皮下脂膜炎样T细胞淋巴瘤9例临床病理分析

Clinical pathological analysis of 9 patients with subcutaneous panniculitis-like T-cell lymphoma

目的探讨皮下脂膜炎样T细胞淋巴瘤(subcutaneous panniculitis like T-cell lymphoma,SPTCL)的病理形态学特征、组织发生、诊断及鉴别诊断、治疗及预后等。方法自2015—2017年采用HE及免疫组织化学SP法对9例SPTCL进行染色,并复习相关文献。结果 9例患者均表现为不同部位的皮下结节和/或硬结节性红斑,伴或不伴淋巴结肿大;所有患者均有典型的病理组织学和免疫组织化学表型改变;肿瘤细胞浸润皮下脂肪组织,镜下见淋巴瘤细胞呈花环状围绕单个脂肪细胞排列,为中等或大细胞,染色质浓染;免疫组织化学T细胞标记物呈阳性,不表达B细胞标记物。结论 SPTCL是一种罕见的皮肤T细胞淋巴瘤,临床表现缺乏特异性,预后较差,但具有相对特征性的组织病理学表现、免疫组织化学表型,可为临床医师制定治疗策略提供帮助。

Objective To explore the pathomorphological features, histogenesis, diagnosis, differential diagnosis, treatment, and prognosis of subcutaneous panniculitis-like T-cell lymphoma（SPTCL）. Methods From 2015 to 2017 Specimens of 9 patients with SPTCL were stained by the HE and immunohistochemical SP methods. The related literature was reviewed. Results All patients showed subcutaneous nodules and/or hard nodular erythema at different sites, with or without lymphadenectasis. All patients had typical histopathological and immunophenotypic changes and tumor cells infiltrating subcutaneous adipose tissue. The lymphoma cells were arranged around a single adipocyte, medium or large cells, and chromatin stained thicker under the microscope. The immunohistochemical T-cell markers were positive, and the B cell markers were not expressed. Conclusion SPTCL is a rare cutaneous T-cell lymphoma. Its clinical manifestations are lack of specificity and poor prognosis. However, it has relatively characteristic histopathological features and immunohistochemical phenotypes. A pathological examination can provide assistance for clinicians to formulate treatment strategies.