Wei Xue-Jing, Zhou Xiao-Ge, Xie Jian-Lan, Zheng Xiao-Dan, Zheng Yuan-Yuan
Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing 100050, China.
Int J Clin Exp Pathol. 2014 Aug 15;7(9):5557-63. eCollection 2014.
Initial reports emphasized the immunophenotypic similarities between benign and malignant T cell populations, while some previous studies indicating that aberrant T-cell antigen loss is a good marker for detecting malignant T-cell proliferation. Recently, we found a very interesting and thought-provoking phenomenon: In benign disease-28 of 38 (73.7%) cases of Kikuchi's disease also showed aberrant phenotypes with loss of pan-T cell antigens, which makes the differential diagnosis between Kikuchi's disease and T cell lymphoma more challenging. In our study, 38 cases of Kikuchi's disease and 30 cases of reactive lymphoid hyperplasia (RLH) were studied by EliVision immunohistochemical staining. As well as TCR gene rearrangement using PCR was negative in 10 tested cases of the Kikuchi's disease. Among these cases, the most common antigen deficiency was CD5 (22 cases), then CD7 (11 cases), CD2 (8 cases) and CD3 (2 cases). Compared with proliferative and xanthomatous types of Kikuchi's disease, antigens tended to be lost in necrotizing type. Based on follow-up data, a correlation was not found between the occurrence of aberrant phenotypes and prognosis. In RLH, obvious pan-T cell antigen loss was also not found. In conclusion, this is the first study to demonstrate distinct patterns of antigen loss in Kikuchi's disease, suggesting that T cell antigen loss is not reliable as an auxiliary diagnostic standard for T cell lymphoma.
最初的报告强调了良性和恶性T细胞群体之间的免疫表型相似性，而此前一些研究表明，异常的T细胞抗原丢失是检测恶性T细胞增殖的良好标志物。最近，我们发现了一个非常有趣且引人深思的现象：在良性疾病中，38例菊池病中有28例（73.7%）也表现出异常表型，伴有全T细胞抗原丢失，这使得菊池病与T细胞淋巴瘤的鉴别诊断更具挑战性。在我们的研究中，采用EliVision免疫组织化学染色法对38例菊池病和30例反应性淋巴组织增生（RLH）进行了研究。此外，10例接受检测的菊池病病例的TCR基因重排采用聚合酶链反应检测结果为阴性。在这些病例中，最常见的抗原缺失是CD5（22例），其次是CD7（11例）、CD2（8例）和CD3（2例）。与增殖型和黄色瘤型菊池病相比，坏死型菊池病的抗原更容易丢失。根据随访数据，未发现异常表型的出现与预后之间存在相关性。在反应性淋巴组织增生中，也未发现明显的全T细胞抗原丢失。总之，这是第一项证明菊池病中存在不同抗原丢失模式的研究，表明T细胞抗原丢失作为T细胞淋巴瘤的辅助诊断标准并不可靠。
