桥本甲状腺炎与黏膜相关淋巴组织的病理学特征

Pathologic and immunohistochemical characteristics of Hashimoto thyroiditis and MALT

目的阐明桥本甲状腺炎(hashimoto thyroiditis,HT)的组织形态学及免疫组织化学特征,分析轻链限制在鉴别HT与黏膜相关淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤中的意义。方法 30例HT的石蜡标本和2例MALT淋巴瘤,分别用HE染色行组织病理学检查以及免疫组织化学检测CD20、CD3、lgκ、lgλ和细胞角蛋白,评价淋巴细胞的浸润及淋巴上皮病变(lymphoepithelial lesion,LEL),轻链限制用于鉴别甲状腺早期淋巴瘤和HT。2例甲状腺原发性淋巴瘤作为对照。结果所有HT标本均显示HT特征性的组织病理特点。免疫组织化学染色显示了形态不显著的LEL,其中B细胞少见,而T细胞大量增生。轻链限制检测显示浆细胞多克隆性增生。2例MALT淋巴瘤显示破坏性淋巴上皮病变、B细胞免疫表型,其中浆细胞样细胞群中显示lgκ轻链限制。结论 HT与淋巴瘤的组织病理学及免疫组织化学特征显著不同,免疫组织化学有助于鉴别。

Objective To describe the morphological and immunohistochemical characteristics of hashimoto thyroiditis（HT） and analyze the significance of light chain restriction in differential diagnosis of HT and MALT lymphoma.Methods HE-stained 30 HT paraffin samples and 2 MALT lymphoma samples were studied histopathologically.CD20,CD3,Igκ,Igλand cytokeratin were detected with immunohistochemistry.Lymphoid infiltration and lymphoepithelial lesions（LEL） were assessed.Differential diagnosis of early thyroid lymphoma and HT was made by light chain restriction.Two patients with primary thyroid lymphoma were used as controls.Results The HT samples showed the histopathological characteristics of HT.Immunohistochemial staining revealed the LEL without significant morphological change,few B-cells and massive proliferation of T-lymphocytes.Light chain restriction test demonstrated polyclonal proliferation of plasma cells.Two MALT lymphoma samples displayed destructive lymphoepithelial lesions,immunophenotype of B-cells and lgκlight chain restriction in plasmacytoid population.Conclusion The histopathological and immunohistochemical characteristics of HT and thyroid lymphoma are significantly different.Imunohistochemistry contributes to their differential diagnosis.