间变性淋巴瘤激酶阴性系统性间变性大细胞淋巴瘤穿刺活检病理诊断分析

ALK-negative systemic anaplastic large cell lymphoma:a pathological diagnosis study of specimens obtained from needle biopsy

目的探讨间变性淋巴瘤激酶(ALK)阴性系统性间变性大细胞淋巴瘤(ALK阴性SALCL)穿刺针活检标本的病理诊断和鉴别诊断。方法收集南阳市中心医院2019年1月至2022年1月经穿刺活检标本确诊为ALK阴性SALCL4例,对其中临床病理资料完整的2例进行分析并行文献复习。结果病例1,女性,69岁,首发为左颈部淋巴结肿大;病例2,男性,72岁,双腹股沟淋巴结肿大。2例高倍镜下可见标志性肿瘤细胞,细胞质丰富淡染,核包括肾形、马蹄形等多种形态。病例1细胞具有显著多形性;病例2低倍镜下见单行性瘤细胞呈片巢状黏附性生长,形态似尿路上皮癌。免疫组化染色2例均LCA(阳性),CD30(阳性),ALK(阴性),CK(阴性),CD20(阴性),PAX5(阴性),CD45RO(阴性).经分子检测,2例TCR克隆性基因重排(阳性),病例1检测到TP63基因重排,病例2有DUSP22-IRF4基因重排。结论ALK阴性SALCL临床少见,穿刺活检易误诊为低分化癌等多种低分化恶性肿瘤,熟悉其临床病理特点并识别出标志性肿瘤细胞,合理选择免疫组化抗体是确诊该肿瘤的关键。

Objective To explore the pathological diagnosis and differential diagnosis of ALK-negative(ALK-)systemic anaplastic large cell lymphoma(ALK-SALCL)of which materials obtained from needle biopsy.Methods Four cases of AlK-negative SALCL were collected from Nanyang Central Hospital from January 2019 to January 2022.Two cases with complete clinicopathological data were analyzed and literature was reviewed.Results Case 1 was a 69-year-old female with left cervical lymph node enlargement.Case 2 was a 72-year-old male with double inguinal lymph node enlargement.At high magnification,the cytoplasm was rich and light staining,and the nuclei were kidney-and horseshoe-shaped.In case 1,the cells showed significant pleomorphism.In case 2,at low magnification,solitary tumor cells were observed to be nestlike adherent growth,resembling urothelial carcinoma.Immunohistochemical staining of 2 cases were LCA(positive),CD30(positive),ALK(negative),CK(negative),CD20(negative),PAX5(negative),CD45RO(negative).Molecular detection showed that clonal gene rearrangement of TCR was positive in 2 cases.TP63 gene rearrangement was detected in case 1,and DUSP22-IRF4 gene rearrangement was detected in case 2.Conclusion ALK-SALCL is a rare malignancy in clinical practice,which is easily misdiagnosed as metastatic carcinoma or other non lymphoid neoplasm on needle biopsy specimens.Familiarizing the pathological features especially identifying"hallmark"cells and accurate application of immunohistochemical anti-bodies is the key to definite diagnosis of the tumor.