Curran R C, Jones E L
J Pathol. 1979 Dec;129(4):179-90. doi: 10.1002/path.1711290404.
Immunohistochemical and histoogical studies have been performed on paraffin sections of 19 cases of non-Hodgkin's lymphoma (NHL). All the cases were lymphocytic in type and, on the basis of the National Lymphoma Investigation classification, 11 were follicular (six small, three mixed small and large, and two large cell types) and eight were diffuse (four intermediate, three poorly and one well-differentiated types). Marshall's metalophil method revealed a population of dendritic histiocytes in and around the follicles of follicular lymphomas. The distribution of the dendritic cells within the neoplastic follicles resembled the distribution of similar cells in reactive follicles, lending support to the concept of an origin for lymphoma follicles from their reactive counterparts. In the diffuse lesions the dendritic cells were large and more pleomorphic than in the follicular lesions, but these features were not so pronounced as those previously observed in Hodgkin's disease. The PAP sequence was used to demonstrate Ig, and as judged by the types of light and heavy chains in the lymphoma cells, the cases were divided into three groups: Group 1 (eight cases) in which the lymphoma cells contained monotypic Ig; Group 2 (six cases) in which monotypic Ig was probably present; and Group 3 (four cases) where no evidence of monotypic Ig secretion was found. Monotypic Ig was most commonly found in follicular lymphomas, mu kappa secretion being the most frequently identified combination of heavy and light chains. The majority of cases (73 per cent.) were thus clearly derived from B lymphocytes. However, the fact that monoclonality was evident in only a proportion of cases suggested that lymphomas may be polyclonal initially and proportion of cases suggested that lymphomas may be polyclonal initially and that monoclonality is a later development. In addition to the lymphoma cells, normal mature plasma cells containing a high concentration of intracellular Ig were present in all but one of the lesions. The Ig was polytypic, cells containing kappa and lambda chains being present in roughly equal numbers and gamma chains pre-dominating. Extracellular Ig (gamma, mu, kappa, lambda) was also present in many lesions. Collections of small non-lymphomatous lymphocytes were also present in all cases. In eight lesions these appeared to have polytypic surface Ig (mu, kappa, lambda). Dendritic cells mingled with these lymphocytes. Collections of small lymphocytes non-reactive for Ig were also present. These had no association with dendritic histiocytes and might have been T cells. It is concluded that in most cases immunohistochemistry alone provides an insufficient basis for the diagnosis of lymphoma and that disturbance of cellular morphology and tissue architecture remain the most useful criteria on which the diagnosis of lymphoma rests.
对19例非霍奇金淋巴瘤（NHL）石蜡切片进行了免疫组织化学和组织学研究。所有病例均为淋巴细胞型，根据国家淋巴瘤研究分类，11例为滤泡型（6例小细胞型、3例小细胞与大细胞混合型、2例大细胞型），8例为弥漫型（4例中等分化型、3例低分化型、1例高分化型）。马歇尔嗜金属法显示滤泡性淋巴瘤滤泡内及周围有一群树突状组织细胞。肿瘤性滤泡内树突状细胞的分布类似于反应性滤泡中相似细胞的分布，这支持了淋巴瘤滤泡起源于其反应性对应物的概念。在弥漫性病变中，树突状细胞比滤泡性病变中的大且多形性更强，但这些特征不如先前在霍奇金病中观察到的那么明显。采用PAP法显示免疫球蛋白（Ig），根据淋巴瘤细胞中轻链和重链的类型，将病例分为三组：第1组（8例），淋巴瘤细胞含有单型Ig；第2组（6例），可能存在单型Ig；第3组（4例），未发现单型Ig分泌的证据。单型Ig最常见于滤泡性淋巴瘤，其中μκ分泌是最常鉴定出的重链和轻链组合。因此，大多数病例（73%）显然来源于B淋巴细胞。然而，仅一部分病例存在单克隆性这一事实表明，淋巴瘤最初可能是多克隆性的，单克隆性是后来发展形成的。除淋巴瘤细胞外，除1例病变外，所有病变中均存在含有高浓度细胞内Ig的正常成熟浆细胞。Ig是多型性的，含有κ链和λ链的细胞数量大致相等，γ链占主导。许多病变中也存在细胞外Ig（γ、μ、κ、λ）。所有病例中均存在小的非淋巴瘤性淋巴细胞聚集。在8个病变中，这些淋巴细胞似乎具有多型性表面Ig（μ、κ、λ）。树突状细胞与这些淋巴细胞混合存在。也存在对Ig无反应的小淋巴细胞聚集。这些细胞与树突状组织细胞无关联，可能是T细胞。结论是，在大多数情况下，仅靠免疫组织化学不足以作为淋巴瘤诊断的依据，细胞形态和组织结构的紊乱仍然是淋巴瘤诊断最有用的标准。
