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目的探讨结节性淋巴细胞为主型霍奇金淋巴瘤(NLPHL)和富于T细胞和(或)组织细胞的B细胞淋巴瘤(TCRBCL)的鉴别诊断。方法按照WHO淋巴瘤新分类法,对15例NLPHL和16例TCRBCL的组织学和免疫表型进行分析,并分别对其中3例NLPHL和4例TCRBCL进行了EBER1／2原位杂交和IgH基因重排检测。结果组织学上,NLPHL和TCRBCL均表现为小淋巴细胞背景中散在分布的肿瘤性大细胞。NLPHL的肿瘤性大细胞形态特征以L&H细胞(即爆米花细胞)为主,TCRBCL的肿瘤性大细胞以中心母细胞类型为主,两者都可伴有其他变异形态。免疫表型上, NLPHL和TCRBCL的肿瘤性大细胞都呈CD20、CD79a、bcl-6和EMA阳性,CD3、CD45RO、CD15和CD30阴性,背景小淋巴细胞以T淋巴细胞为主。但在NLPHL中,CD57阳性细胞明显多于TIA-1阳性细胞,小B淋巴细胞呈小灶状或弥漫散在分布;而在TCRBCL中,TIA-1阳性细胞明显多于CD57阳性细胞,小B淋巴细胞非常稀少。CD21检测显示,NLPHL的结节呈CD21阳性滤泡树突细胞(FDC)网架结构,而TCRBCL以及NLPHL的弥漫类型或弥漫区域中,FDC网架缺乏。NLPHL和TCRBCL都呈EBER1／2阴性,IgH基因重排可检测到80～120 bp的单克隆条带。结论NLPHL和TCRBCL有组织学和免疫表型特征的相似性,诊断和鉴别诊断必须结合形态学和瘤细胞、背景细胞的免疫表型特征。
Objective To investigate the differential diagnosis of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and B cell lymphoma (TCRBCL) enriched in T cells and / or histiocytes. Methods The histological and immunophenotypes of 15 cases of NLPHL and 16 cases of TCRBCL were analyzed according to the WHO new classification of lymphoma, and 3 cases of NLPHL and 4 cases of TCRBCL were analyzed by EBER1 / 2 in situ hybridization and IgH gene weight Pai detection. Results Histologically, both NLPHL and TCRBCL presented as scattered neoplastic neoplastic cells in the context of small lymphocytes. The morphological features of NLPHL were large L & H cells (ie, popcorn cells), while TCRBCL mainly consisted of centroblasts, both of which could be associated with other variants. On the immunophenotype, the neoplastic large cells of NLPHL and TCRBCL were all positive for CD20, CD79a, bcl-6 and EMA, but negative for CD3, CD45RO, CD15 and CD30. The background small lymphocytes were predominantly T lymphocytes. However, in NLPHL, CD57 positive cells were significantly more than those of TIA-1 positive cells and small B lymphocytes were small or diffusely scattered. In TCRBCL, TIA-1 positive cells were significantly more than CD57 positive cells and small B lymphocytes Very rare. CD21 assay showed that NLPHL nodules were CD21-positive follicular dendritic cell (FDC) scaffolds, whereas FDC scaffolds were absent in diffuse or diffuse regions of TCRBCL and NLPHL. NLPHL and TCRBCL were EBER1 / 2 negative, IgH gene rearrangements can detect 80 ~ 120 bp of the monoclonal band. Conclusion NLPHL and TCRBCL have histological and immunophenotypic characteristics of similarity, diagnosis and differential diagnosis must be combined with morphological and tumor cells, the background of the immune cell phenotype characteristics.