Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China, 610041.
Ann Hematol. 2013 Jan;92(1):89-96. doi: 10.1007/s00277-012-1574-3. Epub 2012 Sep 20.
Natural killer (NK) cell neoplasms are unusual disorders. In this study we compared results of flow cytometric immunophenotype (FCI) with cytomorphology, histopathology and clinical findings in a series of patients with NK cell neoplasms with peripheral blood and/or bone marrow involvement, and the FCI of neoplastic and normal NK cells were compared. Retrospective data and specimens (bone marrow aspiration or peripheral blood) from 71 cases of NK cell neoplasms were obtained. All patients have been demonstrated laboratory and clinical features consistent with NK cell neoplasms, and the subtypes were determined by integrated clinical estimation. Routine 4-color flow cytometry (FCM) using a NK/T cell related antibody panels was performed. NK cell neoplasms were divided into two major subtypes by FCI, namely malignant NK cell lymphoma, including extranodal nasal type NK cell lymphoma (ENKL, 11 cases) and aggressive NK cell lymphoma/leukemia (ANKL, 43 cases), and relative indolent chronic lymphoproliferative disorder of NK cell (CLPD-NK, 17 cases). The former exhibited stronger CD56-expressing, larger forward scatter (FSC) and more usually CD7- and CD16-missing. FCI of CLPD-NK was similar to normal NK cells, but CD56-expressing was abnormal, which was negative in five cases and partially or dimly expressed in eight cases. Cytomorphologic abnormal cells were found on bone marrow slides of 4 cases of ENKL and 30 cases of ANKL. Eight cases of ENKL were positive in bone marrow biopsies, and other three cases were negative. In 32 cases of ANKL which bone marrow biopsies were applied, 21 cases were positive in the first biopsies. Lymphocytosis was found only in six cases of CLPD-NK by cytomorphology, and biopsy pathology was not much useful for diagnosing CLPD-NK. These results suggest that FCM analysis of bone marrow and peripheral blood was superior to cytomorphology, bone marrow biopsy, and immunohistochemistry in sensitivity and early diagnosis for ANKL, stage III/IV ENKL and CLPD-NK. FCI could not only define abnormal NK cells but also determine the malignant classification. It is beneficial for clinical management and further study of NK cell neoplasms.
自然杀伤 (NK) 细胞肿瘤是一种不常见的疾病。在这项研究中，我们比较了流式细胞免疫表型 (FCI) 与细胞学、组织病理学和临床表现在一系列伴有外周血和/或骨髓受累的 NK 细胞肿瘤患者中的结果，并比较了肿瘤和正常 NK 细胞的 FCI。回顾性收集了 71 例 NK 细胞肿瘤患者的临床资料和标本（骨髓抽吸或外周血）。所有患者均具有 NK 细胞肿瘤的实验室和临床特征，并通过综合临床评估确定了亚型。使用 NK/T 细胞相关抗体面板进行常规四色流式细胞术 (FCM)。根据 FCI 将 NK 细胞肿瘤分为两个主要亚型，即恶性 NK 细胞淋巴瘤，包括结外鼻型 NK 细胞淋巴瘤 (ENKL，11 例) 和侵袭性 NK 细胞淋巴瘤/白血病 (ANKL，43 例)，以及相对惰性的慢性 NK 细胞淋巴增殖性疾病 (CLPD-NK，17 例)。前者表现为更强的 CD56 表达、更大的前向散射 (FSC)，并且通常 CD7 和 CD16 缺失。CLPD-NK 的 FCI 与正常 NK 细胞相似，但 CD56 表达异常，5 例阴性，8 例部分或弱表达。在 4 例 ENKL 和 30 例 ANKL 的骨髓涂片上发现了形态学异常细胞。8 例 ENKL 骨髓活检阳性，其他 3 例阴性。在 32 例应用骨髓活检的 ANKL 中，21 例首次活检阳性。形态学仅发现 6 例 CLPD-NK 淋巴细胞增多，骨髓活检对诊断 CLPD-NK 意义不大。这些结果表明，FCM 分析骨髓和外周血在敏感性和早期诊断 ANKL、III/IV 期 ENKL 和 CLPD-NK 方面优于细胞学、骨髓活检和免疫组织化学。FCI 不仅可以定义异常 NK 细胞，还可以确定恶性分类。它有利于 NK 细胞肿瘤的临床管理和进一步研究。
