Hunt J P, Chan J A, Samoszuk M, Brynes R K, Hernandez A M, Bass R, Weisenburger D D, Müller-Hermelink K, Nathwani B N
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Am J Clin Pathol. 2001 Oct;116(4):550-9. doi: 10.1309/P2M2-JEA3-YYQF-0P38.
We describe 35 peripheral lymph nodes classified as mantle cell/marginal zone B-cell hyperplasia with clear cells using morphologic and immunologic findings. For the purpose of this study, we obtained clinical follow-up information and performed immunoglobulin gene rearrangement studies on paraffin sections by polymerase chain reaction. Architecturally, the nodes were suggestive of a benign process: no pericapsular infiltration, sinuses readily identified, scattered reactive follicles present, and paracortical nodular hyperplasia present. No monocytoid B cells were present. Focally, small lymphoid cells with round nuclei and clear cytoplasm (clear cells) formed monomorphic nodular, inverse follicular, and/or marginal zone patterns. Flow cytometry and immunohistochemical analysis revealed neither light chain restriction nor an aberrant B-cell phenotype. Immunoglobulin gene rearrangement studies showed a clonal band in 1 of 26 cases in which DNA was amplified. To ascertain the clinical relevance of this positive case, follow-up information was obtained 30 months after the initial biopsy; the 83-year-old woman was alive without treatment but had splenomegaly and bone marrow involvement by marginal zone B-cell lymphoma. The morphologic and immunologic criteria used for diagnosis of mantle cell/marginal zone B-cell hyperplasia with clear cytoplasm are valid; however, to rule out the possibility of occult lymphoma, immunoglobulin gene rearrangement studies and clinical follow-up are necessary.
我们利用形态学和免疫学检查结果描述了35个外周淋巴结，其分类为伴有透明细胞的套细胞/边缘区B细胞增生。为了本研究的目的，我们获取了临床随访信息，并通过聚合酶链反应对石蜡切片进行了免疫球蛋白基因重排研究。在结构上，这些淋巴结提示为良性病变：无包膜周围浸润，窦腔易于辨认，有散在的反应性滤泡，以及副皮质结节性增生。未见单核样B细胞。局部可见核圆形、胞质透明的小淋巴细胞（透明细胞）形成单形性结节、反折滤泡和/或边缘区模式。流式细胞术和免疫组化分析均未显示轻链限制或异常B细胞表型。免疫球蛋白基因重排研究显示，在26例DNA扩增的病例中，有1例出现克隆带。为确定这例阳性病例的临床相关性，在初次活检30个月后获取了随访信息；这位83岁女性未经治疗仍存活，但有脾肿大且边缘区B细胞淋巴瘤累及骨髓。用于诊断伴有透明细胞质的套细胞/边缘区B细胞增生的形态学和免疫学标准是有效的；然而，为排除隐匿性淋巴瘤的可能性，免疫球蛋白基因重排研究和临床随访是必要的。
