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- 男/15岁 右侧扁桃体肿块， 淋巴瘤？IHC标记 2010-8-2
| 以下是引用panzenggang在2010-8-3 8:14:00的发言：
Dear Dr. Jin: Thanks a lot for your pictures. From these photos, I can clearly see a follicular proliferative pattern. But in picture 5, I couldn't tell if there is a positive staing of BCL2 in the follicular B-cells, and maybe there are a few cells with strong BCL2 staining, which may represent reactive T-cells in the germinal center. The last picture (Ki67), I see a relatively high Ki67 staining, but I also see a "negative zone" surrounding the follicle, is this a mantle zone? Also, usually low grade follicular lymphome will not have such a high Ki67 staining, but reactive germinal center can. If you have time, would you please explain to me? Thanks. I didn't see the original slides and it is hard for me to have a global picture of this case just based on the images, so I could be wrong. Sorry I can't type Chinese since I am in the office and we are not allowed to install programs ourselves. Have a nice day. |
非常感谢Dr.Pang对此病例的诊断意见。
此例是会诊病例，原单位诊断为DLBCL。病变位于右侧扁桃体，肿块很大、抗炎治疗数月无效；左侧扁桃体正常。
儿童滤泡型淋巴瘤是2008年WHO分类在滤泡型淋巴瘤中增加的新变型（Variant）。主要发生在颈部淋巴结、其他外周淋巴结和 Waldeyer Ring。 基本形态与成人型无区别，但有下列特点：1）病变比较局限、2）常常缺乏Bcl-2表达和t(14;18)、3）分级为3级、4）患者预后非常好，治愈率高。本病例 Bcl-2-、分级为3b。经RCHOP治疗6个疗程，肿瘤消失、全身情况良好。
近期我会提供低倍镜图像，以利大家观察。谢谢！
- xljin8
血管免疫母细胞淋巴瘤主要发生在60岁左右的中老年人，临床往往有发热、皮疹、肝脾肿大、关节酸痛、多克隆性免疫球蛋白升高、自身免疫性贫血等一系列的症状。组织学典型改变为：分枝状血管明显增生、无定型嗜伊红色沉积、出现较多的反应性免疫母细胞；成簇的透明细胞。此例的年龄、临床表现、免疫表型都不符合AILT的诊断。
间变性大细胞淋巴瘤是儿童和青少年很常见的淋巴瘤，但是形态学往往出现特征性的标志细胞（胚胎样细胞）、肿瘤细胞粘聚成巢状、窦内分布。IHC T细胞标记和ALK-1 往往阳性表达。 而本病例为结节状结构，CD20+CD79a+, 因此也可除外。
- xljin8
