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姓 名: | ××× | 性别: | 男 | 年龄: | 42 |
标本名称: | 淋巴结活检 | ||||
简要病史: | 体检发现左腹股沟淋巴结肿大,成串,直径1.5-2.5 cm。无发热、无肝脾肿大,无消瘦、外周血检查正常。B2-微球蛋白轻度升高。其余检查正常。 | ||||
肉眼检查: | 淋巴结1.5 X 2.0 cm,切面灰红色,均质性。 图1-6HE;图7CD3;图8CD20;图9CD79a;图10CD4; 图11CD8,图12LCA; 图13-14 CD43 |
wangdingding 离线
Am J Clin Pathol. 1999 Apr;111(4):488-94.
Lai R, Weiss LM, Chang KL, Arber DA.
Division of Pathology, City of Hope National Medical Center, Duarte, California 91010, USA.
CD43 expression on B cells is an immunophenotypic feature suggestive of malignancy. In the light of its diagnostic importance, we performed a comprehensive survey of CD43 expression in various types of non-Hodgkin lymphoma (NHL) and determined the frequency of its expression in routinely fixed paraffin-embedded tissues. Tissue sections in 742 cases of NHL, pretreated by the heat-induced epitope retrieval technique, were immunostained using an anti-CD43 antibody. Three categories of CD43 positivity were found: (1) more than 90% of T-cell lymphoma, mantle cell lymphoma, B-cell small lymphocytic lymphoma, and Burkitt lymphoma cases were positive; (2) 20% to 40% of nodal and extranodal marginal zone lymphoma (MZL), diffuse large B-cell lymphoma, Burkitt-like B-cell lymphoma, and lymphoplasmacytoid lymphoma cases were positive; and (3) 0% to 6% of primary splenic MZL and various types of follicular lymphoma cases were positive. Most CD43+ follicular lymphomas were predominantly large cell type with focally diffuse areas; their follicular center cell origin in 4 of 8 cases was supported by the presence of CD10 immunoreactivity and/or t(14;18) fusion gene product. CD43 is frequently detectable in a subset of B-NHL, and, thus, it seems to be a highly sensitive marker for these tumors. CD43 also may be a useful marker for classifying B-cell NHLs by virtue of its differential expression in these tumors.
谢谢Dr.海上明珠!
本例诊断有些困难,主要是出现大量的反应性小T淋巴细胞(CD4+/CD8+),而肿瘤性大B细胞成簇分别(CD20+CD79a+CD10+Bcl-6+MUM-1+)。 初看HE切片时很难确定哪一种淋巴细胞为肿瘤性。CD10+Bcl-6+ 的大B淋巴细胞出现在生发中心外,提示肿瘤细胞浸润。Ki-67+表达也指示大细胞为肿瘤性。
至于分类,我们认为诊断为DLBCL, 非特指类型比较妥当。因为,肿瘤性大B细胞多,成簇发布,不符合富于T细胞的大B细胞淋巴瘤(肿瘤性大B少量、散在分布, 常常要与霍奇金淋巴瘤鉴别)。
此例可能界于经典的弥漫性大B细胞淋巴瘤和富于T细胞的大B细胞淋巴瘤之间。患者的免疫状态比较好。
欢迎提出不同的诊断意见,谢谢!