原发扁桃体淋巴瘤的类型构成研究:213例会诊病例分析

Study on types of structure in primary tonsillar lymphomas: A report of 213 consultation cases

目的探讨会诊病例中原发扁桃体淋巴瘤的病理类型、构成比率以及疑难会诊病例病种。方法收集北京友谊医院2005年1月至2013年11月213例原发扁桃体淋巴瘤的会诊病例,对其临床资料、病理组织学及免疫组织化学标记结果进行回顾性分析,按世界卫生组织(WHO,2008年版)分类标准进行病理诊断及分类,并与国内外原发扁桃体的淋巴瘤进行对比分析。结果 213例原发扁桃体淋巴瘤中,非霍奇金淋巴瘤(NHL)212例(99.5%),霍奇金淋巴瘤(HL)1例(0.5%)。NHL中B细胞来源183例(85.9%),T细胞或NK细胞来源29例(13.6%)。NHL中,检出率构成比居前5位的分别为弥漫大B细胞淋巴瘤-非特殊类型(DLBCL-NOS)138例(64.8%),滤泡性淋巴瘤(FL)12例(5.6%),黏膜相关淋巴组织边缘区B细胞淋巴瘤(MALT)12例(5.6%),结外NK/T细胞淋巴瘤11例(5.2%),外周T细胞淋巴瘤-非特殊类型(PTCL-NOS)9例(4.2%)。本组病例中HL仅1例(0.5%),为经典HL-混合细胞型。病变部位:左侧93例(43.7%),右侧96例(45.1%),双侧24例(11.2%)。结论 213例原发扁桃体淋巴瘤的会诊病例中,包括209例已明确分型和4例未能明确分型病例。已明确分型的病例共12种不同的病理类型。其中,NHL发病远多于HL,B细胞淋巴瘤中以DLBCL-NOS最多见,T细胞或NK细胞淋巴瘤中以结外NK/T细胞淋巴瘤最多见,HL罕见。

Objective To explore the pathological types,component ratio and diagnosis of difficult types of primary tonsillar lymphomas in consultation cases. Methods The clinical data of 213 patients with primary tonsillar lymphoma including results of HE stained specimens and their immunohistochemical examination during January 2005 to November 2013 were retrospectively analyzed. According to the new WHO classifi-cation,all data of these cases were reappraised and combined with related Chinese and foreign references. Results Among these 213 cases,spec-imens in 212 cases（99. 5%）were diagnosed as non-Hodgkin＇s lymphoma（NHL）and 1 case（ 0. 5%）as Hodgkin＇s lymphoma（HL）. Among NHL cases,85. 9% of them were B-cell lymphoma（183 cases）and 13. 6%（29 cases）were T/NK-cell lymphoma. The commonest subtypes were diffuse large B-cell lymphoma（DLBCL）,unspecified DLBCL-NOS in 138 cases（64. 8%）,follicular lymphoma（FL）in 12cases（5. 6%）,extranodal marginal zone B-cell lymphoma of MALT type in 12 cases（5. 6%）,extranodal NK/T-cell lymphoma in 11 cases（5. 2%） and peripheral T-cell lymphoma in 9 cases（4. 2%）. Hodgkin＇s lymphoma was mixed cellularity,only one case in this series was classical Hodgkin＇s lymphoma. The involved sites were left tonsil（93 cases,43. 7%）,right tonsil（96 cases,45. 1%）and both sides（24 cases,11. 2%）. Conclusion Among these 213 primary tonsillar lymphomas for consultation,the types of 209 cases had been clearly pointed out and 4 ca-ses failed in clear classification. The types have clearly been pointed out including 12 kinds of different pathological types. DLBCL is the commo-nest subtype of B-cell lymphoma,and extranodal NK/T-cell lymphoma is the commonest subtype of T-cell or NK-cell lymphoma . Hodgkin ＇s lymphoma（ HL）is very rare.