共2页/28条首页上一页12下一页尾页
回复:30 阅读:4737
腹膜后淋巴结组织(IHC出来了!)

Renghis 离线

帖子:2530
粉蓝豆:102
经验:4081
注册时间:2007-12-13
加关注  |  发消息
楼主 发表于 2013-02-19 20:15|举报|关注(6)
浏览排序[ 顺序 逆序 楼主 支持 精彩 ]  快捷回复
性别年龄35岁临床诊断
一般病史发现肝功能异常5天,发热3天。
标本名称腹膜后淋巴结组织
大体所见腹腔镜夹取活检组织。 灰红不整形碎组织一堆,1X1X0.3CM。
免疫组化结果将于明晚(2月20日)八点左右上传。
 
腹膜后淋巴结组织(IHC出来了!)图1
名称:图1
描述:A229
腹膜后淋巴结组织(IHC出来了!)图2
名称:图2
描述:A230
腹膜后淋巴结组织(IHC出来了!)图3
名称:图3
描述:A231
腹膜后淋巴结组织(IHC出来了!)图4
名称:图4
描述:A232
腹膜后淋巴结组织(IHC出来了!)图5
名称:图5
描述:A233
腹膜后淋巴结组织(IHC出来了!)图6
名称:图6
描述:A234
腹膜后淋巴结组织(IHC出来了!)图7
名称:图7
描述:A235
腹膜后淋巴结组织(IHC出来了!)图8
名称:图8
描述:A236
腹膜后淋巴结组织(IHC出来了!)图9
名称:图9
描述:A237
腹膜后淋巴结组织(IHC出来了!)图10
名称:图10
描述:A238
腹膜后淋巴结组织(IHC出来了!)图11
名称:图11
描述:A239
腹膜后淋巴结组织(IHC出来了!)图12
名称:图12
描述:A240
腹膜后淋巴结组织(IHC出来了!)图13
名称:图13
描述:A241
腹膜后淋巴结组织(IHC出来了!)图14
名称:图14
描述:A242
腹膜后淋巴结组织(IHC出来了!)图15
名称:图15
描述:A243
腹膜后淋巴结组织(IHC出来了!)图16
名称:图16
描述:A244
腹膜后淋巴结组织(IHC出来了!)图17
名称:图17
描述:A245

 

标签:
本帖最后由 Renghis 于 2013-02-22 20:32:53 编辑
0
signature
重归学生时代!
×参考诊断
ALCL,ALK-

zhouquan 离线

帖子:7752
粉蓝豆:290
经验:8263
注册时间:2008-11-09
加关注  |  发消息
21 楼    发表于2013-02-22 21:25:18举报|引用
返回顶部 | 快捷回复

支持ALK阴性的ALCL

0
回复
signature
成功不是得到多少东西,而是把身上多余的东西的扔掉多少。   

Renghis 离线

帖子:2530
粉蓝豆:102
经验:4081
注册时间:2007-12-13
加关注  |  发消息
22 楼    发表于2013-02-23 10:19:20举报|引用
返回顶部 | 快捷回复

 再传几张HE图片:


名称:图1
描述:A246

名称:图2
描述:A247

名称:图3
描述:A248

名称:图4
描述:A249

名称:图5
描述:A250

名称:图6
描述:A251

名称:图7
描述:A252

名称:图8
描述:A253

名称:图9
描述:A254

名称:图10
描述:A255

名称:图11
描述:A256

名称:图12
描述:A257

名称:图13
描述:A258

名称:图14
描述:A259

名称:图15
描述:A260

名称:图16
描述:A261

名称:图17
描述:A262
0
回复
signature
重归学生时代!

邵长景 离线

帖子:31105
粉蓝豆:483
经验:31883
注册时间:2013-01-03
加关注  |  发消息
23 楼    发表于2013-02-23 11:01:03举报|引用
返回顶部 | 快捷回复
引用:20 楼 在 2013-02-22 21:00:08 的发言:

CD3-,CD45RO+,CD30+,ALK-,CD43+,CD68+,后五张是Ki-67吗?

俺支持ALCL。


0
回复
signature
邵长景

邵长景 离线

帖子:31105
粉蓝豆:483
经验:31883
注册时间:2013-01-03
加关注  |  发消息
24 楼    发表于2013-02-23 11:04:50举报|引用
返回顶部 | 快捷回复
引用:20 楼 在 2013-02-22 21:00:08 的发言:

CD3-,CD45RO+,CD30+,ALK-,CD43+,CD68+,后五张是Ki-67吗?

俺支持ALCL。


0
回复
signature
邵长景

liangjinjun 离线

帖子:2328
粉蓝豆:2
经验:2457
注册时间:2007-08-07
加关注  |  发消息
25 楼    发表于2013-02-23 13:23:44举报|引用
返回顶部 | 快捷回复

间变性大细胞淋巴瘤

0
回复
signature
梁晋军

猪猪 离线

帖子:131
粉蓝豆:507
经验:312
注册时间:2006-11-24
加关注  |  发消息
26 楼    发表于2013-02-23 14:07:47举报|引用
返回顶部 | 快捷回复

T细胞的标记做得少了些,最好把CD2,CD7,CD4,CD8,CD5都加上,你诊断就更放心了,CD45RO特异性不好,现在基本已经废弃

最困惑的可能是间变为什么CD68会阳,查了下文献,倒是有的。现在发现CD68能在很多肿瘤中表达

1993 Aug;24(8):886-96.

KP1 (CD68)-positive large cell lymphomas: a histopathologic and immunophenotypic characterization of 12 cases.

Source

Division of Pathology, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico, Aviano, Italy.

0
回复

TK1905 离线

帖子:962
粉蓝豆:283
经验:1054
注册时间:2010-03-14
加关注  |  发消息
27 楼    发表于2013-02-23 21:15:48举报|引用
返回顶部 | 快捷回复

本例反应性淋巴细胞组织细胞很多,所以CD68+吧!CD30如果是几乎全部区域(而不是局部区域)都是这样强度一致的膜点阳性,那么确实是ALCL ALK-型。ALCL ALK+型里面提到淋巴组织细胞变异型、小细胞变异型,而ALK-的ALCL提到其形态学与ALK+的一致,除了小细胞变异型外。所以,本例应该还是ALCL ALK-型,组织学形态本例也算淋巴组织细胞变异型吧,IHC的CD68强阳性的细胞偏小,大细胞(真正的肿瘤细胞)似乎弱阳性

Lymphoma - Non B cell neoplasms

T/NK cell disorders

Anaplastic large cell lymphoma, ALK negative


Reviewer: Dragos Luca, M.D.

Revised: 29 September 2011, last major update September 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Definition
=========================================================================

● ALK negative anaplastic large cell lymphoma (ALCL, ALK-) is included as a provisional entity, and is defined as a CD30+ T cell neoplasm that is not reproducibly distinguishable on morphologic grounds from ALK+ ALCL, but lacks ALK protein (WHO 2008)

Terminology
=========================================================================

● Previously included in the broader category of anaplastic large cell lymphoma

Epidemiology
=========================================================================

● Most frequently 40-65 years old
● Male predominance (M:F ratio 1.5:1)
● Most epidemiologic studies do not separate ALK+ from ALK- neoplasms

Sites
=========================================================================

● Frequent involvement of both lymph nodes and extranodal sites
● Usually nodal; extranodal involvement in skin, bone, soft tissue, GI tract

Etiology
=========================================================================

● Uncertain, some suggest it may be the final stage of histologic progression for a number of T cell lymphomas

Clinical features
=========================================================================

● Presentation with advanced stage III-IV disease in most patients
● Peripheral and/or abdominal lymphadenopathy, B symptoms, high International Prognostic Index

Treatment and prognosis
=========================================================================

● Significantly worse prognosis than ALCL, ALK+ with conventional therapy

● Better prognosis than peripheral T cell lymphoma NOS (ALCL ALK- vs. PTCL: 36% vs. 20%; overall survival: 49% vs. 32%,

 

Postulated normal counterpart
=========================================================================

● Activated mature cytotoxic T cell

Micro description
=========================================================================

● Generally effaced architecture by solid, cohesive sheets of neoplastic cells
● Intrasinusoidal infiltrate or within T cell areas if architecture is partially preserved (mimics metastatic carcinoma)
● Large pleomorphic cells, occasional prominent nucleoli, may have multinucleated, wreath-like and “hallmark” cells, higher N/C ratio than ALCL, ALK+
● May have sclerosis and eosinophilia
Similar morphologic variants compared to ALCL, ALK+, except for small cell(即可以出现淋巴组织细胞变异型)

Cytology description
=========================================================================

● Deeply basophilic cytoplasm, prominent vacuoles, round or lobate nuclei, prominent nucleoli, clumped chromatin, multinucleation

Positive stains
=========================================================================

● Strong and diffuse uniform CD30 staining in all tumor cells (membrane and Golgi zone pattern, also cytoplasmic)
● Variable expression / loss of pan-T-cell antigens: CD2+ and CD3+ more often than CD5+
● Almost always CD43+
● Often CD4+, rarely CD8+
● TIA1, granzyme B, perforin, clusterin, fascin, rarely EMA

Negative stains
=========================================================================

● ALK, CD15, CD20, CD79a, cytokeratin, BCL2, PAX5/BSAP, PGM1, EBV (EBER & LMP1)

Genetics and Molecular
=========================================================================

● T-cell receptor (TCR) gene rearrangement in most cases, irrespective of T cell antigen expression
● No recurrent cytogenetic abnormality

Differential diagnosis
=========================================================================

ALK positive ALCL: ALK+, younger age, less aggressive
Primary cutaneous ALCL: much better prognosis, clinical correlation with staging necessary
Classical Hodgkin lymphoma
Peripheral T cell lymphoma, NOS: difficult differential, WHO recommends conservative approach (diagnose ALCL, ALK- only if very similar to ALCL, ALK+, except for ALK expression)

3

Renghis

ChenJo..

贾兆明
回复

daijia 离线

帖子:1733
粉蓝豆:74
经验:2353
注册时间:2011-10-27
加关注  |  发消息
28 楼    发表于2013-02-23 21:38:46举报|引用
返回顶部 | 快捷回复

ALK阴性的间变性大细胞淋巴瘤(ALCL)。谢谢楼主的好病例。

0
回复
signature
黛佳
回复:30 阅读:4737
共2页/28条首页上一页12下一页尾页
【免责声明】讨论内容仅作学术交流之用,不作为诊疗依据,由此而引起的法律问题作者及本站不承担任何责任。
快速回复
进入高级回复
您最多可输入10000个汉字,按 "Ctrl" + "Enter" 直接发送
搜索回复/乘电梯 ×
按内容
按会员
乘电梯
合作伙伴
友情链接