论文部分内容阅读
目的报道1例胸腔积液诊断间变性大细胞淋巴瘤并进行文献复习,以加强对淋巴瘤细胞学诊断的认识。方法胸腔积液常规细胞学涂片、沉渣包埋,结合免疫组化染色及T细胞受体基因重排,从细胞学角度明确诊断间变性大细胞淋巴瘤。结果胸腔积液涂片中细胞丰富,可见大量散在分布的肿瘤细胞有3种:单核、双核和多核细胞;单核淋巴细胞核浆比高,核呈肾形,核仁明显;多核细胞核排列成花环状或马蹄形,可见多个核仁;双核细胞类似霍奇金淋巴瘤中的R-S细胞。肿瘤细胞胞质丰富,嗜酸性,胞质内可见空泡。背景可见小的成熟淋巴细胞及间皮细胞。沉渣包埋免疫组化示CD30、ALK、CD68、granzyme B和CD4(+),CD15和MUM1(-);散在瘤细胞CD5(+),CD3、CD8和CD20、CK5/6、calretinin和pan-CK(-)。颈部淋巴结活检证实为间变性大细胞淋巴瘤。T细胞受体基因重排为(-)。结论胸腔积液诊断间变性大细胞淋巴瘤少见,难度高。诊断对免疫组化的依赖程度较高。
Objective To report a case of pleural effusion diagnosis of anaplastic large cell lymphoma and review the literature to enhance awareness of lymphoma cytology. Methods Pleural effusion routine cytology smear, sediment embedded, combined with immunohistochemical staining and T cell receptor gene rearrangement, a clear diagnosis of anaplastic large cell lymphoma from the cytological point of view. Results pleural effusion smear cells rich, showing a large number of scattered scattered tumor cells have three kinds: mononuclear, binuclear and multinucleated cells; mononuclear lymphocyte nuclear plasma ratio is high, the nucleus was kidney-shaped nucleoli were obvious; Rare or horseshoe shape, showing multiple nucleoli; binucleated cells resemble RS cells in Hodgkin’s lymphoma. Cytoplasm of tumor cells is rich in eosinophilic cytoplasm visible vacuoles. The background shows small mature lymphocytes and mesothelial cells. The expression of CD30, ALK, CD68, granzyme B and CD4 (+), CD15 and MUM1 (- CK (-). Cervical lymph node biopsy confirmed as anaplastic large cell lymphoma. T cell receptor gene rearrangement as (-). Conclusions Pleural effusion diagnosis of anaplastic large cell lymphoma is rare and difficult. Diagnosis is more dependent on immunohistochemistry.