孤立性浆细胞瘤8例临床病理分析

Solitary plasmacytoma:a clinicopathological analysis of 8 cases

目的分析孤立性浆细胞瘤(SP)的临床病理特征,并探讨EB病毒在SP诊断及鉴别诊断中的意义。方法回顾性分析了2012-11—2020-01在陕西省人民医院就诊的8例SP患者的临床病理资料,并应用原位杂交技术检测其EB病毒表达状况。结果8例SP患者中,5例为髓外浆细胞瘤(EMP),3例为骨的孤立性浆细胞瘤(SPB)。肿瘤组织由肿瘤性的浆样细胞组成,根据瘤细胞分化程度,本组8例SP中2例被进一步诊断为间变性浆细胞瘤。8例SP均呈轻链限制性,不同程度表达浆细胞标记CD38、CD138、MUM1,及B细胞标记CD79a,均不表达CD20。应用原位杂交方法检测EB病毒,1例EBER阳性。结论SP的临床及影像学表现均缺乏特异性,其诊断主要靠组织病理学证实。本组8例中,通过原位杂交检测,仅发现1例EBV阳性。复习文献多为个案报道,且结论不一致,因此,尚不能得出EBV是SP发病的直接原因,亦不能推测EBV感染与SP的预后密切相关。

Objective To analyze the clinicopathological features of solitary plasmacytoma(SP)and to explore the significance of EB virus in the diagnosis and differential diagnosis of SP.Methods The clinicopathological data of 8 patients with SP treated in Shaanxi Provincial People's Hospital from November 2012 to January 2020 were analyzed retrospectively,and the expression of EB virus was detected by in situ hybridization.Results Among the 8 patients with SP,5 were extramedullary plasmacytoma(EMP),and 3 were solitary plasmacytoma of bone(SPB).The tumor tissue was composed of neoplastic plasma-like cells.According to the degree of tumor cell differentiation,4 of the 8 cases of SP were further diagnosed as anaplastic plasmacytoma.All the 8 cases of SP showed light chain restriction,and the plasma cell markers CD38,CD138,MUM1,and B cell labeled CD79a in different degrees.They all did not express CD20.EB virus was detected by in situ hybridization,and one case was EBER positive.Conclusion The clinical and imaging findings of SP are not specific,and its diagnosis is mainly confirmed by histopathology.Among the 8 cases in this group,only one case was positive for EBV by in situ hybridization.Most of the reviewed literatures are case reports,and the conclusions are inconsistent.Therefore,it can not be concluded that EBV is the direct cause of SP,and it can not be inferred that EBV infection is closely related to the prognosis of SP.