[应用积液细胞学标本诊断血液淋巴系统恶性肿瘤：33例研究]

Su Xue-ying, Xu Xia, Tang Yuan, Li Gan-di

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

Zhonghua Bing Li Xue Za Zhi. 2009 Aug;38(8):542-6.

OBJECTIVE

To study the diagnostic accuracy of hematolymphoid malignancy by using effusion fluid cytology specimens and to evaluate the values of immunocytochemistry for this assay.

METHODS

The cytospin preparations/smears and cell block sections of effusion cytology specimens from 33 cases of hematolymphoid malignancy were retrospectively reviewed. Immunocytochemical study was performed. In selected cases, in-situ hybridization for Epstein-Barr virus-encoded RNA and immunoglobulin and T-cell receptor gene rearrangement study were carried out as indicated.

RESULTS

There were 33 cases of hematolymphoid malignancy, including 12 cases of T-lymphoblastic leukemia/lymphoma, 16 cases of mature B cell neoplasm (including 9 cases of diffuse large B-cell lymphoma, 2 cases of Burkitt lymphoma, 2 cases of plasmacytoma/multiple myeloma, 2 cases of B-small lymphocytic leukemia/lymphoma and 1 case of mantle cell lymphoma), 3 cases of mature T or NK-cell neoplasm (including 1 case of extranodal nasal NK/T-cell lymphoma, 1 case of angioimmunoblastic T-cell lymphoma and 1 case of T-cell prolymphocytic leukemia), 1 case of myeloid sarcoma and 1 case of mast cell sarcoma. Amongst the 33 cases studied, 16 represented disease relapses, including 8 cases of diffuse large B-cell lymphoma, 2 cases of plasmacytoma/multiple myeloma, 2 cases of B-small lymphocytic leukemia/lymphoma, 1 case of T-lymphoblastic leukemia/lymphoma, 1 case of angioimmunoblastic T-cell lymphoma, 1 case of mantle cell lymphoma and 1 case of mast cell sarcoma. The remaining 17 cases showed serous effusion as the primary manifestation, with the diagnosis primarily made upon cytologic examination. The cytologic findings seen in all the 33 cases studied were in agreement with the corresponding histologic diagnosis.

CONCLUSIONS

Diagnosis of hematolymphoid malignancy by effusion fluid cytology specimens is possible, especially when coupled with the clinical history, immunophenotype, in-situ hybridization and gene rearrangement study findings. This is especially so for cases with disease relapses.

目的

通过积液细胞学标本研究血液淋巴系统恶性肿瘤的诊断准确性，并评估免疫细胞化学在该检测中的价值。

方法

回顾性分析33例血液淋巴系统恶性肿瘤患者的积液细胞学标本的细胞离心涂片/涂片及细胞块切片。进行免疫细胞化学研究。在选定的病例中，根据需要进行爱泼斯坦-巴尔病毒编码RNA的原位杂交以及免疫球蛋白和T细胞受体基因重排研究。

结果

33例血液淋巴系统恶性肿瘤，包括12例T淋巴母细胞白血病/淋巴瘤、16例成熟B细胞肿瘤（包括9例弥漫性大B细胞淋巴瘤、2例伯基特淋巴瘤、2例浆细胞瘤/多发性骨髓瘤、2例B小淋巴细胞白血病/淋巴瘤和1例套细胞淋巴瘤）、3例成熟T或NK细胞肿瘤（包括1例结外鼻型NK/T细胞淋巴瘤、1例血管免疫母细胞性T细胞淋巴瘤和1例T细胞原淋巴细胞白血病）、1例髓系肉瘤和1例肥大细胞肉瘤。在研究的33例病例中，16例为疾病复发，包括8例弥漫性大B细胞淋巴瘤、2例浆细胞瘤/多发性骨髓瘤、2例B小淋巴细胞白血病/淋巴瘤、1例T淋巴母细胞白血病/淋巴瘤、1例血管免疫母细胞性T细胞淋巴瘤、1例套细胞淋巴瘤和1例肥大细胞肉瘤。其余17例以浆液性积液为主要表现，主要通过细胞学检查确诊。所有33例研究病例的细胞学检查结果与相应的组织学诊断一致。