ALK阴性的间变性大细胞淋巴瘤（ALCL）。谢谢楼主的好病例。

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)

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

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

间变性大细胞淋巴瘤

 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

支持ALK阴性的ALCL

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

俺支持ALCL。

第二批免疫组化今天下午做，预计晚上八点前可以有结果。

组织细胞肉瘤

间变性大细胞淋巴瘤

第一批免疫组化结果：CD45（+）、CD30（+）、ALK（-）、EMA（—）、CK（-）、Vimentin（+）。

确实难！考虑差不多，大细胞类淋巴瘤如间变T、弥漫大B、组织细胞类肿瘤如FDCS、组肉等等

组织细胞肉瘤。

细胞团块状，不考虑淋巴瘤；

HL？

非常抱歉，自动免疫组化仪器今天出故障，免疫组化结果要推迟到明天，敬请谅解。

耐心等IHC。