Asplund Sheryl L, McKenna Robert W, Howard Michael S, Kroft Steven H
University of Texas Southwestern Medical School, Dallas, Texas, USA.
Am J Surg Pathol. 2002 May;26(5):624-9. doi: 10.1097/00000478-200205000-00008.
The presence of prominent proliferation centers (PCs) in lymph nodes (LNs) involved with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has been associated with atypical blood smear morphology. Atypical CLL has in turn been associated with variant immunophenotypes and poor outcome. However, the significance of abundant PCs remains controversial. We have analyzed the flow cytometric immunophenotypic features of 54 CLL/SLL LNs and correlated these findings with the morphologic and clinical features. The LN histology was assigned to one of two groups based on the prominence of PCs: Group I LNs contained scattered small, sometimes ill-defined PCs in a background of monotonous small round lymphocytes. Group II LNs had increased numbers and sizes of PCs resulting in an obviously nodular appearance at low magnification. Flow cytometry was performed using broad three- or four-color antibody panels that included anti-CD5, CD19, CD20, CD23, CD38, FMC7, and surface immunoglobulin (sIg). The intensity of expression of all markers was scored semi-quantitatively using isotypic controls and internal positive and negative populations as standards. There were 32 group I and 22 group II LNs that, by definition, expressed CD19, CD5, and CD23. Little variability was seen in the intensity of expression of CD19, and the majority of cases expressed CD23 brightly. CD5 varied from very dim to an intensity similar to that of normal T cells; the majority had an intermediate level of CD5 expression. FMC7 was expressed to a significant extent in 11 cases (21%). CD20 was relatively bright in 17 cases (32%). sIg was dim in 29 cases (55%) and moderate or bright in 24 cases (45%). CD38 was expressed significantly in 25 cases (47%). There was no correlation between histologic group and intensity of expression of any individual marker or with an immunophenotypic atypia score based on FMC7, CD20, and sIg. There was also no correlation between morphology or immunophenotype and clinical features. These findings do not support the interpretation that the prominence of proliferation centers in CLL/SLL LNs defines biologically distinct subtypes.
在与慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）相关的淋巴结（LN）中，显著增殖中心（PC）的存在与非典型血液涂片形态有关。非典型CLL又与变异免疫表型及不良预后相关。然而，丰富的PC的意义仍存在争议。我们分析了54例CLL/SLL LN的流式细胞术免疫表型特征，并将这些发现与形态学和临床特征相关联。根据PC的突出程度，LN组织学被分为两组之一：I组LN在单调的小圆形淋巴细胞背景中含有散在的小的、有时界限不清的PC。II组LN的PC数量和大小增加，在低倍镜下呈现明显的结节状外观。使用包含抗CD5、CD19、CD20、CD23、CD38、FMC7和表面免疫球蛋白（sIg）的宽泛三色或四色抗体组合进行流式细胞术检测。使用同型对照以及内部阳性和阴性群体作为标准，对所有标志物的表达强度进行半定量评分。有32例I组LN和22例II组LN，根据定义，它们表达CD19、CD5和CD23。CD19的表达强度变化不大，大多数病例CD23表达明亮。CD5的表达强度从非常微弱到与正常T细胞相似；大多数病例CD5表达水平中等。11例（21%）病例中FMC7有显著表达。17例（32%）病例中CD20相对明亮。29例（55%）病例中sIg暗淡，24例（45%）病例中sIg中等或明亮。25例（47%）病例中CD38有显著表达。组织学分组与任何单个标志物的表达强度之间，或与基于FMC7、CD20和sIg的免疫表型非典型评分之间均无相关性。形态学或免疫表型与临床特征之间也无相关性。这些发现不支持CLL/SLL LN中增殖中心的突出程度定义生物学上不同亚型的解释。
