55例非霍奇金淋巴瘤免疫分型与骨髓血液学分析

doi:10.3969/j.issn.1673-8640.2015.02.007

摘要/Abstract

摘要： 目的

了解免疫组化在非霍奇金淋巴瘤诊断中的应用价值,通过骨髓形态学了解非霍奇金淋巴瘤患者病情进展情况,以确定临床分期。

方法

用单克隆相关抗体对部分非霍奇金淋巴瘤标本做免疫组化检测,55例淋巴瘤患者均做骨髓形态学检查。

结果

免疫组化:T细胞淋巴瘤相关抗体CD3阳性率85.00%,CD45RO阳性率90.47%; B细胞淋巴瘤相关抗体CD20阳性率89.65%,CD79a阳性率88.90%。骨髓形态学:淋巴瘤骨髓侵犯9例(16.36%),进展为淋巴瘤-白血病期的7例(12.72%)。19例患者淋巴瘤细胞<5%,对此类患者应进行动态观察,密切观察骨髓中的形态学变化。

结论

免疫组化可以确定T、B淋巴瘤类型,是对组织形态学诊断的补充,使淋巴瘤诊断更准确可靠。骨髓形态学可以确定淋巴瘤患者有无骨髓侵犯及有无进展为淋巴瘤-白血病期,以确定临床分期。

关键词: 淋巴瘤, 非霍奇金, 免疫分型, 骨髓, 组化

Abstract: Objective

To understand the progression of non-Hodgkin's lymphoma through bone marrow morphology, and to find out the application significance of immunohistochemistry in the diagnosis of non Hodgkin's lymphoma in order to determine the clinical stage.

Methods

The monoclonal antibody to some specimens of non-Hodgkin's lymphoma was used for immunohistochemical detection, and bone marrow morphology was performed in 55 lymphoma patients.

Results

By immunohistochemistry, the positive rate of T cell lymphoma associated antibody CD3 was 85.00%, and that of CD45RO was 90.47%, that of B cell lymphoma associated antibody CD20 was 89.65%, and that of CD79a was 88.90%. By bone marrow morphology, 9 cases (16.36%) had bone marrow involvement, 7 cases (12.72%) progressed to lymphoma-leukemia period. There were 19 patients whose lymphoma cells <5%, for those patients, a dynamic observation should be on, which can closely observe the morphological changes in bone marrow.

Conclusions

Immunohistochemistry can determine the type of T or B lymphoma, and it is a supplement to the histomorphological diagnosis of lymphoma, so that a more accurate and reliable diagnosis can be made. Bone marrow morphology can determine whether the patients' bone marrow is involved and whether it is already advanced in leukemia period, therefore the clinical stage of lymphoma can be identified.

Key words: Lymphoma, Non-Hodgkin, Immunophenotyping, Bone marrow, Histochemistry

中图分类号:

R446.11

杨丽妙, 张亚平, 杨洪乐, 邢江涛, 胡蕊, 朱芸. 55例非霍奇金淋巴瘤免疫分型与骨髓血液学分析[J]. 检验医学, 2015, 30(2): 132-136.

YANG Limiao, ZHANG Yaping, YANG Hongle, XING Jiangtao, HU Rui, ZHU Yun. Immunophenotyping and bone marrow hematology analysis in 55 cases of non-Hodgkin's lymphoma[J]. Laboratory Medicine, 2015, 30(2): 132-136.

图/表 5

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淋巴瘤分类	例数	CD3	CD45RO	CD30	CD34	CD45	CD56	CD68	轻链λ	轻链Κ	LCA	ALK	Bcl-2
血管T免疫母细胞淋巴瘤	8	7/8	7/7	0	2/2	0	0	5/6	1/1	0	1/1	0/1	0/1
肠病型T细胞淋巴瘤	4	4/4	2/3	0/1	0	0	0	3/3	2/2	1/2	0	0	0
外周T细胞淋巴瘤	4	2/3	4/4	0	2/2	3/3	0/1	3/3	0/2	0/2	2/2	0	1/1
皮下脂膜炎样T细胞淋巴瘤	2	1/1	2/2	0	0	1/1	1/1	2/2	0	0	1/1	0	0
鼻咽部T细胞淋巴瘤	3	3/3	3/3	0	0	1/1	0	2/2	0	0	0	0	0
间变性T细胞淋巴瘤	3	0/1	1/2	2/2	0	0	0	0	0	0	0	0	0
总例数	24	17/20	19/21	2/3	4/4	5/5	1/2	15/16	3/5	1/4	4/4	0/1	1/2

淋巴瘤分类	例数	CD3	CD45RO	CD30	CD34	CD45	CD56	CD68	轻链λ	轻链Κ	LCA	ALK	Bcl-2
血管T免疫母细胞淋巴瘤	8	7/8	7/7	0	2/2	0	0	5/6	1/1	0	1/1	0/1	0/1
肠病型T细胞淋巴瘤	4	4/4	2/3	0/1	0	0	0	3/3	2/2	1/2	0	0	0
外周T细胞淋巴瘤	4	2/3	4/4	0	2/2	3/3	0/1	3/3	0/2	0/2	2/2	0	1/1
皮下脂膜炎样T细胞淋巴瘤	2	1/1	2/2	0	0	1/1	1/1	2/2	0	0	1/1	0	0
鼻咽部T细胞淋巴瘤	3	3/3	3/3	0	0	1/1	0	2/2	0	0	0	0	0
间变性T细胞淋巴瘤	3	0/1	1/2	2/2	0	0	0	0	0	0	0	0	0
总例数	24	17/20	19/21	2/3	4/4	5/5	1/2	15/16	3/5	1/4	4/4	0/1	1/2

淋巴瘤分类	例数	CD20	CD79a	CD30	CD34	CD45	CD68	CD45Ro	LCA	Vim	Bcl-2	Bcl-6
黏膜相关性B细胞淋巴瘤	9	9/9	2/2	0/2	0	1/1	4/8	4/8	2/2	2/2	0	0
弥漫大B细胞淋巴瘤	8	6/8	2/3	1/1	2/2	1/1	7/8	5/8	2/2	1/1	0	0
滤泡性B细胞淋巴瘤	4	4/4	1/1	1/1	0	1/1	4/6	3/4	0	0	2/2	0
套细胞淋巴瘤	2	2/2	1/1	0	0	1/1	0/1	1/2	0	0	2/2	1/2
纵隔B细胞淋巴瘤	1	0/1	0	0	0	0	0	0	0/1	0	0	0
伯基特淋巴瘤	6	5/5	1/1	0	0	1/1	4/4	4/5	0	1/1	0	1/1
淋巴肉芽肿淋巴瘤	1	0	1/1	0	0	0	1/1	0	0	0	0	0
总例数	31	26/29	8/9	2/4	2/2	5/5	20/28	17/27	4/5	4/5	4/4	2/3

淋巴瘤分类	例数	CD20	CD79a	CD30	CD34	CD45	CD68	CD45Ro	LCA	Vim	Bcl-2	Bcl-6
黏膜相关性B细胞淋巴瘤	9	9/9	2/2	0/2	0	1/1	4/8	4/8	2/2	2/2	0	0
弥漫大B细胞淋巴瘤	8	6/8	2/3	1/1	2/2	1/1	7/8	5/8	2/2	1/1	0	0
滤泡性B细胞淋巴瘤	4	4/4	1/1	1/1	0	1/1	4/6	3/4	0	0	2/2	0
套细胞淋巴瘤	2	2/2	1/1	0	0	1/1	0/1	1/2	0	0	2/2	1/2
纵隔B细胞淋巴瘤	1	0/1	0	0	0	0	0	0	0/1	0	0	0
伯基特淋巴瘤	6	5/5	1/1	0	0	1/1	4/4	4/5	0	1/1	0	1/1
淋巴肉芽肿淋巴瘤	1	0	1/1	0	0	0	1/1	0	0	0	0	0
总例数	31	26/29	8/9	2/4	2/2	5/5	20/28	17/27	4/5	4/5	4/4	2/3

分组	例数	Hb(例数)					WBC(例数)			PLT(例数)
分组	例数	正常	轻度贫血	中度贫血	重度贫血		正常	减低	增高	正常	减低	增高
骨髓侵犯	16	7	3	2	4		7	3	6	11	3	2
骨髓未侵犯	39	27	6	6	0		26	5	8	21	8	10
分组	例数	白细胞分类[例数(范围%)]
分组	例数	幼粒细胞	中性细胞	嗜酸细胞		碱性		单核	原淋	幼淋	淋巴细胞
骨髓侵犯	16	3(2~6)	16(7~75)	3(1~2)		1(1)		16(2~34)	5(2~81)	7(1~49)	16(12~19)
骨髓未侵犯	39	10(1~3)	39(18~90)	15(1~27)		8(1~2)		35(3~35)	1(1)	2(1~2)	39(2~69)