Adamek D, Moskała M, Kałuza J, Gościński I
Department of Neuropathology, Jagiellonian University, Medical College, Kraków.
Folia Neuropathol. 1999;37(1):27-33.
In a series of 66 CT-guided stereotactic biopsies (SB) of the brain performed in 1995-1998, four were found to be the primary non-Hodgkin's lymphomas (PCNSL). All cases were studied with immunohistochemistry (broad panel of antibodies; reactions performed mainly on cytological smears) and with the use of an electron microscopy. In an immunophenotyping all cases were positive for leukocyte common antigen (LCA) and 3/4 showed B-cell phenotype. Since the PCNSL are typically located in central, periventricular region of brain and the surgical removal does not bring any benefit, the stereotactic biopsy is a method of choice to make a definite diagnosis that opens the chances for implementation of chemo- and radiotherapy. The diagnostic difficulties that are derivatives of an extremely small amount of the available biopsy material were discussed and the role of the immunophenotyping and of the electron microscopy for avoiding the possible diagnostic mistakes was stressed. Cytological smears stained with H&E and the smears and histological slides with immunohistochemical reaction against glial fibrillary acidic protein (GFAP) showing sometimes extremely dense network of astrocytes mingled with neoplastic lymphoma cells are especially interesting and seem to suggest the involvement of astroglia in the pathogenesis of PCNSL.
在1995年至1998年期间进行的一系列66例CT引导下的脑立体定向活检（SB）中，发现4例为原发性非霍奇金淋巴瘤（PCNSL）。所有病例均进行了免疫组织化学研究（使用多种抗体；主要在细胞学涂片上进行反应）并采用了电子显微镜检查。在免疫表型分析中，所有病例的白细胞共同抗原（LCA）均呈阳性，3/4显示B细胞表型。由于PCNSL通常位于脑的中央、脑室周围区域，手术切除并无益处，因此立体定向活检是做出明确诊断的首选方法，为实施化疗和放疗创造了机会。文中讨论了因活检材料极少而产生的诊断困难，并强调了免疫表型分析和电子显微镜检查在避免可能的诊断错误方面的作用。用苏木精和伊红（H&E）染色的细胞学涂片以及对胶质纤维酸性蛋白（GFAP）进行免疫组化反应的涂片和组织学切片有时显示出极其密集的星形胶质细胞网络与肿瘤性淋巴瘤细胞混合在一起，这尤其令人感兴趣，似乎提示星形胶质细胞参与了PCNSL的发病机制。
