Wang Sa, Ernst Linda M, Smith Brian R, Tallini Giovanni, Howe John G, Crouch Jill, Cooper Dennis L
Department of Pathology, Yale University School of Medicine, New Haven, Conn, USA.
Arch Pathol Lab Med. 2003 Dec;127(12):1619-22. doi: 10.5858/2003-127-1619-STWIAW.
We report a case of Whipple disease in a 55-year-old woman who presented with arthralgia, weight loss, and lymphadenopathy. Tropheryma whippleii bacilli were identified in the mesenteric lymph nodes by diastase-resistant periodic acid-Schiff stain and confirmed by electron microscopy. Retrospectively, previous biopsy specimens from the duodenum and right axillary lymph node of this patient, which were initially considered to demonstrate reactive changes, also showed features consistent with involvement by Whipple disease. At the time of presentation, a large kappa-restricted monoclonal B-cell population with the phenotype CD20+CD19+CD5-CD10- was identified in the patient's peripheral blood, lymph nodes, and bone marrow by flow cytometry study. The monoclonality of the mesenteric lymph node B cells was confirmed by immunohistochemical stain for kappa chain after antigen retrieval and also by polymerase chain reaction with the primer set targeting FR2-V(H). Routine cytogenetic study failed to reveal any chromosomal abnormalities, and polymerase chain reaction for Bcl-2 major and minor breakpoint cluster of t(14:18) was not detected. The monoclonal B cells have persisted in blood for the entire follow-up period (10 months). The possibility of reactive monoclonal B-cell proliferation versus Whipple disease-related B-cell lymphoma is discussed.
我们报告一例55岁女性的惠普尔病，该患者表现为关节痛、体重减轻和淋巴结病。通过耐淀粉酶的过碘酸希夫染色在肠系膜淋巴结中鉴定出惠普尔嗜组织菌，并经电子显微镜确认。回顾性分析，该患者先前十二指肠和右腋窝淋巴结的活检标本最初被认为显示出反应性改变，现在也显示出与惠普尔病累及相符的特征。在就诊时，通过流式细胞术研究在患者外周血、淋巴结和骨髓中鉴定出一个具有CD20 + CD19 + CD5 - CD10 - 表型的大的κ限制性单克隆B细胞群体。通过抗原修复后κ链的免疫组织化学染色以及使用靶向FR2 - V(H)的引物组进行聚合酶链反应，证实了肠系膜淋巴结B细胞的单克隆性。常规细胞遗传学研究未发现任何染色体异常，也未检测到t(14:18)的Bcl - 2主要和次要断裂点簇的聚合酶链反应。在整个随访期（10个月），单克隆B细胞一直存在于血液中。讨论了反应性单克隆B细胞增殖与惠普尔病相关B细胞淋巴瘤的可能性。
