一例淋巴结病理，送到检验中心做的病理检查。初次报告淋巴结增生，建议免疫组化检查，结果出来后报告滤泡型淋巴瘤二级，印戒细胞亚型，我以前没见到过这种淋巴瘤，哪位老师对此型了解，希望赐教为盼。。。

这种淋巴瘤预后怎么样啊

再就是不做免疫组化诊断的要点是啥呢。。。

难道都是木鸡。。。？？？

把图发来瞧瞧。这其实就是FL，印戒细胞亚型只是指肿瘤性淋巴细胞形态学上的一种变形呈印戒样

O(∩_∩)O~，谢谢了，其实我就是想不太明白，为什么这种淋巴瘤和增生这么难鉴别，难道只有靠免疫组化？预后方面怎么样能说说吗？

 先看看上文中的印戒细胞淋巴瘤的HE染色的图片：

 印戒细胞淋巴瘤可以是各种类型淋巴造血组织肿瘤。可以是何杰金淋巴瘤，也可是非何杰金淋巴瘤；可以发生在T细胞，也可以是B细胞属性；可以发生在不同亚型的淋巴瘤。

 细针吸样本诊断印戒细胞淋巴瘤则更为困难，更易误诊为印戒细胞癌。需要IHC等方法用于诊断与鉴别诊断。

Cancer Cytopathol. 2013 Sep;121(9):525-32. doi: 10.1002/cncy.21291. Epub 2013 Mar 27.

Fine-needle aspiration diagnosis of lymphomas with signet ring cell features: Potential pitfalls and solutions.

Wang J, Katz RL, Stewart J, Landon G, Guo M, Gong Y.

Source

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.

Abstract

BACKGROUND:

Lymphoma with signet ring cell features (LSF) is a rare morphologic variant of non-Hodgkin lymphoma. Although it has been well documented in the surgical pathology literature, to the best of the authors's knowledge, the features of LSF in fine-needle aspiration (FNA) samples have rarely been reported. An accurate cytologic diagnosis of LSF is of important therapeutic significance.

METHODS:

The authors retrospectively reviewed 7 FNA cases of LSF for cytologic features, ancillary studies, corresponding histologic findings, and the patients' clinical and radiologic information to illustrate the diagnostic clues and potential pitfalls.

RESULTS:

The final diagnoses, based on a multidisciplinary approach, were follicular lymphoma (5 patients), large B-cell lymphoma of follicular center cell origin (1 patient), and low-grade B-celllymphoma with plasmacytoid features (1 patient). FNAs were obtained from both lymph node and extranodal sites. Common cytologic features included various percentages of signet ring cells in a background of nonvacuolated lymphomatous cells, lymphoglandular bodies, and cytoplasmic rings. The majority of signet ring cells contained a single, large, clear intracytoplasmic vacuole that pushed the nucleus laterally whereas fewer cells contained ≥ 2 vacuoles that indented the nucleus into a scalloped or stellate configuration. These cells resemble, to some degree, other lesions with signetring cell features. One of the diagnostic clues of LSF was the similarity in nuclear details betweensignet ring cells and surrounding nonvacuolated lymphoid cells.

CONCLUSIONS:

Familiarity with cytologic features, correlation with clinical/radiologic information, and ancillary studies are important for an accurate diagnosis of LSF and for distinguishing it from other lesions with signet ring cell features in FNA samples. Cancer (Cancer Cytopathol) 2013;121:525-32. 

 印戒细胞淋巴瘤的表型分类可以是大B细胞淋巴瘤。

Int J Surg Pathol. 2013 Aug;21(4):399-403. doi: 10.1177/1066896912474342. Epub 2013 Jan 30.

Extreme signet ring cell change in a large B-cell lymphoma of follicular origin.

Bogusz AM, Tierno B, Brown D, Pihan G.

Source

Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.

Abstract

We report a large B-cell lymphoma of follicular origin with extreme signet ring cell differentiation. Initially classified as follicular lymphoma on a fine needle core biopsy, the presence of cohesive sheets of extrafollicular signet ring cells triggered an excisional biopsy for further characterization. The excised lymph node revealed focal follicular hyperplasia, follicular lymphoma, and a neoplasm composed of vague nodules and sheets of large atypical cells, all of which virtually exhibited large clear intracytoplasmic vacuoles with peripheral displacement of nuclei. The tumor cells were negative for mucin and lacked immunoreactivity with pancytokeratin, but were strongly immunoreactive with CD20, BCL-2, BCL-6, and CD10 antibodies. Electron microscopy studies revealed electron-lucent vacuoles with no particular internal structure. This case is unique in that extreme signet ring celldifferentiation somewhat obscured the true cytological identity of the interfollicular lymphoma and suggested alternative diagnoses.

B细胞性印戒细胞淋巴瘤很易被误诊为印戒细胞癌， 

Medicina (B Aires). 2004;64(6):521-4.

[Signet ring cell lymphoma mimicking mucin-producing carcinoma].

[Article in Spanish]

Sáenz de Chirife AM, Rojas Bilbao E, Giménez L, Marino L, Celeste F.

Source

Departamento de Patología, Instituto de Oncología Angel H. Roffo, Facultad de Medicina, Universidad de Buenos Aires, Argentina.

Erratum in

·         Medicina (B Aires). 2005;65(1):92.

Abstract

Signet ring cell lymphoma is a rare neoplasm characterized by large, vacuolated and clear cellsmimicking mucin-producing adenocarcinoma. It is localized in nodal and extranodal sites. A case of a 59 years old male, with a diffuse lymphoma signet ring cell type localized on oropharyngeal mucosa is reported. The histopathology study showed signet ring cells and the immunophenotype was: vimentine(+), CD45(+), CD20(+), Ig M(+), Kappa chain(+) and high index proliferative activity of neoplastic cells (Ki 67:70%). After a review of the literature and previous reports, we could not find a similar case in this anatomic site. The patient had a unfavourable clinical course and died two months after the diagnosis without receiving any treatment.

皮肤B细胞性淋巴瘤可呈印戒细胞形态。

Am J Dermatopathol. 2001 Jun;23(3):181-4.

Cutaneous B-cell lymphoma with signet ring-cell morphology: a clinicopathologic and immunohistochemical study of three cases.

Moran CA, Suster S, Abbondanzo SL.

Source

Department of Anatomic Pathology, University of Alabama at Birmingham, Kracks Building KB726, Birmingham, AL 35294, USA.

Abstract

Three cases of primary cutaneous B-cell lymphoma with prominent signet ring-cell features are presented. The patients were three men between the ages of 37 years and 74 years (average, 55.5 years). Clinically, the three patients presented with multiple skin nodules. In one patient, the nodules had been present for approximately 5 weeks, although in the two other patients, the nodules were of unknown duration. The lesions were located in the upper extremities (forearm) and measured from 2 cm to 3 cm in diameter. No evidence of lymphadenopathy was observed in any of the patients. Surgical excision of the nodules was performed. Histologically, in two cases, the superficial and deep dermis was replaced by a diffuse cellular proliferation, and in one patient, the tumor cell population adopted a nodular pattern of growth involving adnexal structures and infiltrating the subcutaneous fat. In all cases, the tumors were composed of cells showing signet ring-cell features, with striking indentation of the nuclei toward the periphery of the cell. Immunohistochemical studies using antibodies for B-cell and T-cell markers (L-26 and UCHL) as well as antibodies for leukocyte common antigen, keratin, and kappa and lambda light chains were performed in all cases. The tumor cellsshowed a positive reaction for leukocyte common antigen, L-26, and lambda light chain restriction. Follow-up information was only available in one patient, who has remained alive and well 2 years after diagnosis without evidence of progression of the disease. The present cases highlight the importance of recognizing this unusual morphologic type of lymphoma so as to arrive at a correct diagnosis. 

 小淋巴细胞淋巴瘤表现为印戒细胞淋巴瘤，在结内呈窦性生长特点，很容易被误诊为印戒细胞癌。需要IHC鉴别。

Ann Diagn Pathol. 1999 Aug;3(4):220-6.

Signet-ring cell variant of small lymphocytic lymphoma with a prominent sinusoidal pattern.

Ramnani D, Lindberg G, Gokaslan ST, Albores-Saavedra J.

Source

Division of Anatomic Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Abstract

Signet-ring cell lymphoma is a rare morphologic variant of non-Hodgkin's lymphoma characterized by neoplastic lymphoid cells with cytoplasmic vacuoles or eosinophilic globules that impart a signet-ringcell morphology. Although most cases are variants of follicular center B-cell lymphomas, this pattern also can be seen in T-cell lymphomas. An indolent clinical course and prolonged survival have characterized the majority of published cases. We document the case of a 62-year-old African-American woman with diffuse small lymphocytic signet-ring lymphoma having a predominant sinusoidal growth pattern, which, to our knowledge, has not been previously reported. The prominent sinusoidal pattern of signet-ring lymphocytes contributes to its confusion with metastatic signet-ring cell adenocarcinoma. The correct diagnosis is greatly facilitated by the use of appropriate immunohistochemical stains for lymphoid markers.

 印戒细胞窦性组织细胞增生症，更像是印戒细胞癌。

Cancer. 1997 Jul 15;80(2):277-85.

Signet-ring sinus histiocytosis: a reactive disorder that mimics metastatic adenocarcinoma.

Guerrero-Medrano J, Delgado R, Albores-Saavedra J.

Source

Instituto Nacional de Cancerología, Distrito Federal, México.

Abstract

BACKGROUND:

Signet-ring sinus histiocytosis is a rare and distinctive reactive disorder recently observed in the axillary lymph nodes of patients with breast carcinoma. This form of sinus histiocytosis closely resembles and can easily be confused with metastatic adenocarcinoma.

METHODS:

To determine the incidence of this reactive process in lymph nodes from different anatomic sites, broaden its morphologic spectrum, and discuss the differential diagnosis, the authors examined lymph nodes from 316 radical prostatectomy specimens, 184 modified radical mastectomy specimens, 108 colectomy specimens, 57 gastrectomy specimens, and 27 radical hysterectomy specimens. These surgical procedures were performed to treat carcinoma of the prostate, breast, colon, stomach, and uterine cervix, respectively. A total of 9741 lymph nodes were histologically examined. The lymph nodes containing sinus signet-ring cells were stained with mucicarmine, Alcian blue, and periodic acid-Schiff stains (PAS). Immunostains for epithelial, lymphoid, and histiocytic markers were also performed. In two cases, tissue was retrieved from the paraffin block and subsequently processed for electron microscopic examination.

RESULTS:

Only 4 of 316 radical prostatectomy specimens (1.2%) and 2 of 184 axillary dissections (1.08%) contained lymph nodes with signet-ring sinus histiocytosis. Of 9741 lymph nodes reviewed, 37 (24 pelvic and 13 axillary lymph nodes) had signet-ring sinus histiocytosis, for an incidence of 0.38%. Microscopically, the signet-ring histiocytes lacked nuclear atypia and were mucin negative. In two cases, clusters of histiocytes with rounded, eosinophilic, diastase resistant, PAS positive cytoplasmic globules were observed. Both types of signet-ring cells showed reactivity for histiocytic markers and were negative for cytokeratin and lymphoid markers. By electron microscopy, most histiocytes were shown to have a large empty vacuole that displaced the nucleus. Granular material was observed in some of the vacuoles. Some histiocytes exhibited a rounded cytoplasmic body composed of central electron dense, granular material and a rim of microfibrils. No lipid droplets were identified.

CONCLUSIONS:

Signet-ring sinus histiocytosis is a rare and distinctive reactive disorder found incidentally in the pelvic and axillary lymph nodes of patients with carcinoma of the prostate and breast, respectively. Although this histiocytic reaction mimics metastatic adenocarcinoma andsignet-ring cell lymphoma, it can be identified by careful cytologic analysis together with positive reactivity for histiocytic markers, negative mucin stains, and lack of reactivity for epithelial and lymphoid markers. The etiology and pathogenesis of this unusual form of sinus histiocytosis remains unclear.

胃发生的MALT也可呈现癌样印戒细胞。

Am J Surg Pathol. 1996 May;20(5):588-98.

Carcinoma-like signet-ring cells in gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Zamboni G, Franzin G, Scarpa A, Bonetti F, Pea M, Mariuzzi GM, Menestrina F.

Source

Istituto di Anatomia Patologica, Università di Verona, Italy.

Abstract

We noticed the presence of epithelial signet-ring cells (SRCs) in a proportion of primary gastric B-celllymphomas, and in some endoscopic biopsies we found it difficult to decide whether they represented an associated carcinoma. To evaluate the frequency and nature of this phenomenon, we reviewed 108 stomachs resected for primary lymphoma, including 70 mucosa-associated lymphoid tissue (MALT) and 38 non-MALT lymphomas. We found SRCs, either isolated or grouped in clusters, in 26 of 70 MALT lymphomas. The SRCs were always localized in the superficial portion of the lamina propria and associated exclusively with lymphomatous areas. Isolated and scarce SRCs were also found in four of 22 cases of polyclonal atypical lymphoid hyperplasia. Our data suggests that SRCs occurring in gastric MALT lymphomas represent a particular type of LEL in which the foveolar cellsdisaggregated by the lymphomatous infiltration acquire a globoid, signet-ring appearance. These "foveolar" LELs are found in 37% of MALT lymphomas and are usually associated with the more classic and constant "neck" LELs, which are localized between the foveolae and mucopeptic glands. An awareness of the existence of the foveolar LEL may help avoid overdiagnosis of SRC carcinoma on gastric endoscopic biopsies. 

 印戒细胞淋巴瘤也可发生在骨髓。

J Clin Pathol. 1994 Feb;47(2):184-6.

Signet-ring cell lymphoma of bone marrow.

Talbot DC, Davies JH, Maclennan KA, Smith IE.

Source

ICRF Clinical Oncology Unit, Churchill Hospital, Headington, Oxford.

Abstract

A case of signet-ring cell lymphoma affecting bone marrow is reported. The tumour presented as multiple lytic lesions in the lumbosacral spine. A bone biopsy specimen showed the typical appearances of signet-ring cell lymphoma, and the cells stained positively with antiserum to CD20, though neither immunoglobulin light or heavy chains could be shown within the vacuoles. The patient subsequently responded to chemotherapy.

 印戒细胞淋巴瘤也可以是T细胞属性。

Acta Derm Venereol. 1993 Aug;73(4):255-8.

Cutaneous T cell lymphoma of signet ring cell type: a specific clinico-pathologic entity.

Vaillant L, Monégier du Sorbier C, Arbeille B, de Muret A, Lorette G.

Source

Department of Dermatology, University of Tours, France.

Abstract

We describe a new case of signet ring cell peripheral T cell lymphoma in a 45-year-old man. Thislymphoma had a very indolent course, since--without treatment--the clinical staging has shown no evidence of disease progression 11 years after initial symptoms. Immunophenotype indicated pan T antigens (Leu 4 CD3, Leu 1 CD5) and T suppressor cytotoxic antigen (IOT8 CD8) expression. Several T antigens (Leu 5b CD2, Leu 9 CD7, Leu 3a CD4) were not expressed. The proliferation index was less than 5% with Ki 67 monoclonal antibodies. The ultrastructural study showed characteristic cytoplasmic vacuoles containing microvesicles. Five cases of signet ring T celllymphoma, which were very similar to our case, have been previously described. Their characteristics were primary cutaneous presentation, indolent course, good response to current therapies and a long survival period. The indolent course of these signet ring cell lymphomas may indicate that this type oflymphoma is a low grade malignant lymphoma and not only a morphological pattern.

 CD30+的T细胞淋巴瘤也可呈印戒细胞形态。

Histopathology. 1997 Jan;30(1):90-2.

CD30+ anaplastic large-cell lymphoma, null type, with signet-ring appearance.

Falini B, Liso A, Pasqualucci L, Flenghi L, Ascani S, Pileri S, Bucciarelli E.

Source

Institutes of Haematology, University of Perugia, Italy.

 印戒细胞T细胞淋巴瘤的临床病理学报道。

J Clin Pathol. 1989 Mar;42(3):239-45.

Signet ring cell lymphoma of T cell type.

Cross PA, Eyden BP, Harris M.

Source

Department of Histopathology, Christie Hospital, Manchester.

Abstract

A rare variant of non-Hodgkin's lymphoma, signet ring lymphoma of T cell phenotype (only the fourth to be reported) in a 75 year old man was studied by light microscopy, immunohistochemistry, electron microscopy and gene rearrangement studies. Ultrastructurally, a wider spectrum of cell size and nuclear shape was observed in this case than in the previously recorded cases. The morphology of the signet ring vacuoles was identical to that found in the commoner B cell signet ring lymphoma of clear vacuole type, and it is suggested that the vacuoles derive from multivesicular bodies. The four cases reported so far have all presented with skin disease, and the limited evidence available suggests that the prognosis may be good.

T细胞性印戒细胞增生发生在皮肤，易误诊为真性组织细胞淋巴瘤。

Am J Dermatopathol. 1987 Apr;9(2):120-8.

T-cell signet-ring cell proliferation in the skin simulating true histiocytic lymphoma.

van der Putte SC, Toonstra J, Bruns HM, van Wichen DF, van Unnik JA, van Vloten WA.

Source

Institute of Pathology, University of Utrecht, The Netherlands.

Abstract

We report the case of a solitary ulcerating lesion on the elbow of a 32-year-old man. Routine histopathological examination strongly suggested a histiocytic malignancy. However, electron-microscopical, enzyme-cytochemical, and immunological studies revealed that the "tumor" cells were T lymphocytes with an unusual (Leu 1+, Leu 3a+, Leu 4+, Leu 5b+, OKT4+, HLA-DR+, Ki-1+, Leu MI+) immunological phenotype and an even more uncommon morphology characterized by the development of giant multivesicular bodies giving some cells a signet-ring cell appearance, and autophagocytosis. The lesion healed spontaneously, notwithstanding its malignant histology. 

非常感谢，资源好丰富