedullary of 10 cases with primary lymphoma. Conclusion For most patients, bone marrow pathology of DLBCL BMI is distinctive. In the minority, IHC is contributive to the differentiation of the mild and interstitial pattern of BMI and merged with more small lymphocytes. Bone marrow biopsy is significantly important in the diagnosis of DLBCL BMI.