Su X-Y, Huang J, Jiang Y, Tang Y, Li G-D, Liu W-P
Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.
Cytopathology. 2012 Apr;23(2):96-102. doi: 10.1111/j.1365-2303.2011.00937.x. Epub 2011 Oct 30.
Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL-N), is a rare form of lymphoma that typically occurs at extranodal sites. It is one of the most common extranodal lymphomas in China. Literature on effusions and cytological findings relating to ENKTCL-N is limited. We studied five consecutive cases of ENKTCL-N effusions collected over a 3-year period. The cytomorphological, immunocytochemical and molecular biological features were evaluated with literature review. The purpose of this study is to discuss how to diagnose ENKTCL-N cytologically in effusions.
Smears and cell block sections were reviewed for each case. Immunocytochemistry was performed on 4-μm paraffin sections. Antibodies used were as follows: cCD3 (intracytoplasmic CD3), CD45RO, surface CD3, CD20, CD79a, CD56, TIA-1, granzyme B, CD30, CD99, TdT and Ki-67. In situ hybridization for EBER1/2 (EBER-ISH) and T-cell receptor γ (TCRγ) gene rearrangement were performed for all cases.
Large to medium-sized tumour cells with pleomorphic nuclei and coarse chromatin were found in a necrotic background in all cases. The cytoplasm of the tumour cells was scant to moderately abundant with occasional cytoplasmic projections; in Giemsa-stained smears, fine granules were present in some tumour cells. Mitotic figures were frequent. The tumour cells were all positive for CD56, granzyme B, TIA-1 and cCD3, and were negative for surface CD3, CD20 or CD79a, CD99 and TdT. The MIB index was 50-80%. Epstein-Barr virus-encoded RNA (EBER) hybridizing signals were detected for most neoplastic cells. The T-cell receptor gamma gene rearrangement analysis showed germ-line configuration, except for one case.
Effusion cytology may be appropriate for establishing the diagnosis of ENKTCL-N, particularly for patients in whom tissue biopsy is not possible.
结外鼻型自然杀伤/T细胞淋巴瘤（ENKTCL-N）是一种罕见的淋巴瘤形式，通常发生于结外部位。它是中国最常见的结外淋巴瘤之一。关于ENKTCL-N的积液及细胞学表现的文献有限。我们研究了在3年期间连续收集的5例ENKTCL-N积液病例。通过文献复习对其细胞形态学、免疫细胞化学及分子生物学特征进行评估。本研究的目的是探讨如何在积液中通过细胞学方法诊断ENKTCL-N。
对每例病例的涂片和细胞块切片进行复查。在4μm石蜡切片上进行免疫细胞化学检测。所用抗体如下：胞质CD3（cCD3）、CD45RO、表面CD3、CD20、CD79a、CD56、TIA-1、颗粒酶B、CD30、CD99、末端脱氧核苷酸转移酶（TdT）和Ki-67。对所有病例进行EBER1/2原位杂交（EBER-ISH）及T细胞受体γ（TCRγ）基因重排检测。
所有病例在坏死背景中均发现有核多形性和染色质粗糙的大至中等大小肿瘤细胞。肿瘤细胞的胞质稀少至中等丰富，偶见胞质突起；在吉姆萨染色涂片中，部分肿瘤细胞可见细颗粒。有丝分裂象常见。肿瘤细胞CD56、颗粒酶B、TIA-1和cCD3均呈阳性，表面CD3、CD20或CD79a、CD99及TdT均呈阴性。MIB指数为50%-80%。大多数肿瘤细胞检测到爱泼斯坦-巴尔病毒编码RNA（EBER）杂交信号。T细胞受体γ基因重排分析显示除1例病例外均为种系构型。
积液细胞学检查可能适合于ENKTCL-N的诊断，特别是对于无法进行组织活检的患者。
