Zhu Hong, Zhou Xiao-ge
Department of Pathology, Beijing Friendship Hospital, Capital University of Medical Science, China.
Zhonghua Bing Li Xue Za Zhi. 2010 Aug;39(8):528-31.
To investigate the architectural and cytological variations of plasma cell neoplasms, and discuss the diagnosis and differential diagnosis.
Histological and immunohistochemical examinations were used to study the morphologic and immunophenotypic features of 46 cases of plasma cell neoplasms.
40 out of 46 cases were diffuse growth pattern. 3 cases had a nestlike architecture that can mimic neuroendocrine tumors and 3 cases had a prominent fibrous sclerosis background. Amyloid deposition, calcification or ossification and angiomatoid areas can be prominent and may obscure the neoplastic plasma cells. Cytologically, 30 cases were composed of relatively mature plasma cells and can be recognized without too much difficulty. Tumor cells resembled immunoblasts in 6 cases and small lymphocytes in 4 cases. In another 2 cases tumor cells were easily confused with Signet-ring cells or clear cells. Tumor cells were composed of anaplastic cells, histocytoid cells and spindle cells in each one case, respectively. Lastly, tumor cells can be polymorphous which composed of multilobated, monocytoid or multinucleated cells in one case. 93.1% (27/29) cases expressed CD79a while only 5.1% (2/39) cases expressed CD20.87.1% (27/31) cases expressed CD38 and 83.3% (25/30) cases expressed CD138, 96.8% (30/31) cases expressed MUM-1. Light chain restrictions were detected in 38 cases, that 27 cases expressed lambda and 11 for kappa.
Except for the common architecture and cytology in plasma cell tumor, unusual morphology may appear. Thus, pay attention to distinguish from lymphoma such as small lymphocytic lymphoma and anaplastic large cell lymphoma, pooly differentiated carcinoma, clear cell carcinoma or Signet-ring cell carcinoma, sarcoma, etc. And immunohistochemistry is essential in the diagonosis.
探讨浆细胞肿瘤的组织结构及细胞学变异，并讨论其诊断与鉴别诊断。
采用组织学及免疫组化检查研究46例浆细胞肿瘤的形态学及免疫表型特征。
46例中40例为弥漫性生长模式。3例具有巢状结构，可模拟神经内分泌肿瘤，3例有明显的纤维硬化背景。淀粉样物质沉积、钙化或骨化以及血管瘤样区域可很突出，可能掩盖肿瘤性浆细胞。细胞学上，30例由相对成熟的浆细胞组成，不难识别。6例肿瘤细胞类似免疫母细胞，4例类似小淋巴细胞。另外2例肿瘤细胞容易与印戒细胞或透明细胞混淆。肿瘤细胞分别在1例中由间变细胞、组织细胞样细胞和梭形细胞组成。最后，1例肿瘤细胞可呈多形性，由分叶状、单核样或多核细胞组成。93.1%（27/29）的病例表达CD79a，而仅5.1%（2/39）的病例表达CD20。87.1%（27/31）的病例表达CD38，83.3%（25/30）的病例表达CD138，96.8%（30/31）的病例表达MUM-1。38例检测到轻链限制，其中27例表达λ链，11例表达κ链。
除浆细胞肿瘤常见的结构和细胞学表现外，可能出现不寻常形态。因此，要注意与小淋巴细胞淋巴瘤、间变性大细胞淋巴瘤等淋巴瘤、低分化癌、透明细胞癌或印戒细胞癌、肉瘤等相鉴别。免疫组化在诊断中至关重要。
