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多形性T 细胞淋巴瘤和大细胞间变性淋巴瘤是近年来确定的淋巴瘤类型,可能原发于皮肤,也可能是蕈样肉芽肿的进一步发展。本文2例是根据临床、组织学、免疫表型和超微结构作出诊断。例1诊断为多形性T 细胞淋巴瘤,因有异形核的不典型T 细胞。根据淋巴细胞的大、中、小而分为低度或高度恶性,免疫表型大多数细胞显示T9,CD25(IL2受体)和CD30(Ki-1)等抗原,Ki-67显示与增殖相关的核抗原阳性细胞占30%。电镜下根据细胞大小、胞浆的电子密度、核形和核染色质的结构分为大、中、小3组,中或大淋巴细胞清楚地属于恶性克隆。按照Suchi 的分类,开始时本例认为属高度恶性,但是放疗后斑块完全消失达2年。例2为大细胞间变性淋巴瘤,诊断是根据光镜检查,早期损害为典型的MF 所见。晚期损害在整个真皮发现相对单一形态的大淋巴细胞的弥漫性浸润,表皮之间有一无浸润的狭带。核呈卵圆形或肾形,核仁明显、胞浆丰富略嗜碱性,核膜清晰,有多数不典型的丝状分裂,肿瘤细胞出现Ki-1抗原为最有力的诊断依据。迅速扩大的肿瘤结节内,恶性克隆免疫表型为活化T 辅助细胞,40%肿瘤细胞显示Ki-
The pleomorphic T-cell lymphoma and the large-cell anaplastic lymphoma are lymphoma types that have been identified in recent years and may be primary to the skin, and may be further development of mycosis granuloma. In this article, 2 cases were diagnosed according to clinical, histological, immunophenotypic and ultrastructural features. Example 1 was diagnosed as pleomorphic T-cell lymphoma due to atypical T cells with aberrant nucleus. According to the large, medium, and small lymphocytes, they are classified as low-grade or highly malignant. The majority of immunophenotypic cells show antigens such as T9, CD25 (IL2 receptor) and CD30 (Ki-1), and Ki-67 shows proliferation-related The nuclear antigen-positive cells account for 30%. Under the electron microscope, the cell size, cytoplasmic electron density, karyotype, and nuclear chromatin structure were divided into large, medium, and small groups. Medium or large lymphocytes clearly belonged to malignant clones. According to Suchi’s classification, this example was considered highly malignant at the beginning, but plaque disappeared completely after radiotherapy for 2 years. Example 2 is an intercellular anaplastic lymphoma. Diagnosis was based on light microscopy and early lesions were typical of MF. Late lesions showed diffuse infiltration of relatively large single lymphocytes in the entire dermis with a non-infiltrated band between the epidermis. The nucleus is oval or kidney-shaped. The nucleolus is obvious, the cytoplasm is rich and slightly basophilic, and the nuclear membrane is clear. There are atypical filamentous divisions. The Ki-1 antigen is the most powerful diagnostic basis for tumor cells. In rapidly expanding tumor nodules, the malignant clonal phenotype is activated T helper cells and 40% of tumor cells show Ki-