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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)的诊断和鉴别诊断特点。方法 对 1980～ 2 0 0 0年 2 4 5例霍奇金淋巴瘤 (HL)进行回顾性分析 ,发现NLPHL4例 ;另外 2例NLPHL为 2 0 0 0年会诊病例 ;复旦大学肿瘤医院提供 1例。 7例均应用链霉菌抗生物素蛋白 过氧化物酶法(SP法 )检测瘤细胞 (CD4 5、CD2 0、CD15、CD30、波形蛋白 )和背景细胞 (CD3、CD2 0、CD4 5RO、CD5 7、CD6 8、TIA 1)的免疫表型 ,并采用WHO1997年淋巴瘤诊断标准重新分类。结果 NLPHL7例 ,男 4例 ,女 3例 ,平均年龄 4 3.8岁 ,中位年龄 4 3岁 ,表现为颈部、锁骨上或腋窝淋巴结肿大 ,临床Ⅰ期。组织学上 ,NLPHL病变淋巴结结构破坏 ,大部分为肿瘤性病变 ,主要呈结节性生长 ,结节内可见L&H细胞浸润 ,其中 1例NLPHL病变淋巴结可见少部分呈生发中心进行性转化 (PTGCs)改变。免疫组织化学染色显示瘤细胞呈CD4 5、CD2 0阳性 ,CD15、CD30、波形蛋白阴性 ,背景细胞中可见大量CD2 0阳性的B小淋巴细胞及较多CD5 7阳性细胞 ,TIA 1阳性细胞极少见。结论 对NLPHL的诊断必需结合免疫表型特征 ,要注意与经典型霍奇金淋巴瘤及B细胞淋巴瘤相鉴别
Objective To investigate the diagnostic and differential diagnosis of nodulocytic predominant Hodgkin’s lymphoma (NLPHL). Methods Twenty-five cases of Hodgkin’s lymphoma (HL) from 1980 to 2000 were retrospectively analyzed. Four cases of NLPHL were found, two cases of NLPHL were diagnosed in 2000, and one case of Fudan University Cancer Hospital . 7 cases were detected by streptavidin peroxidase method (SP method) detection of tumor cells (CD4 5, CD20, CD15, CD30, vimentin) and background cells (CD3, CD20, CD4 5RO, CD5 7 , CD6 8, TIA 1) immunophenotype, and using the WHO 1997 criteria for the classification of new lives in Africa. Results 7 cases of NLPHL, 4 males and 3 females, the average age of 4 3.8 years old, the median age 43 years old, manifested as neck, supraclavicular or axillary lymph nodes, clinical stage Ⅰ. Histologically, the lymphadenopathy of NLPHL lesions were damaged, most of them were neoplastic lesions. The main pathological changes were nodular growth. The infiltration of L & H cells was seen in nodules. A small number of PTGCs were found in one NLPHL lesion, change. Immunohistochemical staining showed that the tumor cells were CD4 5, positive for CD20, negative for CD15, CD30, and vimentin. A large number of CD20 positive B lymphocytes and more CD57 positive cells were found in the background cells, with very few TIA 1 positive cells see. Conclusion The diagnosis of NLPHL must be combined with the immunophenotypic characteristics, should pay attention to the classic Hodgkin’s lymphoma and B-cell lymphoma phase identification