Pettit C K, Zukerberg L R, Gray M H, Ferry J A, Rosenberg A E, Harmon D C, Harris N L
Department of Pathology, Massachusetts General Hospital, Boston 02114.
Am J Surg Pathol. 1990 Apr;14(4):329-34.
Primary lymphoma of bone is an uncommon neoplasm that can be difficult to diagnose and subclassify. Only in a few cases has the immunophenotype been determined with monoclonal antibodies. We evaluated the histological features and immunophenotype of 12 cases of primary lymphoma of bone. The patients ranged in age from 16 to 80 years (mean, 41 years) with a male:female ratio of 1:1. The sites involved included femur (three cases), humerus (two cases), tibia (three cases), pelvis (two cases), ulna (one case), and scapula (one case). All cases were diffuse large-cell lymphomas: nine large-cleaved (eight with multilobated cells), two large-cell not otherwise specified, and one immunoblastic. Sclerosis was noted in six cases. Immunohistochemical studies on frozen-tissue sections demonstrated staining with the following antibodies: 11 of 11 with CD45, 12 of 12 with CD20, eight of 12 with monotypic immunoglobulin (six IgG, two IgM, seven kappa, one lambda). Tumor cells were negative for T-cell markers in each case. Ten patients are alive and well 0.5-4.5 years (median, 1.5 years) following treatment with radiation or chemotherapy. Two patients had recurrence at another site 0.75 years and 4 years after the initial diagnosis, respectively. Primary bone lymphoma is a B-lineage large-cell lymphoma with an unusually high incidence of large-cleaved and multilobated cells. The frequency of IgG heavy chain expression suggests a post-germinal center stage of differentiation. Frozen section immunohistologic studies are useful in the diagnosis of this tumor. Aggressive therapy has resulted in a favorable outcome in most cases.
骨原发性淋巴瘤是一种罕见的肿瘤，诊断和分类可能存在困难。仅在少数病例中通过单克隆抗体确定了免疫表型。我们评估了12例骨原发性淋巴瘤的组织学特征和免疫表型。患者年龄在16至80岁之间（平均41岁），男女比例为1:1。受累部位包括股骨（3例）、肱骨（2例）、胫骨（3例）、骨盆（2例）、尺骨（1例）和肩胛骨（1例）。所有病例均为弥漫性大细胞淋巴瘤：9例大细胞有裂沟（8例有多叶细胞），2例大细胞未另行分类，1例免疫母细胞型。6例可见硬化。对冰冻组织切片进行的免疫组织化学研究显示，以下抗体呈阳性染色：11例中有11例CD45阳性，12例中有12例CD20阳性，12例中有8例单型免疫球蛋白阳性（6例IgG、2例IgM、7例κ链、1例λ链）。各病例中肿瘤细胞的T细胞标志物均为阴性。10例患者在接受放疗或化疗后0.5至4.5年（中位时间1.5年）存活且状况良好。2例患者分别在初次诊断后0.75年和4年于另一部位复发。骨原发性淋巴瘤是一种B细胞系大细胞淋巴瘤，大细胞有裂沟和多叶细胞的发生率异常高。IgG重链表达频率提示为生发中心后分化阶段。冰冻切片免疫组织学研究对该肿瘤的诊断有用。积极治疗在大多数病例中取得了良好的结果。
