Hernandez Osvaldo, Oweity Thaira, Ibrahim Sherif
Department of Pathology, New York University Medical Center, New York, New York, USA.
Cytojournal. 2005 Sep 9;2:14. doi: 10.1186/1742-6413-2-14.
An elevated CD4/CD8 T-cell ratio on flow cytometry (FCM) analysis has been reported in the literature to be associated with Hodgkin lymphoma (HL). The purpose of our study was to determine the diagnostic significance of an elevated CD4/CD8 ratio in lymph node fine needle aspiration (FNA) specimens.
Between 1996 and 2002, out of 837 lymph node FNAs submitted for flow cytometry analysis, 85 cases showed an elevated CD4/CD8 ratio, defined as greater than or equal to 4, without definitive evidence of a lymphoproliferative disorder. The cytologic diagnoses of these 85 cases were grouped into four categories: reactive, atypical, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). Histologic follow-up was available in 17/85 (20%) of the cases.
5 of the 64 cases in which FCM and cytology did not reveal evidence of a lymphoproliferative disease had tissue follow-up because of persistent lymphadenopathy and high clinical suspicion. 3/5 (60%) confirmed the diagnosis of reactive lymphadenopathy. The two remaining cases (40%) were positive for lymphoma (1HL, 1NHL). 8/15 cases called atypical on cytology had histologic follow-up. 7/8 (87.5%) cases were positive for lymphoma (3HL, 4NHL). 3/4 cases called HL on cytology had tissue follow-up and all 3 (100%) confirmed the diagnosis of HL. One case diagnosed as NHL on cytology was found to be a diffuse large B-cell lymphoma. In summary, out of 17 cases with histologic follow-up 4/17 (24%) were reactive with CD4/CD8 T-cell ratio of 4.1-29, 7/17 (41%) were HLs with CD4/CD8 T-cell ratio of 5.3-11, and 6/17 (35%) were NHLs with CD4/CD8 T-cell ratio of 4.2-14.
An elevated CD4/CD8 ratio on FCM is a nonspecific finding which may be seen in both reactive and lymphoproliferative disorders. The cytomorphologic features of the smear are more relevant than the sole flow cytometric finding of an elevated CD4/CD8 ratio.
文献报道，流式细胞术（FCM）分析中CD4/CD8 T细胞比值升高与霍奇金淋巴瘤（HL）相关。我们研究的目的是确定淋巴结细针穿刺（FNA）标本中CD4/CD8比值升高的诊断意义。
1996年至2002年间，在提交进行流式细胞术分析的837例淋巴结FNA中，85例显示CD4/CD8比值升高（定义为大于或等于4），且无明确的淋巴增殖性疾病证据。这85例的细胞学诊断分为四类：反应性、非典型性、霍奇金淋巴瘤（HL）和非霍奇金淋巴瘤（NHL）。85例中有17例（20%）有组织学随访结果。
64例FCM和细胞学检查未发现淋巴增殖性疾病证据的病例中，5例因持续性淋巴结肿大和高度临床怀疑而进行了组织学随访。3/5（60%）确诊为反应性淋巴结病。其余2例（40%）为淋巴瘤阳性（1例HL，1例NHL）。15例细胞学诊断为非典型性的病例中有8例进行了组织学随访。7/8（87.5%）例为淋巴瘤阳性（3例HL，4例NHL）。4例细胞学诊断为HL的病例中有3例进行了组织学随访，全部3例（100%）确诊为HL。1例细胞学诊断为NHL的病例被发现为弥漫性大B细胞淋巴瘤。总之，17例有组织学随访结果的病例中，4/17（24%）为反应性，CD4/CD8 T细胞比值为4.1 - 29；7/17（41%）为HL，CD4/CD8 T细胞比值为5.3 - 11；6/17（35%）为NHL，CD4/CD8 T细胞比值为4.2 - 14。
FCM检测中CD4/CD8比值升高是一个非特异性发现，在反应性和淋巴增殖性疾病中均可出现。涂片的细胞形态学特征比单纯流式细胞术检测到的CD4/CD8比值升高更具相关性。
