干燥综合征患者腮腺淋巴样疾病的临床、组织病理学及免疫组织化学研究

Clinical, histopathological and immunohistological study of lymphoid disorders in the parotid gland of patients with Sjögren's syndrome.

作者信息

Bozinović Marija Trenkić, Katić Vuka, Krasić Dragan, Veselinović Dragan, Jovanović Predrag, Krstić Miljan

机构信息

Clinical Center Nis, *Clinic for Ophthalmology, Nis, Serbia.

出版信息

Vojnosanit Pregl. 2009 Dec;66(12):955-60. doi: 10.2298/vsp0912955t.

DOI:10.2298/vsp0912955t

PMID:20095514

Abstract

BACKGROUND/AIM: Sjögren's syndrome is a chronic autoimmune systemic disease characterized by polyglandular tissue destruction, leading to keratoconjunctivitis sicca and xerostomia. These patients have 44-fold increased risk of developing salivary gland lymphoma, of which 80% are marginal zone (MALT) type. Having in mind that criteria for distinguishing benign lymphoepithelial lesions from MALT lymphoma are obscure, the aim of this study was to provide practical information that could be integrated into diagnostic practice.

METHODS

Among 32 parotidectomies, 27 cases were identified as having benign lymphoepithelial disorders and 5 cases low grade MALT lymphoma. Histological sections were stained routinely with hematoxylin and eosin (H&E and special stains. Immunohistochemical study was performed by LSAB2 method, by using primary antibodies for CD20, CD3, Kappa and Lambda light chains and Cytokeratin (Dako Denmark).

RESULTS

The 27 patients with Sjögren's sialoadenitis (22 women and 5 men), and 5 patients with MALT lymphoma (only women) were included in this analysis. According to the Ann Harbor Classification, all patients with MALT lymphoma had stage IE. Both groups of patients had an indolent clinical course, except permanent, rapid parotid enlargement in the patients with MALT lymphoma. Histologically, the periductal lymphoid infiltrate, gradually extended to the acini, completely replacing them by a sea of polyclonal lymphocytes, immunoblasts, germinal centers and plasma cells (confirmed immunohistochemically), but sparing the ducts and preserving lobular appearance. The histological feature of salivary gland MALT lymphoma included heterogeneous B-cell infiltrate that totally or subtotally had effaced the normal glandular structure. Malign lymphoepithelial lesions, representing infiltration of the ductal and epithelial structures by monoclonal neoplastic B-cells, positive for CD20, were highlighted by antibody to cytokeratin.

CONCLUSION

The optimal diagnosis of salivary gland MALT lymphoma requires careful integration of clinical, morphological and immunohistochemical results.

摘要

背景/目的：干燥综合征是一种慢性自身免疫性全身性疾病，其特征为多腺性组织破坏，导致角结膜干燥症和口干症。这些患者发生涎腺淋巴瘤的风险增加44倍，其中80%为边缘区（MALT）型。鉴于区分良性淋巴上皮病变与MALT淋巴瘤的标准尚不明确，本研究旨在提供可纳入诊断实践的实用信息。

方法

在32例腮腺切除病例中，27例被确定为患有良性淋巴上皮疾病，5例为低级别MALT淋巴瘤。组织学切片常规用苏木精和伊红（H&E）染色及特殊染色。免疫组织化学研究采用LSAB2法，使用针对CD20、CD3、κ和λ轻链以及细胞角蛋白（丹麦达科公司）的一抗。

结果

本分析纳入了27例干燥综合征涎腺炎患者（22例女性和5例男性）以及5例MALT淋巴瘤患者（均为女性）。根据安阿伯分期系统，所有MALT淋巴瘤患者均为IE期。两组患者的临床病程均较为惰性，但MALT淋巴瘤患者出现永久性、快速腮腺肿大。组织学上，导管周围淋巴浸润逐渐扩展至腺泡，被大量多克隆淋巴细胞、免疫母细胞、生发中心和浆细胞完全替代（免疫组织化学证实），但导管未受累且保留小叶外观。涎腺MALT淋巴瘤的组织学特征包括异质性B细胞浸润，完全或部分取代正常腺结构。恶性淋巴上皮病变表现为单克隆肿瘤性B细胞浸润导管和上皮结构，CD20阳性，细胞角蛋白抗体可突出显示。