27例血管免疫母细胞性T细胞淋巴瘤的免疫表型分析

Angioimmunoblastic T cell lymphoma: immunohistochemical analysis of 27 cases

目的:分析27例血管免疫母细胞性T细胞淋巴瘤(angioimmunoblastic T-cell lymphoma,AITL)的免疫表型,重点探讨CXCL-13、PD-1、CD10、bcl-6在其诊断中的作用,其中3例CD30阳性病理的诊断意义及问题。方法:收集黄石市第二医院病理科2009年1月至2015年7月间诊断的27例血管免疫母细胞性T细胞淋巴瘤,对其进行常规形态学和免疫学表型分析,观察对预后的影响。结果:27例血管免疫母细胞性T细胞淋巴瘤中,免疫组织化学表达阳性:CD3(27/27)、CXCL13(27/27)、PD-1(27/27)、C D 1 0(2 0/2 7)、b c l-6(2 3/2 7)其中有3例C D 3 0散在阳性(3/2 7),C D 2 0(0/2 7),C D 4和C D 8阳性细胞混合组中,20例CD4阳性细胞占优势,5例CD8阳性细胞占优势,1例CD4、CD8全阴性,1例C D 4、C D 8全阳性。C D 2 1滤泡树突细胞阳性,并显示明显的围绕血管特征,同时也提示在肿瘤中均存在滤泡树突网。结论:AITL是一种来源生发中心辅助性T细胞的高度侵袭性肿瘤。CXCL13PD-1CD10bcl-6在诊断中为有用标记物,四种联合应用更能提示诊断。本组3例AITL中存在CD30阳性细胞除鉴别诊断外,其临床意义有待研究。

Objective：To detect the meaning of CXCL13, PD-1, CD10 and bcl-6 on the diagnosis of angioimmunoblastic T cell lymphoma （AITL）. Methods：27 cases of AITL retrieved from in-house and consultation ifles （from January 2009 to July 2015） were reviewed with emphasis on the clinicopathologic characteristics, immunophenotypes and the prognostic impact. Results：Immunophenotypes：CD3 （27/27）, CXCL13 （27/27）, PD-1 （27/27）, CD10 （20/27）, bcl-6 （23/27）, CD30 focal positive in 3 cases （3/27）, CD20 （0/27）. In CD4 and CD8 positive AITL cases：20 cases were CD4 dominantly expressed, 5 cases were CD8 dominantly expressed, one case was both CD4 and CD8 positive. The staining of CD21 showed follicular dendritic cell positive, and reveal the pattern with the cells arranged around the blood vessel, which prompting the exist of follicular dendritic in tumor cells. Conclusion：AITL is the type of highly invasive tumor and derived from helper T cells of germinal center. Application of CXCL13, PD-1, CD10 and bcl-6 immunostains offers a reasonable marker for diagnosis, and combination of the four antibodies can improve the standard of diagnosis. Moreover, the role of CD30 immunoreactivity can give a differentiation diagnosis in AITL, besides the clinical significance needs more research.