单形性嗜上皮性肠道T细胞淋巴瘤3例临床病理观察

Monomorphic epitheliophilic intestinal T-cell lymphoma: a clinicopathological study of three cases

目的探讨单形性嗜上皮性肠道T细胞淋巴瘤(MEITL)的临床病理特征、诊断与鉴别诊断,以提高对单形性嗜上皮性肠道T细胞淋巴瘤的认识。方法收集本院诊断的3例MEITL的临床资料,进行组织学及免疫组化观察,并复习相关文献,归纳该肿瘤的诊断和鉴别诊断要点。结果镜下见淋巴细胞弥漫浸润肠壁全层,肠黏膜糜烂伴溃疡形成,可见淋巴上皮病变,肿瘤细胞大小较为一致,细胞中等大小,核仁可见,细胞膜不规则,胞质淡染,可见核分裂象及核碎裂。免疫组化:3例均表达CD3、CD2、CD7、CD8、CD56、TIA-1,均不表达CD20、PAX-5、CD30、EBER、H3k36me,Ki-67增殖指数约70%,p53散在弱阳。结论MEITL较为罕见,临床症状不特异,早期易漏诊,晚期易与其他恶性肿瘤混淆,大多为术后病理诊断明确。

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of monomorphic epitheliophilic intestinal T-cell lymphoma(MEITL) in order to improve the understanding of rhis type of lymphoma.MethodsThe clinical data of 3 cases of MEITL diagnosed in our hospital were collected, histological and immunohistochemical observation were performed, and relevant literature was reviewed to summarize the main points of diagnosis and differential diagnosis of MEITL. Results Under the microscope, lymphocytes permeated the entire intestinal wall, intestinal mucosal erosion accompanied by ulcer formation, and lymphoepithelial lesions were observed.Tumor cells were relatively uniform, medium in size, visible nucleoli, irregular cell membranes, pale cytoplasm, and mitotic figures and nuclear fragmentation were observed. Immunohistochemical analysis showed that CD3, CD2, CD7,CD8, CD56 and TIA-1 were expressed in all 3 cases, while CD20, PAX-5, CD30, EBER and H3k36me were not expressed in all cases. Ki67 index was about 70%, and p53 was weakly positive. Conclusion MEITL is relatively rare,the clinical symptoms are not specific, and thus the early stage is easy to miss diagnosis;the late stage is easily confused with other malignant tumors, but most of the postoperative pathological diagnosis is clear.