胸腔积液诊断间变性大细胞淋巴瘤细胞病理学探讨

Anaplastic large cell lymphoma presenting as a pleural effusion

目的报道1例胸腔积液诊断间变性大细胞淋巴瘤并进行文献复习,以加强对淋巴瘤细胞学诊断的认识。方法胸腔积液常规细胞学涂片、沉渣包埋,结合免疫组化染色及T细胞受体基因重排,从细胞学角度明确诊断间变性大细胞淋巴瘤。结果胸腔积液涂片中细胞丰富,可见大量散在分布的肿瘤细胞有3种:单核、双核和多核细胞;单核淋巴细胞核浆比高,核呈肾形,核仁明显;多核细胞核排列成花环状或马蹄形,可见多个核仁;双核细胞类似霍奇金淋巴瘤中的R-S细胞。肿瘤细胞胞质丰富,嗜酸性,胞质内可见空泡。背景可见小的成熟淋巴细胞及间皮细胞。沉渣包埋免疫组化示CD30、ALK、CD68、granzyme B和CD4(+),CD15和MUM1(-);散在瘤细胞CD5(+),CD3、CD8和CD20、CK5/6、calretinin和pan-CK(-)。颈部淋巴结活检证实为间变性大细胞淋巴瘤。T细胞受体基因重排为(-)。结论胸腔积液诊断间变性大细胞淋巴瘤少见,难度高。诊断对免疫组化的依赖程度较高。

Objective To report one case of anaplastic large cell lymphoma diagnosed on pleural fluid,and to draw the attention of cytopathologists.Methods The clinico-pathologic analysis,cytomorphologic and immunohistochemical examination,and PCR for TCR-gene rearrangement were used in this study.Results HE stained smears revealed numerous monodispersed highly atypical cells which did not form cellular aggregates or epithelial structures.Multinucleated cells had a wreath-like nuclear arrangement and some binucleated cells existed similarly to R-S cells in Hodgkin lymphoma.The pleural fluid contained some small lymphocytes and methothelial cells in the background.The tumor cells expressed CD30,ALK,CD68,granzyme B,CD4 diffusely and strongly,and CD5 focally.CD3,CD8,and CD20 were negative.The cervical node biopsy verified the final diagnosis of anaplastic large cell lymphoma.No gene rearrangement of TCRs was found.Conclusions It is difficult to diagnose anaplasic large cell lymphoma on cytologic examination of pleural fluids.The immunohistochemical stains are helpful.