肺黏膜相关淋巴组织边缘区B细胞淋巴瘤合并肺鳞状细胞癌临床病理观察

Primary mucosa-associated lymphoid tissue lymphoma accompanying lung squamous cell carcinoma: a clinicopathologic analysis

目的探讨肺黏膜相关淋巴组织边缘区B细胞(MALT)淋巴瘤合并肺鳞状细胞癌的临床表现、病理特点、免疫组化染色及鉴别诊断,提高对它的认识。方法分析1例胸腔积液患者的临床病史及影像学资料,行组织学形态、细胞病理学和免疫组化染色观察,并进行相关文献复习。结果患者男性,65岁。因低热、乏力、咳血1月余入院。胸部CT示右肺中叶肺不张,左肺上叶前段球形影,右侧胸腔积液。支气管镜下见右肺中叶支气管狭窄,黏膜面见乳头状突起。B超示右胸腔内较多积液。支气管活检组织镜下,支气管黏膜下小淋巴细胞弥漫性浸润生长,乳头由淋巴细胞、单核样细胞、浆细胞等组成,细胞大小较一致,胞质少,核染色深,偶见核仁,未见明显滤泡或生发中心,部分浸润支气管上皮和上皮下腺体,形成淋巴上皮内病变;部分支气管上皮细胞核大、深染,有异形,可见核分裂,病变累及表皮全层,形成原位鳞状细胞癌,局灶突破基底膜,向下浸润生长。免疫组化染色:肿瘤样淋巴细胞CD20、CD79a、LCA、bcl-2均(+),鳞状细胞癌细胞CK-广、p63、p40均(+)。胸水沉渣石蜡切片见细胞丰富,肿瘤细胞黏附性差,多单个散在分布,细胞大小较一致,形状不规则,瘤细胞核异型明显,呈圆形或椭圆形,有切迹、裂沟,并可见核仁。免疫组化染色:LCA、CD20、CD79a均(+)。结论肺MALT淋巴瘤合并肺鳞状细胞癌极其少见,明确诊断比较困难。典型的病理组织学形态和免疫组化染色是明确诊断的依据。

Objective To study the clinicopathological features, immunohistochemical findings, diagnosis and prognosis of primary mucosa-associated lymphoid tissue lymphoma accompanied with lung squamous cell carcinoma. Methods A 65 year old man with pleural fluid was admitted to this hospital for further evaluation and treatment. The clinical data, computerized tomographic checkup, pathological morphology and immunohistoehemistry of the case were discussed. The related literatures were reviewed. Results A 65 - year - old patient was admitted to the hospital because of low-grade fever, hypodynamia and coughing with blood for one month. The chest computerized tomograph showed pulmonary closure of the middle lobe and a round-shape shadow in apical segment of the left upper lobe trachea. Bronehoscopy showed stenosis and a few small protrusions in middle lobe of right lung. B-type ultrasonography showed there was much pleural fluid in the right thoracic cavity. Microscopic histology showed infiltration of flake small round malignant cells under bronchial mucosa. The Fleming＇ s center and follicle could not been found. Lymphoepithelial lesions were identified in it. Squamous cell carcinoma could been seen in the bronchial mucosa. Immunohistochemistry showed that tumor cells were positive for CD20, CD79a, LCA, bcl-2 proteins and squamous carcinoma cells were positive for CK and p63 proteins. Sediment of pleural fluid showed that there were an abound of cells, with less adhesiveness, diffused distribution, and inequality of size. Tumor nuclei were round or oval, with notch or fissure, and visible nucleoli. Immunohistochemistry was the same as before. Conclusions Primary mucosa-associated lymphoid tissue lymphoma complicated with lung squamous cell carcinoma is an extremely rare. The diagnosis is difficult sometimes. Typical histopathology and immunohistochemistry are needed to make a definite diagnosis.