淋巴瘤误诊4例临床病理分析

Analysis of 4 cases of lymphoma misdiagnosed

目的提高淋巴瘤的病理诊断水平。方法回顾性分析4例淋巴瘤误诊病例的临床资料及组织病理学切片,增加免疫标记予以协助确诊并复习相关文献。结果例1,低级别滤泡性淋巴瘤(follicular lymphoma,FL)误诊为淋巴结淋巴组织反应性增生,与对BCL-2阴性低级别FL的形态学认识不足有关。例2,乳腺ALK-1^+间变性大细胞淋巴瘤小细胞变异型,误诊为套细胞淋巴瘤,与对ALK-1^+的间变性大细胞淋巴瘤小细胞变异型的形态学认识不足和对免疫标记Cyclin D1(+)定位误判有关。例3,结外NK/T细胞淋巴瘤、鼻型,误诊为直肠黏膜溃疡伴穿孔,与诊断时对增生、浸润细胞观察不细,缺乏相关标志物协助有关。例4,淋巴结边缘区淋巴瘤,误诊为反应性增生,与对边缘区淋巴瘤形态学认识不足有关。结论淋巴瘤的诊断是建立在形态学基础之上,并合理选择免疫标志物、密切结合临床资料综合分析的结果,必要时借鉴基因学及遗传学检测协助诊断,必须提高对该类淋巴瘤的认识,提高诊断水平,以指导临床为患者提供规范化、个体化治疗。

Purpose To improve the level of pathological diagnosis of lymphoma. Methods The clinical data and histopathological sections of 4 cases of lymphoma misdiagnosed were reviewed, the immune markers was added to assist in the diagnosis and the relevant literatures were also reviewed. Results Case 1, low-grade follicular lymphoma （FL） was misdiagnosed as reactive hyperplasia of lymph node, which was related to the lack of morphological awareness of BCL-2 negative low grade FL. Case 2, the breast anaplastie large cell lymphoma （ALCL） of ALK-1 ＋ , small cell variant, which misdiagnosed as mantle cell lymphoma, was related to the lack of morphological understanding of small cell variant of ALCL （ ALK-1 ＋ ） and misreading of the location of Cyclin D1 （ ＋ ）. Case 3, NK/T cell lymphoma, nasal type, which misdiagnosed as rectal mucosa ulcer with perforation, was attributed to misread the prolifera- tion and invasive cells, and the lack of relevant markers for the diagnosis. Case 4, marginal zone lymphoma of the lymph nodes was misdiagnosed as reactive hyperplasia, which attributed to the lack of understanding of the morphology of marginal zone lymphoma. Conclusion The diagnosis of lymphoma is established on the basis of morphology, the rational selection of immune markers and the results of the comprehensive analysis of the clinical data. When necessary, genetics and genetic testing may helpful for the diagnosis. We must improve the understanding of this type of lymphoma, improve the level of diagnosis, in order to guide the standardized and personalized clinical treatment of patients.