脾脏非霍奇金淋巴瘤的临床病理特征及其与免疫表型的关系

The relationship of clinicopathology and immunophenotypes in non-Hodgkin's lymphomas of the spleen

目的 探讨脾脏非霍奇金淋巴瘤 (NHL)的临床病理特征及其与瘤细胞属性的关系。方法 复习 19例NHL的临床病理资料、进行随访、并用SP法行CD45RO、CD2 0及髓过氧化物酶等免疫组织化学染色 ,对CD45RO阳性的病例加作CD8、CD5 6、TIA - 1、CD6 8免疫表型检测和EBER原位杂交。结果 (1) 19例均有脾脏肿大 ,其中 5 2 .6 % (10 / 19)有脾脏占位病变 ,(2 ) 73 .7% (14/ 19)为B细胞性 ,滤泡型 5例 ,弥漫型 9例 ;中心母细胞性 8例 ,中心母细胞 /中心细胞性 3例 ,小细胞性 4例 ;10例原发脾脏NHL均为B细胞性 ;(3) 2 6 .3% (5 / 19)为外周T细胞性 ,大细胞性 4例 ,小细胞性 1例 ;TIA- 1阳性 3例 ,其中CD8阳性和CD5 6阳性各 1例 ,且均为EBER1/ 2阳性 ,余 1例为CD8、CD5 6、EBER均阴性 ;均为继发脾脏NHL ;(4 ) 73.7% (14/ 19)有随访 ,9例生存者中有 8例为原发脾脏NHL ,生存时间为 8个月～ 10年不等 ;5例死亡病例均为继发脾脏NHL ,生存时间为 2～ 6个月不等。结论 脾脏NHL的临床病理表现与瘤细胞的属性有一定关系 ,原发脾脏NHL的预后明显优于继发脾脏NHL ,对原发脾脏NHL的诊断应从严把握。

Objective To investigate the relationship between clinicopathologic features and immunophenotypes in non Hodgkin's lymphoma (NHL) of the spleen. Methods Clinicopathologic analysis and follow up; immunohistologic staining by SP method and EBER in situ hybridization. Results (1) Splenomegaly was found in all 19 cases of spleen NHL, 10 of the 19 (52.6%) cases had masses or a mass in their enlarged spleen; (2) 14 of the 19 (73.7%) cases were of B cell type (including 5 cases of follicular type and 9 cases of diffuse type) ,in which 8 cases were centroblastic, 3 of centroblast/centrocyte and 4 cases of small lymphocyte types; all 10 cases of primary splenic lymphomas (PSL) were B cell type; (3) 5 of the 19 cases (26.3%) had peripheral T cell origin, including 4 cases of large cell type and 1 case of small cell type; of the 3 TIA 1 positive cases, 2 were also positive for EBER 1/2 (one CD 8+ and another CD56+), the remaining case was CD8-, CD56-, EBER1/2-; all 5 cases were secondary NHL of the spleen; (4) Follow up data were obtained for 14/19 cases (73.7%). 8 of 9 surviving cases were primary NHL. The range of survival period varied from 8 to 10 years. All 5 deceased cases had secondary NHL and their survival period was 2 to 6 months. Conclusions Some relationship exists between the clinicopathology and origin of the tumor cells in splenic NHL, the prognosis of primary NHL is better than that of the secondary NHL and the diagnosis of primary NHL should be made with discretion.