Brittig Ferenc, Ajtay Elvira, Jaksó Pál, Kelényi Gábor
Department of Pathology, County Hospital, Veszprém, Hungary.
Pathol Oncol Res. 2004;10(1):57-60. doi: 10.1007/BF02893411. Epub 2004 Mar 18.
In the course of a routine clinical check up of the 54 year old male a splenic well circumscribed tumor like mass of 12 cm in diameter was discovered. Splenectomy with removal of splenic hilar lymph nodes and liver wedge biopsy were performed. Four years later the patient is symptom free. In the removed spleen the tumor like lesion showed a pattern consistent with the diagnosis of inflammatory pseudotumor. However, besides lymphocytes, plasma cells, macrophages, eosinophils and myofibroblasts a high number of slightly polymorphic, frequently binucleated cells positive for CD21 and CD23 were seen. These cells which were scattered or formed smaller or larger groups and fascicles were considered to represent follicular dendritic reticulum cells (FDRCs) and the lesion a FDRC tumor. Flow cytometric DNA ploidy analysis showed a hyperdiploid cell population inside the tumor like lesion. Besides FDRC tumors of high and of intermediate malignancy the present case may represent a low grade type of moderate proliferation activity. The FDRCs of the lesion and a few smaller spindle cells were EBER positive indicative of the presence of EBV. No EBER positive cells were seen in the uninvolved spleen.
在对一名54岁男性进行常规临床检查过程中，发现脾脏有一个直径12厘米、边界清晰的肿瘤样肿块。进行了脾切除术，切除脾门淋巴结并做了肝脏楔形活检。四年后，患者无症状。在切除的脾脏中，肿瘤样病变显示出与炎性假瘤诊断相符的模式。然而，除淋巴细胞、浆细胞、巨噬细胞、嗜酸性粒细胞和成肌纤维细胞外，还可见大量CD21和CD23阳性的轻度多形性、常为双核的细胞。这些细胞散在分布或形成大小不等的细胞团和束状结构，被认为代表滤泡树突状网状细胞（FDRCs），该病变为FDRC肿瘤。流式细胞术DNA倍体分析显示肿瘤样病变内有超二倍体细胞群。除高恶性和中恶性的FDRC肿瘤外，本病例可能代表一种具有中等增殖活性的低级别类型。病变中的FDRCs和一些较小的梭形细胞EBER阳性，提示存在EBV。在未受累的脾脏中未见EBER阳性细胞。
