免疫组化标记： 

感谢大家，尤其是海上明月老师的关注和指导！

谢谢反馈周小鸽教授会诊结果！

B细胞克隆分析显示，DH-JH呈单克隆性重排，IgK Vk-Kde/JkCk intron-Kde 也是呈单克隆性重排；其余5管呈多克隆性重排。

最后诊断：（左腋窝）淋巴结非霍奇金滤泡性淋巴瘤，II级，部分区域细胞生长较活跃。

在一些癌症病人，经过化疗后的几年或若干年，有发生淋巴瘤的风险。

病人27年前患过“卵巢癌”，有可能接受过化疗。不知道是不是这样。 editUploadImages("rcontent732655", 732655, 2);

考虑淋巴结反应性增生，倾向透明血管型Castleman病

已有诊断结果。

I agree with some of above experts' opinion. 1. BCL6 stain will help; 2. "有无结缔组织病史？eg.类风湿性关节炎等？用药史" is important. any history of autoimmune disease, HIV, EBV positive? 3. I would consider it as an atypical lymphoid proliferation at this moment instead of a follicular lymphoma.

what don't support follicular lymphoma are: 1. H&E figs: intact mantle zone. 2. the follicles in H&E fig 7 and other figs appears to have many tangible-body macrophages (unusual for low-grade FL). 3. bcl2 negative (unusual for low-grade FL). 4. CD21 and ki-67 pattern is somewhat like a reactive follicle invaded by something from outside the follicle. 5. in IHC Fig 11, the contour of the follicle revealed by bcl2 stain is more typical for florid hyperplasia observed in autoimmune disease, drugs, HIV...and other reactive conditions. 6. there are a lot of follicular T-cells within follicles (might be a hint of etiology?).

 mark

 这个病例是典型的BCL-2 negative Follicular lymphoma, low grade.  如果看多了，就会知道诊断要点在哪里。我先卖个关子，因为我经常收到这种病例，误诊经常发生。其实看多了，不需要做B cell gene rearrangemnent 来确诊。

多谢！