Sargent Rachel Lynn, Cook James R, Aguilera Nadine I, Surti Urvashi, Abbondanzo Susan L, Gollin Susanne M, Swerdlow Steven H
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Am J Surg Pathol. 2008 Nov;32(11):1643-53. doi: 10.1097/PAS.0b013e3181758806.
Lymphoplasmacytic lymphoma (LPL) is a small B-cell lymphoma with plasmacytic differentiation that does not fulfill the criteria for any other small B-cell lymphoma. Cytogenetic characterization of nodal LPL is limited and the distinction from marginal zone lymphomas with plasmacytic differentiation can be problematic. Thus, 17 cases of lymph node-based LPL were studied with fluorescence immunophenotypic and interphase cytogenetics for the investigation of neoplasia (FICTION) using a CD79a antibody and probes to detect trisomies of chromosomes 3 (15 cases), 12 (16 cases), and 18 (17 cases); rearrangements (R) of IgH (10 cases), BCL6 (6 cases), PAX5 (7 cases), and MALT1 (16 cases); and deletion 6q21 (7 cases). Cases with IgH R were further studied with an IgH/BCL2 probe. In cases without FICTION studies, previously reported fluorescence in situ hybridization results for IgH, PAX5, and deletion 6q21 were available from prior studies. The histopathology, immunophenotype, and available clinical data were also reviewed. Three pathologic categories were recognized: 5 classic LPL, 5 vaguely nodular polymorphous (VN-P), and 7 other. Among the classic LPL, 4/4 had an IgM paraproteinemia, 5/5 had bone marrow involvement (BM+), and 1/5 had +MALT1. One of one VN-P LPL had an IgM paraprotein, 2/4 were IgM+, 2/4 IgG+, 1/3 had BM+, and 1/5 had an IgH R. Among the other cases, 2/3 had a paraprotein, 2/7 were IgM+, 5/7 IgG+, and 0/3 had BM+. Of these cases, 1 showed +12, 1 +18, and 1 IgH/BCL2 rearrangement plus +18. None of the 17 cases had a 6q21 deletion or +3. Therefore, with rare exception, lymph node-based LPL with classic or more varied histopathologic features does not have the cytogenetic abnormalities frequently associated with bone marrow-based LPL/Waldenstrom macroglobulinemia or many of the marginal zone lymphomas. The search for better objective inclusionary criteria for LPL must continue.
淋巴浆细胞淋巴瘤（LPL）是一种具有浆细胞分化的小B细胞淋巴瘤，不符合任何其他小B细胞淋巴瘤的标准。结内LPL的细胞遗传学特征有限，与具有浆细胞分化的边缘区淋巴瘤的鉴别可能存在问题。因此，我们使用CD79a抗体和探针，对17例基于淋巴结的LPL进行了荧光免疫表型和间期细胞遗传学肿瘤研究（FICTION），以检测3号染色体三体（15例）、12号染色体三体（16例）和18号染色体三体（17例）；免疫球蛋白重链（IgH）重排（10例）、B细胞淋巴瘤6（BCL6）重排（6例）、配对盒基因5（PAX5）重排（7例）和黏膜相关淋巴组织淋巴瘤易位蛋白1（MALT1）重排（16例）；以及6q21缺失（7例）。对有IgH重排的病例进一步用IgH/BCL2探针进行研究。对于未进行FICTION研究的病例，可从先前研究中获得先前报道的IgH、PAX5荧光原位杂交结果和6q21缺失情况。我们还回顾了组织病理学、免疫表型及现有的临床数据。识别出三种病理类型：5例经典LPL、5例模糊结节多形性（VN-P）和7例其他类型。在经典LPL中，4/4有IgM副蛋白血症，5/5有骨髓受累（BM+），1/5有+MALT1。1例VN-P LPL有IgM副蛋白，2/4为IgM+，2/4为IgG+，1/3有BM+，1/5有IgH重排。在其他病例中，2/3有副蛋白，2/7为IgM+，5/7为IgG+，0/3有BM+。在这些病例中，1例显示+12，1例显示+18，1例显示IgH/BCL2重排加+18。17例病例中均无6q21缺失或+3。因此，除极少数例外，具有经典或更多样化组织病理学特征的基于淋巴结的LPL不存在与基于骨髓的LPL/华氏巨球蛋白血症或许多边缘区淋巴瘤常见相关的细胞遗传学异常。寻找更好的LPL客观纳入标准的工作必须继续。
