Cazals-Hatem D, André M, Mounier N, Copin M C, Divine M, Berger F, Bosly A, Kerneis Y, Brière J, Quesnel B, Diebold J, Gaulard P
Service d'Anatomie Pathologique, Hôpital Beaujon, AP-HP, Clichy, France.
Am J Surg Pathol. 2001 Mar;25(3):297-306. doi: 10.1097/00000478-200103000-00003.
Between 1987 and 1993, 77 of 2855 lymphomas included in the LNH87 protocol of the GELA as non-Hodgkin lymphoma (NHL) and reviewed by a panel of pathologists had a diagnosis changed to Hodgkin lymphoma (HL). Some of these lymphomas had been initially interpreted as anaplastic large-cell lymphoma Hodgkin-like (ALCL-HL subtype). The purpose of this study was to analyze the histologic pitfalls initially encountered, to define more clearly the diagnostic criteria of lymphomas placed in the gray zone around HL, and to follow the survival of these 77 patients affected with HL and initially treated with NHL regimens. The 77 cases of HL were reviewed by three hematopathologists and immunostained with a large panel of antibodies, including CD30, CD15, CD3, CD20, CD45, CD43, LMP-1, EMA, BNH-9, TiA1, and ALK1. Each case was classified according to the Lukes-Rye system and the British National Lymphoma Investigation (BNLI) grading. The initial clinical presentation of patients was analyzed, and the overall and event-free survival rates of the 77 patients were estimated. Among the 77 HLs, 46 were misinterpreted as NHL by primary individual pathologists (12 as ALCL, 8 as ALCL-HL, 12 as peripheral T-cell lymphoma (PTCL), 6 as B-cell lymphoma, and 8 as unclassifiable NHL). The other 31 cases had been first considered by the panel as consistent with ALCL-HL (n = 18) or with PTCL (n = 13) and were changed later in view of an immunophenotype concordant with HL. Fifty-five percent of the patients completed the full NHL treatment. The 5-year event-free and overall survival rates were 54% and 77%, respectively. The current results indicate that lymphomas initially called ALCL-HL should not be regarded as a variant of ALCL, but as HL. The clinical consequences of misdiagnoses seem to be a lower event-free survival rate compared with that of classical HL, probably because of more relapses of initially inappropriately treated HL.
1987年至1993年间，在GELA的LNH87方案纳入的2855例淋巴瘤中，有77例最初被病理学家小组诊断为非霍奇金淋巴瘤（NHL），后诊断变更为霍奇金淋巴瘤（HL）。其中一些淋巴瘤最初被解释为霍奇金样间变性大细胞淋巴瘤（ALCL-HL亚型）。本研究的目的是分析最初遇到的组织学陷阱，更明确地界定处于HL灰色地带的淋巴瘤的诊断标准，并追踪这77例最初接受NHL方案治疗的HL患者的生存情况。77例HL病例由三位血液病理学家进行复查，并用包括CD30、CD15、CD3、CD20、CD45、CD43、LMP-1、EMA、BNH-9、TiA1和ALK1在内的大量抗体进行免疫染色。每例病例均根据卢克斯-赖伊系统和英国国家淋巴瘤研究（BNLI）分级进行分类。分析了患者的初始临床表现，并估计了77例患者的总生存率和无事件生存率。在77例HL中，46例最初被个别病理学家误诊为NHL（12例为ALCL，8例为ALCL-HL，12例为外周T细胞淋巴瘤（PTCL），6例为B细胞淋巴瘤，8例为无法分类NHL）。另外31例病例最初被专家组认为符合ALCL-HL（n = 18）或PTCL（n = 13），后来鉴于与HL一致的免疫表型而变更诊断。55%的患者完成了完整的NHL治疗。5年无事件生存率和总生存率分别为54%和77%。目前的结果表明，最初称为ALCL-HL的淋巴瘤不应被视为ALCL的一种变体，而应视为HL。误诊的临床后果似乎是无事件生存率低于经典HL，可能是因为最初治疗不当的HL复发更多。
