T-区淋巴瘤临床及病理形态学探讨

A Clinico-Pathological Investigation of T-zone Lymphomas

自从Lukes和Collins等(1974)提出恶性淋巴瘤的功能性分类后,我们即注意到T-淋巴细胞瘤的形态特点。根据Lennert等对T-区淋巴瘤所描述的临床及病理组织形态学特征,将过去我院病理诊断为恶性淋巴瘤的病例,进行回顾性复查,并把临床及组织形态符合T-区淋巴瘤的病例加以详细观察分析,目的在于寻求T-区淋巴瘤瘤细胞的特点,以提高对T-淋巴细胞瘤的认识。

Among all biopsy proved cases of malignant Iymphomas encounted in the period October 1964 to October 1979 , 8 cases were histologically compatible with the T-zone lymphoma described by Lennert.The results of the clinical and pathological investigati ons of these 8 cases are as follows:As 92 Cases of Hodgkin's lymphomas were excluded from 319 malignant lymphomas, T-zone lymphomas (8 cases) constituted 3.1% of all non-Hodgkin's, lymphoma s ( 257 cases). There were 6 males and 2 females, most of them are children and adolescents, the youngest was 16 months and the oldest was 61 years of age.There was generalized enlargement of the lymph nodes in all 8 cases. 7 cases showed mediastinal masses roentgenologically. There was dyspnea and cough in 4 cases, facial edema in 2, tumors of the oro-pharyngeal ring in 5. Three cases had leucocytosis with a reactive leucopoiesis in the bone marrow. Enlargement of the lymph nodes and the symptoms disappeared in 2 cases which received chemotherapy at an early stage of the disease,5 cases died,l case failed to be followed-up.Histopathological features. The nuclei of the tumor cells were moderate in size, pleomorphic or irregularly round, convoluted or non-convoluted. The nuclei were faint and the chromatin was dispersed and finely granular. The cytoplasm was moderate in amount, with indistinct cell borders. There were reticulum cells, plasma cells, eosi-nophiles and epithelial strand-like proliferating small vessels scatt-ered diffusely between the tumor cells. Predominance of T-zone affection of the neoplastic process may be observed in some early and minimal lesion.Lennert was of the opinion that T-zone lymphoma definitely originated from T-lymphocytes. Matter postulated that the evolution of T-lymphocytes is in the following sequence:non-functional undifferen-tiated T1, lymphoblastoid T2 and finally, functional small T3. On the basis of the present study, the author postulated that malignant Iymp-homas originating from T-lymphocytes may have been derived from the above mentioned variously differentiated threetypes of cells and may be classified as well-defferentiated. poorly-differentiatiated and undiffere-ntiated.