Ottaviani Giulia, Bueso-Ramos Carlos E, Seilstad Kay, Medeiros L Jeffrey, Manning John T, Jones Dan
Department of Hematopathology, University of Texas-MD Anderson Cancer Center, Houston TX, USA.
Am J Surg Pathol. 2004 Dec;28(12):1632-40. doi: 10.1097/00000478-200412000-00013.
The growth of angioimmunoblastic T-cell lymphoma (AIL) in lymph node often produces complex patterns of neoplastic T cells and nonneoplastic B cells that complicate diagnosis. To understand better how these different patterns of B-cell expansion arise, we compared the microanatomic localization of B cells and T cells within the follicular, paracortical, and sinusoidal compartments in 30 patients with AIL (including 10 with multiple sequential samples) with that seen in 33 cases of other types of T-cell lymphoma. With early or partial nodal involvement in AIL, germinal center B-cell expansions were relatively undisturbed and often associated with a variably distended D2-40+ CD31+ perifollicular sinus that surrounded most of the follicular compartment. Identifiable tumor T cells resided mostly in the paracortex. In later stages of AIL with more complete nodal effacement, bcl-6+ follicular B-cell proliferations shifted to distorted FDC networks arrayed along patent trabecular sinuses and were more intermixed with tumor T cells. In both AIL and other T-cell lymphomas, the density and locations of follicular B cells as well as bcl-6-negative monocytoid B cells were largely related to the patency of adjacent sinuses, except in Epstein-Barr virus (EBV)+ and histiocyte-rich B-cell proliferations, which arose in paracortical locations. The prominence of the perifollicular sinus in early stages of AIL resembled that seen in reactive lymphadenitis during conditions of lymphatic engorgement and implicates cytokines within lymph fluid in maintaining both the normal and altered germinal center reactions. Patterns of sinus drainage largely explain the useful changes in B-cell distribution that occur in nodal T-cell lymphomas and represent an important tool in classification and diagnosis of these tumors.
血管免疫母细胞性T细胞淋巴瘤（AIL）在淋巴结中的生长常常产生肿瘤性T细胞和非肿瘤性B细胞的复杂模式，这使诊断变得复杂。为了更好地理解这些不同的B细胞扩增模式是如何产生的，我们比较了30例AIL患者（包括10例有多个连续样本的患者）的滤泡、副皮质和窦状间隙内B细胞和T细胞的微解剖定位，与33例其他类型T细胞淋巴瘤中的情况进行对比。在AIL早期或部分淋巴结受累时，生发中心B细胞扩增相对未受干扰，且常与围绕大部分滤泡间隙的不同程度扩张的D2-40+CD31+滤泡周窦相关。可识别的肿瘤T细胞大多位于副皮质。在AIL后期，淋巴结更完全被破坏时，bcl-6+滤泡B细胞增殖转移至沿开放小梁窦排列的扭曲滤泡树突状细胞网络，并与肿瘤T细胞更混合。在AIL和其他T细胞淋巴瘤中，滤泡B细胞以及bcl-6阴性单核样B细胞的密度和位置在很大程度上与相邻窦的通畅性有关，但在爱泼斯坦-巴尔病毒（EBV）阳性和组织细胞丰富的B细胞增殖中除外，后者出现在副皮质位置。AIL早期滤泡周窦的突出类似于在淋巴充血情况下反应性淋巴结炎中所见，提示淋巴液中的细胞因子在维持正常和改变的生发中心反应中起作用。窦引流模式在很大程度上解释了淋巴结T细胞淋巴瘤中发生的B细胞分布的有用变化，并代表了这些肿瘤分类和诊断的重要工具。
