眼附属器淋巴瘤组织病理学及免疫表型研究

Histopathology and immunophenotype of ocular adnexal lymphoma

目的 探讨眼附属器淋巴瘤的临床特点、组织学分型及免疫表型。方法 收集眼附属器淋巴瘤病例 3 3例 ,采用HE染色常规观察形态学特点。采用多种抗体标记B淋巴细胞 ,行T细胞鉴别 ,检测细胞增殖活性及探讨B细胞起源 ,进行免疫组织化学染色诊断和鉴别诊断、判定免疫表型、细胞分化及增殖状态。结果 2 9例 (87 9% )瘤细胞B细胞标记物CD2 0、CD79a阳性 ,并出现κ或λ的克隆性增生 ,诊断为结外边缘区B细胞淋巴瘤 ,黏膜相关淋巴组织型 (MZL MALT)。 2例 (6 1% )诊断为弥漫性大B细胞淋巴瘤。 1例 (3 % )为组织学典型的浆细胞瘤分化。 1例 (3 % )为此部位极为罕见的T细胞淋巴瘤 ,免疫表型为T细胞分化。结论 MZL MALT型淋巴瘤是眼附属器淋巴瘤中最常见的一类 ,免疫组化抗体标记在诊断和鉴别诊断中起重要作用。

ObjectiveTo study the histopathological classification and immunophenotype of the ocular adnexal lymphoma.MethodsThe monoclonal antibodies CD20,CD79a,CD5,CD10,CD23,Bcl 2,Cyclin D1 were used for expression of B cell and CD45RO,TIA for T cell, the CD68 for histiocyte and CD21 for follicular dendritic cell.The polyclonal antibodies CD3ε were used for T cell expression and κ,λ for B cell expression.The Ki 67 was used for tumor cells proliferation and Bcl 6 for the neoplastic cell origin. The immunohistochemical staining was used to observe the immunophenotype and cell differentiation and to classify its subtypes according to the WHO classification.ResultsThe tumor cells of 29 cases expressed B cell makers(CD20,CD79a were positive) and showed immunoglobin light chain restriction(κ or λ positive), which demonstrated extranodal marginal zone B cell lymphoma, mucosa associated lymphoid tissue type(MZL MALT)(87 9%).Two cases were diffuse large B cell lymphoma(6 1%),in which the tumor cells overexpressed Ki 67 and a few cells weakly positive for Bcl 6.One case was typical plasmacytoma (3 0%) in histopathology.Another one case was very rare type of T cell lymphoma(3 0%), which was morphologically polymorphic cells,infiltrated into the vessels and expressed the T cell markers(CD3ε and TIA were positive).ConclusionThe extranodal marginal zone B cell lymphoma,mucosa associated lymphoid tissue type(MZL MALT)is most common type in the ocular adnexa.The immunohistochemical analysis is more helpful in confirming the diagnosis and classifing the subtypes.