[孤立性浆细胞瘤：43例临床病理及免疫表型分析]

Yang Fan, Liu Wei-ping, Jiang Li-li, Li Feng-yuan, Liao Dian-ying, Li Gan-di

Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China.

Sichuan Da Xue Xue Bao Yi Xue Ban. 2006 Jan;37(1):93-6, 144.

OBJECTIVE

To investigate the clinicopathologic and immunophenotypic features of solitary plasmacytoma and discuss the diagnosis and differential diagnosis of the tumor.

METHODS

Clinicopathological study and follow up study were made on 43 cases of solitary plasmacytoma, including 24 cases of extramedullary plasmacytoma (EMP) and 19 cases of solitary plasmacytoma of bone (SPB). Immunohistochemical staining was performed by SP method using antibodies CD20, CD79a, PC, Ig kappa, Ig lamda, IgA, IgD, IgE, IgG and IgM.

RESULTS

Rgarding EMP, the male/female ratio is 2.5 to 1, the age ranges from 3 to 70 years (mean 49). Clinically, the neoplasms of 22 cases were located in nasal cavity or nasosinus, 2 cases were located in lung and tonsil respectively. Rgarding SPB, the male/female ratio is 1:1, the age ranges from 36 to 72 years (mean 53). Clinically, the neoplasms of 8 cases were located in vertebrae, 3 cases in pelvis, 6 cases in clavicle, rib and femur respectively, 2 case in radius and tibia respectively. Histopathological examination revealed tumor cells diffuse infiltration with necrosis and ulceration; the well-differentiated tumor cells were similar to the normal plasmacyte in shape; the poorly-differentiated tumor resembled centroblasts; there were a few interstitial tissues with plenty of vessels or formation of blood lakes; and there was deposition of amyloid materials. Immunophenotypic analysis showed that all tumor cells were positive for CD79a and negative for CD20; that plasma cell marker (VS38C) was expressed in 41 cases; that light chain restriction was detected in all 43 cases( 31 for lamda and 12 for kappa), and that heavy chain expression was detected in 39 for IgG, 1 for IgA, 2 for both IgG and IgM, and 1 for IgA/IgG.

CONCLUSION

The special histopathology in this group of solitary plasmacytomas is presented. The well-differentiated tumors should be distinguished from reactive plasmacytosis and MALT. And, when poorly-differentiated solitary plasmacytomas were tentatively diagnosed, large cell lymphoma, melanoma and poorly differentiated carcinoma should be considered in differential diagnosis.

目的

探讨孤立性浆细胞瘤的临床病理及免疫表型特征，讨论该肿瘤的诊断及鉴别诊断。

方法

对43例孤立性浆细胞瘤进行临床病理研究及随访，其中包括24例髓外浆细胞瘤（EMP）和19例骨孤立性浆细胞瘤（SPB）。采用SP法，用CD20、CD79a、PC、Igκ、Igλ、IgA、IgD、IgE、IgG和IgM抗体进行免疫组化染色。

结果

关于EMP，男女比例为2.5∶1，年龄范围为3至70岁（平均49岁）。临床上，22例肿瘤位于鼻腔或鼻窦，2例分别位于肺和扁桃体。关于SPB，男女比例为1∶1，年龄范围为36至72岁（平均53岁）。临床上，8例肿瘤位于椎体，3例位于骨盆，6例分别位于锁骨、肋骨和股骨，2例分别位于桡骨和胫骨。组织病理学检查显示肿瘤细胞弥漫浸润伴坏死和溃疡形成；高分化肿瘤细胞形态与正常浆细胞相似；低分化肿瘤类似中心母细胞；有少量间质组织，血管丰富或形成血湖；并有淀粉样物质沉积。免疫表型分析显示，所有肿瘤细胞CD79a阳性，CD20阴性；41例表达浆细胞标记（VS38C）；43例均检测到轻链限制（31例为λ链，12例为κ链），39例检测到重链表达，其中IgG 39例，IgA 1例，IgG和IgM均为2例，IgA/IgG 1例。