Bacchi C E, Dorfman R F, Hoppe R T, Chan J K, Warnke R A
Department of Pathology, Stanford University Medical Center, California 94305.
Am J Clin Pathol. 1991 Nov;96(5):589-93. doi: 10.1093/ajcp/96.5.589.
The authors report the histories of two patients with undifferentiated carcinoma metastatic to lymph nodes simulating the "syncytial variant" of nodular sclerosing Hodgkin's disease. One of the patients initially was treated for Hodgkin's disease, but the clinical evolution was more typical of carcinoma. Both lesions were characterized histologically by noncohesive aggregates of large neoplastic cells with abundant eosinophilic cytoplasm and conspicuous nucleoli. Although cells compatible with diagnostic Reed-Sternberg cells were identified in an "appropriate" cellular background in both patients, the diagnosis of carcinoma was supported by intense cytokeratin immunoreactivity. Subtle histologic clues that should suggest the possibility of metastatic carcinoma in a patient whose morphologic data suggests the syncytial variant of nodular sclerosing Hodgkin's disease include sinus infiltration, phagocytosis of neutrophils by tumor cells, marked nuclear anaplasia, and the presence of spindle-shaped tumor cells.
作者报告了两例未分化癌转移至淋巴结的病例，其形态类似结节硬化型霍奇金淋巴瘤的“合体细胞变异型”。其中一名患者最初被诊断为霍奇金淋巴瘤并接受治疗，但临床病程更符合癌的表现。两个病变在组织学上均表现为大的肿瘤细胞形成的非黏附性聚集，胞质丰富嗜酸性，核仁明显。尽管在两名患者的“合适”细胞背景中均发现了符合诊断标准的里德-斯腾伯格细胞，但强烈的细胞角蛋白免疫反应支持了癌的诊断。对于形态学数据提示为结节硬化型霍奇金淋巴瘤合体细胞变异型的患者，应提示可能为转移性癌的细微组织学线索包括窦浸润、肿瘤细胞吞噬中性粒细胞、明显的核间变以及梭形肿瘤细胞的存在。
