12例卵巢原发性淋巴瘤临床病理学研究

Primary ovarian lymphoma:a clinicopathological study of 12 cases

目的:研究12例卵巢原发性淋巴瘤的临床病理学特征。方法:分析12例卵巢原发性淋巴瘤的组织病理学、免疫表型、原位杂交、荧光原位杂交特点及诊断与鉴别诊断要点。结果:病例1~7肿瘤由大淋巴细胞构成,瘤细胞表达广谱B细胞标记CD20和PAX5,Ki-67增殖指数大于40%,诊断为弥漫大B细胞淋巴瘤。病例8~11肿瘤细胞由单形性中等大小弥漫生长的富于黏附性的淋巴细胞组成,“星空”现象多见。瘤细胞CD20、BCL6和CD10阳性,肿瘤细胞c-myc高表达,Ki-67增殖指数接近100%,荧光原位杂交提示MYC基因重排,诊断为Burkitt淋巴瘤。病例12由幼稚的小淋巴细胞组成,细胞质稀少蓝灰色,肿瘤细胞CD20、CD10、CD34、CD117和TDT阳性,诊断为B淋巴母细胞淋巴瘤。结论:卵巢原发性淋巴瘤根据临床病程病理分为弥漫大B细胞淋巴瘤、Burkitt淋巴瘤和B淋巴母细胞淋巴瘤,其诊断、鉴别诊断与病理分型依赖于临床、病理组织形态学、免疫组织化学及分子遗传学。

Objective:To explore the clinicopathologic characteristics of 12 cases of primary ovarian lymphoma.Methods:The histomorphology,immunophenotype,in situ hybridization,fluorescence in situ hybridization(FISH),diagnostic and differential diagnostic features of 12 patients with primary ovarian lymphoma were analyzed.Results:A diffuse proliferation of large lymphoid cells was seen in cases 1-7.The neoplastic cells typically expressed pan-B-cell markers such as CD20 and PAX5,and the Ki-67 proliferation index was greater than 40%,which led to diagnosis of diffuse large B-cell lymphoma.The tumor cells in cases 8-11 were medium sized and showed a diffuse monotonous pattern of growth.The tumor cells appeared to be cohesive.A so-called starry sky pattern was usually present.The tumor cells typically expressed CD20,BCL6 and CD10,and the tumor cell highly expressed c-myc,and the Ki-67 proliferation index was nearly 100%,and fluorescence in situ hybridization suggested that MYC gene was rearrangeed,which led to diagnosis of Burkitt lymphoma.Case 12 was composed of small sized blast cells with scant bluish-grey cytoplasm.The tumor cells were positive for CD20,CD10,CD34,CD117 and TDT,and was diagnosed as B-lymphoblastic lymphoma.Conclusion:Primary ovarian lymphoma is very rare.The diagnosis,differential diagnosis and histological type of primary ovarian lymphoma needs a constellation of clinical findings,pathological histomorphology,immunohistochemistry and molecular genetics.