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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)的临床病理特征和病理诊断。方法复习3例NLPHL患者的临床病理资料、免疫表型、EBV原位杂交及抗原受体基因重排PCR检测结果。结果 3例NLPHL中,淋巴结结构破坏,淋巴组织呈结节性或结节-弥漫性增生,可见进行转化的生发中心(PTGC),小淋巴细胞背景中散在大型单个核或多分叶核异型肿瘤细胞。免疫组化:3例肿瘤细胞CD20、PAX5、Oct-2和BOB.1均(+);仅1例CD30弱(+);2例bcl-6(+);CD3、CD15和LMP1(-);CD21(+)显示扩大的不规则滤泡树突细胞网。3例EBV原位杂交均(-)。运用激光显微切割收集肿瘤细胞并对其进行抗原受体基因重排PCR检测,2例IgH单克隆性重排(+)(1例为Fr2a,1例为Fr3a),3例TCRγ多克隆性重排。结论 NLPHL是一种罕见的具有独特临床病理特征的霍奇金淋巴瘤亚型,细致的形态学观察及完善的免疫组化检查有助于诊断和鉴别诊断。
Objective To investigate the clinicopathological features and pathological diagnosis of nodulized lymphoid-predominant Hodgkin’s lymphoma (NLPHL). Methods The clinical and pathological data, immunophenotypes, EBV in situ hybridization and antigen receptor rearrangement PCR in 3 NLPHL patients were reviewed. Results In 3 cases of NLPHL, the structure of lymph node was destroyed, the nodular or nodular-diffuse lymphoid tissue was hyperplastic. The transformed germinal center (PTGC) and small lymphoid cells were scattered in the background of large single or multilocular tumor cells . Immunohistochemistry: CD20, PAX5, Oct-2 and BOB.1 were all found in 3 cases of tumor cells (+); only 1 case of CD30 was weak (+); 2 cases of bcl- ; CD21 (+) showed enlarged irregular follicular dendritic cell network. Three cases of EBV in situ hybridization (-). Tumor cells were harvested by laser microdissection and subjected to PCR for antigen receptor gene rearrangement. Two monoclonal IgH rearrangements (+) (1 case of Fr2a and 1 case of Fr3a) and 3 cases of TCRγ polyclonal rearrange. Conclusion NLPHL is a rare Hodgkin lymphoma subtype with unique clinical and pathological features. Detailed morphological observation and perfect immunohistochemical examination are helpful for the diagnosis and differential diagnosis.