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目的探讨宫颈淋巴瘤样病变和宫颈淋巴瘤的临床病理特点及免疫球蛋白重链(IgH)基因重排在两者鉴别诊断上的价值。方法对10例宫颈淋巴瘤样病变和16例宫颈淋巴瘤进行临床资料分析和组织病理学观察,以免疫组织化学(EnVision法)检测 B、T 淋巴细胞标记物和免疫球蛋白轻链(κ,λ)的表达,并应用半套式聚合酶链反应方法检测了4例淋巴瘤样病变和4例淋巴瘤中 IgH基因重排的情况。结果宫颈淋巴瘤样病变患者年龄24～54岁(中位年龄43岁),临床多表现为宫颈糜烂或息肉,镜下观察可见表浅分布的、局灶或弥漫性免疫母细胞样大细胞浸润,伴淋巴细胞转化成熟现象和多型性炎性细胞浸润(多量成熟浆细胞、嗜酸性粒细胞、中性粒细胞)。宫颈淋巴瘤患者年龄28～78岁(中位年龄58岁),临床表现为宫颈肿块或弥漫性宫颈肥大,镜下观察示12例弥漫性大 B 细胞淋巴瘤和4例滤泡性淋巴瘤,二者组织学形态分别以弥漫分布、形态单一的肿瘤性大淋巴细胞浸润和肿瘤性滤泡形成为特点,病灶中少有多型性炎性细胞浸润,也不出现淋巴细胞转化成熟现象。宫颈淋巴瘤样病变中,免疫母细胞样大细胞κ和λ染色结果欠满意。4例宫颈淋巴瘤病例和2例宫颈淋巴瘤样病变中检出单克隆性 IgH 基因重排。结论宫颈淋巴瘤样病变和淋巴瘤主要依据不同的临床和病理形态特点相互区分。IgH 基因重排检测对于二者鉴别有帮助,但需注意部分良性病变也有单克隆性淋巴细胞增生。
Objective To investigate the clinicopathological features of cervical lymphoma-like lesions and cervical lymphoma and the value of immunoglobulin heavy chain (IgH) gene rearrangement in the differential diagnosis of cervical lymphoma-like lesions and cervical lymphoma. Methods 10 cases of cervical lymphoma-like lesions and 16 cases of cervical lymphoma were analyzed by clinical data and histopathological observation. EnVision method was used to detect B and T lymphocyte markers and immunoglobulin light chain (κ, λ) expression, and semiquantitative polymerase chain reaction method was used to detect IgH rearrangement in 4 cases of lymphoma-like lesions and 4 cases of lymphoma. Results Cervical lymphoma-like lesions of patients aged 24 to 54 years (median age 43 years), clinical manifestations of cervical erosion or polyps, microscopic observation showed superficial distribution of focal or diffuse immune somatic cell-like macrophage infiltration , With the phenomenon of lymphocyte maturation and polymorphic inflammatory cell infiltration (a large number of mature plasma cells, eosinophils, neutrophils). Cervical lymphoma patients aged 28 to 78 years (median age 58 years), the clinical manifestations of cervical mass or diffuse cervical hypertrophy, microscopic examination showed 12 cases of diffuse large B cell lymphoma and 4 cases of follicular lymphoma, The two histological features were characterized by diffuse distribution, single form of large tumorous lymphocytic infiltration and tumorous follicular formation, with few inflammatory cells infiltrating into the lesion and no phenomenon of lymphocyte maturation. Cervical lymphoma-like lesions, immunoblastic large cell kappa and lambda staining results unsatisfied. Monoclonal IgH gene rearrangements were detected in 4 cases of cervical lymphoma and 2 cases of cervical lymphoma-like lesions. Conclusions Cervical lymphoma-like lesions and lymphomas are distinguished from each other mainly on the basis of different clinical and pathological features. IgH gene rearrangement test for the identification of both helpful, but need to pay attention to some benign lesions also have monoclonal lymphocyte proliferation.