Baumhoer D, Tzankov A, Dirnhofer S, Tornillo L, Terracciano L M
Institute of Pathology, University Hospital Basel, Basel, Switzerland.
Histopathology. 2008 Jul;53(1):81-90. doi: 10.1111/j.1365-2559.2008.03069.x. Epub 2008 Jun 6.
Liver involvement is a common finding in patients suffering from lymphoproliferative disease, and histopathological patterns of infiltration vary according to lymphoma subtype. Data correlating the form of liver involvement with distinct lymphoma subtypes is, however, scarce. The aim was to review 89 liver biopsies diagnosed with lymphoma infiltration and evaluate the infiltration patterns.
In equivocal cases, additional immunohistochemical and molecular pathology analyses were performed to differentiate between neoplastic and reactive cell infiltrates and to classify the lymphoma subtypes. Diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukaemia (CLL), Hodgkin's lymphoma (HL) and Burkitt lymphoma (BL) were the most prevalent subtypes in our series, which included 14 different lymphoma entities in total. Whereas DLBCL and BL predominantly demonstrated tumour nodules deranging the normal hepatic architecture, CLL and HL mostly showed infiltration of the portal fields. Interestingly, distinct lymphoma entities, particularly marginal zone B-cell lymphomas (MZL) and HL, commonly revealed lympho-epithelial lesions of bile ducts, which were observed in 10% of all investigated cases. Four cases, initially interpreted as T-cell lymphomas, proved to be reactive T-cell lesions.
Distinct lymphoma subtypes show characteristic patterns of liver infiltration. Additional molecular analyses can support diagnosis by verification of clonality or detection of characteristic genetic aberrations.
肝脏受累是淋巴增殖性疾病患者的常见表现，且浸润的组织病理学模式因淋巴瘤亚型而异。然而，将肝脏受累形式与不同淋巴瘤亚型相关联的数据却很匮乏。本研究旨在回顾89例经诊断为淋巴瘤浸润的肝脏活检病例，并评估其浸润模式。
在诊断不明确的病例中，进行了额外的免疫组织化学和分子病理学分析，以区分肿瘤性和反应性细胞浸润，并对淋巴瘤亚型进行分类。弥漫性大B细胞淋巴瘤（DLBCL）、慢性淋巴细胞白血病（CLL）、霍奇金淋巴瘤（HL）和伯基特淋巴瘤（BL）是我们系列研究中最常见的亚型，该系列研究共包括14种不同的淋巴瘤实体。DLBCL和BL主要表现为破坏正常肝结构的肿瘤结节，而CLL和HL大多表现为门管区浸润。有趣的是，不同的淋巴瘤实体，特别是边缘区B细胞淋巴瘤（MZL）和HL，常出现胆管淋巴上皮病变，在所有研究病例中有10%观察到这种病变。4例最初被诊断为T细胞淋巴瘤的病例，后来证实为反应性T细胞病变。
不同的淋巴瘤亚型表现出特征性的肝脏浸润模式。额外的分子分析可通过验证克隆性或检测特征性基因畸变来支持诊断。
