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具有惰性表现的NK/T细胞淋巴瘤伴CD30阳性大细胞转化一例并文献复习 被引量:2

Inert natural killer/T-cell lymphoma with large cell transformation: report of one case and review of literature
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摘要 目的探讨具有惰性表现的NK/T细胞淋巴瘤伴CD30阳性大细胞转化患者的病理学特征.方法收集苏州大学附属第三医院诊断的1例具有惰性表现的NK/T细胞淋巴瘤伴CD30阳性大细胞转化患者的相关病理学资料,观察该患者病理组织学特点及免疫组织化学表型,并进行文献复习.结果该患者于2006年4月和2017年3月两次行病理活组织检查,第1次为骶管内肿瘤切除术,镜下示弥漫一致的小淋巴样细胞增生,核不规则,染色质颗粒状,核仁不明显,局灶坏死.免疫组织化学示CD20(-)、CD3(-)、ALK(-)、CD30(-)、CD43(+)、CD2(+)、CD56(+)、TIA-1(+)、GrB(+)、CD4 (-)、CD8(-),诊断为结外NK/T细胞淋巴瘤,鼻型.第2次为左颈部淋巴结活组织检查,镜下示小淋巴细胞背景中散在大细胞浸润,大细胞胞质丰富,核大、不规则,部分核折叠,核仁明显,核分裂易见,脉管内可见瘤栓,小淋巴细胞大小较一致,形态较规则,胞质少,核分裂罕见.免疫组织化学结果显示AE1/AE3(-)、CD20(-)、CD3(+)、ALK(-)、CD30(+)、CD43(+)、CD2(+)、EMA(-)、Ki-67(70%+)、CD56(+)、TIA-1(+)、GrB(+)、CD4(-)、CD8(-),诊断为结外NK/T细胞淋巴瘤,鼻型,复发.两次活组织检查中EB病毒编码的小分子RNA(EBER)检测均为阳性.结论具有惰性表现的结外NK/T细胞淋巴瘤非常罕见,其发病与EB病毒感染密切相关,诊断必须依赖于病理组织学表型及免疫组织化学. Objective To investigate the clinicopathologic features of inert natural killer/T (NK/T)-cell lymphoma with CD30-positive large cell transformation. Methods The pathological data of one patient diagnosed as inert NK/T-cell lymphoma with CD30-positive large cell transformation in the Third Hospital Affiliated to Soochow University from April 2006 to March 2017 were collected. The histopathological features and immunohistochemical phenotype of the patient were observed and followed up. Results The patient received biopsy twice in April 2006 and March 2017. The first tumorectomy in sacral canal showed that diffuse and small lymphoid cell hyperplasia, irregular nucleus, granular chromatin, unobvious nucleolus, focal necrosis. Immunohistochemistry showed CD20(-), CD3(-), ALK(-), CD30(-), CD43(+), CD2(+), CD56(+), TIA-1(+), GrB(+), CD4(-), CD8(-). Finally, the patient was diagnosed as extranodal NK/T-cell lymphoma, nasal type. The microscopic examinations after the second left cervical lymph node biopsy showed large cells infiltrated into the background of small lymphocytes, plentiful cytoplasm, large nuclei, irregular nucleus, part of nuclear folding, obvious nucleolus, mitotic figures visible, visible intravascular tumor suppository, consistent small lymphocytes. Blood vessel invasion could be seen, as wells as consistent small lymphocytes, regular form, less cytoplasm, rare nuclear fission. Immunohistochemistry showed AE1/AE3(-), CD20(-), CD3(+), ALK (-), CD30(+), CD43(+), CD2(+), EMA(-), Ki-67(70%+), CD56(+), TIA-1(+), GrB(+), CD4(-), CD8(-). Finally, the patient was diagnosed as NK/T-cell lymphoma, nasal, recurrence. In situ hybridization showed EB virus encoded RNA (EBER) was positive for two biopsies. Conclusions Inert extranodal NK/T-cell lymphoma is very rare. The pathogenesis is closely related to EB virus infection. Its diagnosis must rely on histopathology and immunohistochemistry.
作者 王辉 谢军 李青 Wang Hui;Xie Jun;Li Qing(Department of Pathology,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China)
出处 《白血病.淋巴瘤》 CAS 2019年第6期350-353,共4页 Journal of Leukemia & Lymphoma
基金 常州市卫生局重大项目(ZD201618) 常州市科技应用基础项目(CJ20179035).
关键词 NK/T细胞淋巴瘤 鼻型 惰性 EB病毒 Natural killer/T-cell lymphoma,nasal type Inert Epstein-Barr virus
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