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目的探讨以细胞病理学及免疫细胞化学方法通过胸腔积液诊断浆母细胞淋巴瘤的特点。方法对1例浆母细胞淋巴瘤胸腔积液进行常规细胞学涂片、沉渣包埋、免疫组化染色、基因重排及EBV检测,并进行文献复习。结果胸腔积液涂片中细胞丰富,由单个散在或松散聚集的细胞组成,细胞大,有一定量的胞质,核浆比明显增高;部分胞质空泡状;核大,单核、双核或多核,圆或卵圆形,部分细胞核形不整,染色质细颗粒状,可见单个或多个核仁。大细胞间可见核偏位的浆细胞样细胞,核分裂易见,可见凋亡小体和易染体巨噬细胞。免疫组化:肿瘤细胞CD38和CD138(+),棕黄色颗粒沉积在细胞膜或部分胞质;MUM-1(+);B细胞标记物CD20、CD79α和PAX-5(-),T细胞标记物CD3、CD4和UCHL(-),CD15、CD30、ALK、calretinin、TTF-1、AE1/AE3和EMA(-)。Ki-67指数为90%。颈部淋巴结活检证实为浆母细胞淋巴瘤。免疫球蛋白Ig重链(IgH)单克隆性基因重排,EBV(-)。结论经胸腔积液诊断浆母细胞淋巴瘤少见,难度高。诊断及鉴别诊断对免疫组化的依赖程度较高。
Objective To investigate the characteristics of plasmacytoid lymphoma by pleural effusion by cytopathology and immunocytochemistry. Methods One patient with pleomorphic lymphoma pleural effusion was examined by routine cytological smear, sediment embedding, immunohistochemical staining, gene rearrangement and EBV detection. Results Pleural effusion smear cells rich in a single scattered or loosely aggregated cells, large cells, a certain amount of cytoplasm, nuclear ratio was significantly increased; part of the cytoplasmic vacuolar; nuclear large, single-core, dual-core or Multi-nuclear, round or oval, part of the nucleus irregular, chromatin fine granular, visible single or multiple nucleolus. Big cell can be seen between the nuclear deviation of plasmacytoid cells, mitotic easily seen apoptotic bodies and edema macrophages. Immunohistochemistry: tumor cells CD38 and CD138 (+), brown granules deposited on the cell membrane or in part of the cytoplasm; MUM-1 (+); B cell markers CD20, CD79α and PAX-5 CD3, CD4 and UCHL (-), CD15, CD30, ALK, calretinin, TTF-1, AE1 / AE3 and EMA (-). Ki-67 index is 90%. Cervical lymph node biopsy confirmed as plasma cell lymphoma. Immunoglobulin Ig heavy chain (IgH) monoclonal rearrangement, EBV (-). Conclusion The diagnosis of plasmablastic lymphoma rare, highly difficult. Diagnosis and differential diagnosis of immunohistochemical dependence.