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目的研究脑脊液细胞学方法对原发中枢神经系统淋巴瘤(primary central nervous system lymphoma,PC-NSL)的诊断意义。方法回顾性分析21例脑脊液细胞学阳性的PCNSL患者的临床资料,PCNSL的诊断综合应用脑脊液细胞学、脑脊液免疫细胞化学、脑脊液淋巴细胞基因分析和流式细胞分析等方法。结果 21例患者临床-神经影像学分型包括脑脊膜型13例,实质型4例,室管膜(下)型3例,眼型1例。脑脊液细胞学检查21例均见淋巴瘤细胞或异型淋巴细胞。脑脊液免疫细胞化学检查17例呈B淋巴细胞优势,符合B淋巴细胞来源淋巴瘤,10例Ki67阳性细胞比例在40%～60%。7例流式细胞分析中5例以B细胞为主,B细胞比例66%～87%;1例以NK/T细胞为主。脑脊液淋巴细胞基因重排检测3例为IgH单克隆,1例为T细胞受体单克隆。最终6例行脑活检并确诊PCNSL。综合上述结果,21例确诊PCNSL,其中B细胞型19例,T细胞型2例。结论综合应用脑脊液细胞学、免疫细胞化学、细胞基因重排检测和流式细胞分析的脑脊液学方法,是诊断PCNSL的重要途径。
Objective To study the diagnostic value of cerebrospinal fluid cytology in primary central nervous system lymphoma (PC-NSL). Methods The clinical data of 21 patients with positive CSF NSCLC were retrospectively analyzed. The diagnosis of PCNSL combined with CSF cytology, CSF immunocytochemistry, cerebrospinal fluid lymphocyte gene analysis and flow cytometry analysis. Results The clinical-neuroimaging findings included 13 cases of meningeal type, 4 cases of parenchyma, 3 cases of ependymal (lower) type and 1 case of ocular type. Cerebrospinal fluid cytology in 21 cases were seen lymphoma cells or atypical lymphocytes. Cerebrospinal fluid immunocytochemistry in 17 cases showed the advantages of B lymphocytes, in line with B lymphocyte lymphomas, 10 cases of Ki67 positive cells in 40% to 60%. Five of the seven cases of flow cytometry were B cells, with B cells accounting for 66% -87%. One patient had predominantly NK / T cells. Three cases of cerebrospinal fluid lymphocyte gene rearrangement test were monoclonal IgH and one case was T cell receptor monoclonal. The final 6 cases of brain biopsy and confirmed PCNSL. Taken together, 21 cases were diagnosed as PCNSL, including 19 cases of B cell type and 2 cases of T cell type. Conclusion The comprehensive application of cerebrospinal fluid cytology, immunocytochemistry, cell gene rearrangement detection and flow cytometry of cerebrospinal fluid is an important way to diagnose PCNSL.