Tan Leonard Hwan-Cheong, Tan Soo-Yong
Department of Pathology, Singapore General Hospital, Singapore.
Hematol Oncol. 2014 Sep;32(3):145-54. doi: 10.1002/hon.2116. Epub 2013 Nov 19.
We compare 30 biopsies each of Pattern 1 angioimmunoblastic T-cell lymphoma (AITL1) and reactive lymphoid hyperplasia (RLH) by immunohistology, in-situ hybridization for Epstein-Barr virus-encoded RNA and T-cell receptor-γ (TRG)-clonality. AITL1 cases, more often than RLH controls, were older [median ages 61 (range 23-79) vs 46 (range 11-59) years, p < 10(-4)], non-Chinese [16/30 (53%) vs 8/28 (29%), p = 0.035], presented nodally [29/30 (97%) vs 23/30 (77%), p = 0.024], showed: pan-T cell antigen attenuation [25/29 (86%) vs 5/21 (24%), p = 1.0 × 10(-5)], CD4 predominance [25/28 (89%) vs 12/23 (52%), p = 3.4 × 10(-3)], interfollicular lymphoid CD10-positivity [16/30 (53%) vs 1/29 (3%), p = 1.5 × 10(-5)], TRG clonality [16/28 (57%) vs 1/20 (5%), p = 1.4 × 10(-4)], higher maximum number of Epstein-Barr virus-encoded RNA + nuclei per 0.5-mm high-power field [median 6 (range 0-70) vs 1 (range 0-40), p = 0.012] and interfollicular Ki-67 proliferation fraction [median 40% (range 10-80%) vs 20% (range 5-40), p < 10(-4)], whereas their germinal centres (GCs) more often showed attenuation of CD10 [30/30 (100%) vs 11/29 (38%), p = 5.3 × 10(-8)] and CD57 [18/25 (72%) vs 4/22 (18%), p = 2.4 × 10(-4)] (respectively). GC-predominant PD-1 and ICOS immunoreactivity were more often seen in RLH [20/22 and 9/19 controls (91% and 47%)] than AITL1 [9/25 and 3/19 cases (36% and 16%), p = 1.0 × 10(-4) and 0.033, respectively]. Significant independent predictors against AITL1 were: solid GC CD10 immunoreactivity {p = 0.023, odds ratio (OR) for AITL1 0.01 [95% confidence interval (CI): 0.0002-0.529]}; lower interfollicular proliferation fraction [p = 0.047, OR for AITL1 1.1 (95% CI: 1.001-1.209) per % rise in Ki-67]; younger presenting age [p = 0.028, OR for AITL1 1.136 (95% CI: 1.014-1.272) per year older]. Hence, GCs and perifollicular zones in AITL1 are distinct from those in RLH.
我们通过免疫组织化学、爱泼斯坦-巴尔病毒编码RNA原位杂交和T细胞受体-γ（TRG）克隆性分析，对30例1型血管免疫母细胞性T细胞淋巴瘤（AITL1）活检标本和30例反应性淋巴组织增生（RLH）活检标本进行了比较。与RLH对照组相比，AITL1病例年龄更大[中位年龄61岁（范围23 - 79岁）对46岁（范围11 - 59岁），p < 10⁻⁴]，非华裔[16/30（53%）对8/28（29%），p = 0.035]，表现为淋巴结受累[29/30（约97%）对23/30（约77%），p = 0.024]，且具有以下特点：全T细胞抗原减弱[25/29（约86%）对5/21（约24%），p = 1.0×10⁻⁵]，CD4为主[25/28（约89%）对12/23（约52%），p = 3.4×10⁻³]，滤泡间淋巴细胞CD10阳性[16/30（53%）对1/29（3%），p = 1.5×10⁻⁵]，TRG克隆性[16/28（57%）对1/20（5%），p = 1.4×10⁻⁴]，每0.5毫米高倍视野中爱泼斯坦-巴尔病毒编码RNA阳性核的最大数量更高[中位值6（范围0 - 70）对1（范围0 - 40），p = 0.012]以及滤泡间Ki-67增殖分数更高[中位值40%（范围10 - 80%）对20%（范围5 - 40%），p < 10⁻⁴]，而其生发中心（GCs）更常出现CD10减弱[30/30（100%）对11/29（38%），p = 5.3×10⁻⁸]和CD57减弱[18/25（72%）对4/22（18%），p = 2.4×10⁻⁴]（分别）。以GC为主的PD-1和ICOS免疫反应性在RLH中[20/22和9/19例对照组（91%和47%）]比在AITL1中[9/25和3/19例（36%和16%），p分别为1.0×10⁻⁴和0.033]更常见。与AITL1相关的显著独立预测因素为：实体GC CD10免疫反应性{p = 0.023，AITL1的优势比（OR）为0.01[95%置信区间（CI）：0.0002 - 0.529]}；较低的滤泡间增殖分数[p = 0.047，Ki-67每升高1%，AITL1的OR为1.1（95%CI：1.001 - 1.209）]；发病年龄较小[p = 0.028，每年长一岁，AITL1的OR为1.136（95%CI：1.014 - 1.272）]。因此，AITL1中的GCs和滤泡周区域与RLH中的不同。
