细胞蜡块诊断淋巴瘤18例

Diagnosis of 18 cases of lymphoma using cell wax blocks

目的探讨18例浆膜腔积液中细胞学诊断淋巴瘤的临床病理学特征、免疫表型、诊断及鉴别诊断、治疗及预后。方法收集武汉大学人民医院2016年1月—2018年12月间由浆膜腔积液诊断为淋巴瘤患者18例,通过常规液基涂片、制作细胞蜡块、HE染色及免疫细胞化学染色,个别病例采用基因重排检测或流式细胞学检查,并部分对照其细胞学诊断和活检组织病理诊断的符合率。结果18例均行免疫细胞化学检测,结果均为非霍奇金淋巴瘤。其中无淋巴瘤病史的有12例:包括4例弥漫性大B细胞淋巴瘤;1例淋巴浆细胞样淋巴瘤;1例浆细胞瘤;2例T淋巴母细胞淋巴瘤;1例NK/T细胞淋巴瘤;1例外周T细胞淋巴瘤,非特殊类型;2例T细胞淋巴瘤。其余6例均有淋巴瘤病史,其中4例为弥漫性大B细胞淋巴瘤,2例为血管免疫母细胞性T细胞淋巴瘤。结论浆膜腔积液是淋巴瘤的较常见并发症,细胞病理学诊断淋巴瘤难度虽相对较大,但通过制备细胞蜡块,在镜下观察肿瘤细胞成分单一,表现为大量散在分布的不成熟淋巴样细胞,细胞之间无黏附性,同时结合免疫细胞化学染色等相关检测方法,可明确诊断,值得推广。

Objective To investigate the clinicopathological features,immunophenotype,diagnosis,differential diagnosis,treatment and prognosis of cytological diagnosis of serous cavity effusion from 18 cases of lymphoma.Methods 18 patients with lymphoma diagnosed by serous cavity effusion from January 2016 to December 2018 in Renmin Hospital of Wuhan University were collected,these cases were performed with conventional liquid-based smear,cell wax block,HE staining and immunocytochemical staining,seldom cases were subjected to gene rearrangement detection or flow cytology.And the coincidence rates of cytological diagnosis and biopsy histopathological diagnosis were compared.Results All 18 cases were performed with immunocytochemical staining,all of which were diagnosed as non-Hodgkin’s lymphoma.There were 12 cases without lymphoma history,including 4 cases of diffuse large B cell lymphoma;1 case of lymphoplasmacytoid lymphoma;1 case of plasmacytoma;2 cases of T lymphoblastic lymphoma,1 case of NK/T cell lymphoma;1 case of peripheral T-cell lymphoma,not otherwise specified;2 cases of T-cell lymphoma.The remaning 6 cases had known lymphoma history,4 cases of which were diffuse large B cell lymphoma,2 cases of angioimmunoblastic T cell lymphoma.Conclusion Serous effusion is a common complication of lymphoma,and the cytopathological diagnosis of lymphoma is relatively difficult.However,the diagnosis can be confirmed by observing the morphology of tumor cells through cell blocks(the tumor cell composition is uniform under the microscope,showing a large number of immature lymphoid cells scattered in the distribution,no adhesion between cells)and combined with immunocytochemical staining and other related detection methods,the diagnosis can be confirmed,which is worth promoting.