不一致性淋巴瘤1例并文献复习

Clinicopathologic features of discordant lymphoma: report of a case and review of the literature

目的探讨不一致性淋巴瘤的临床病理学特征。方法对1例不一致性前纵隔弥漫性大B细胞淋巴瘤和右锁骨上淋巴结结节硬化型Hodgkin淋巴瘤的病理特征进行观察并复习相关文献。结果患者女性,34岁,前纵隔无痛性包块及右锁骨上淋巴结肿大。镜下观察前者中等大小或较大的瘤细胞呈弥漫状排列,胞质丰富淡染,核呈圆形泡状,核分裂象多见;后者淋巴结由胶原纤维分隔成结节状,内见散在的陷窝细胞、少量R-S细胞、爆米花细胞等,背景为大量炎细胞。免疫表型:前者Pax-5、CD20、CD79a均呈强阳性,Ki-67增殖指数为80%;后者Pax-5、CD30肿瘤细胞均呈强阳性,Ki-67增殖指数为60%,CD15部分肿瘤细胞呈阳性。结论不一致性淋巴瘤极为罕见,表现形式多样,临床特征及病理学特征因各个部位的淋巴瘤类型不同而各异,治疗方案及预后根据恶性程度更高的类型而定。

Purpose To explore the clinicopathologic features of discordant lymphoma. Methods The pathologic feature of a case of discordant lymphoma was studied and the related literatures were reviewed. Results A 34-year-old women presented a painless mass in the frontal mediastinum and fight supraclavicular lymphnodes. Macroscopically, the mediastinal mass was infiltrated by a diffuse pro- liferation of medium-sized cells, empty and bright cytopalsm, a large round nucleus. The fight supraclavicular lymph node was separa- ted by large annular fibrotic bands and infiltrated by lacunar cells, R-S cells, multinucleated giant cells and inflammatory cells. The tumor cells in the mediastinal mass showed positive staining for Pax-5, CD20, CD79a and Ki-67 （80%）. The tumor cells in fight su- praclavicular lymph node showed positive staining of Pax-5, CD30, CD15 and Ki-67 （60%）. Conclusion Discordant lymphoma is extremely rare and diverse. The clinical manifestations and pathological features are due to the type of lymphoma, and the treatment op- tions and prognosis are determined according to the higher malignancy type.