Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Nursing, HungKuang University, Taichung, Taiwan.
Diagn Pathol. 2020 Jul 7;15(1):82. doi: 10.1186/s13000-020-00991-3.
Primary intestinal follicular lymphoma (PI-FL) is a rare and indolent lymphoma and is challenging for diagnosis with endoscopic biopsy specimens. Whole slide imaging (WSI) has been increasingly used for assisting pathologic diagnosis, but not for lymphoma yet, probably because there are usually too many immunostained sections in a single case. In this study we attempted to identify morphological clues of PI-FL in the endoscopic biopsy specimens by measuring various parameters using WSI.
We retrospectively investigated 21 PI-FL cases, and scanned the HE sections from 17 of these cases with endoscopic biopsy specimens. Sections from 17 intestinal biopsies showing reactive lymphoid hyperplasia were scanned for comparison. The density and diameter of lymphoid follicles and the shortest distance of these follicles to the surface epithelia were measured on WSI. Comparisons of the aforementioned parameters were made between the neoplastic and reactive follicles.
The density of follicles was significantly higher in PI-FL than that of reactive hyperplasia (median 0.5 vs. 0.2/mm; p < 0.01). Furthermore, the neoplastic follicles were significantly larger (median diameter 756.9 vs. 479.7 μm; p < 0.01). The shortest distance of follicles to the surface epithelia tended to be closer in PI-FL (104.7 vs. 177.8 μm, p = 0.056), but not statistically significant.
In this study we found that in PI-FL the density and diameter of lymphoid follicles as measured from WSI were significantly different from that of intestinal reactive lymphoid hyperplasia. When facing the diagnostic challenge between these two entities in routine practice, pathologists might be alerted by these morphological clues and request for immunohistochemistry for differential diagnosis.
原发性肠道滤泡淋巴瘤（PI-FL）是一种罕见的惰性淋巴瘤，通过内镜活检标本进行诊断具有挑战性。全玻片成像（WSI）已越来越多地用于辅助病理诊断，但尚未用于淋巴瘤，可能是因为单个病例中通常有太多免疫染色切片。在这项研究中，我们试图通过使用 WSI 测量各种参数来识别内镜活检标本中 PI-FL 的形态学线索。
我们回顾性调查了 21 例 PI-FL 病例，并对其中 17 例的 HE 切片进行了扫描。为了进行比较，对 17 例显示反应性淋巴组织增生的肠道活检切片进行了扫描。在 WSI 上测量了淋巴滤泡的密度和直径以及这些滤泡到表面上皮的最短距离。比较了肿瘤性和反应性滤泡的上述参数。
PI-FL 中滤泡的密度明显高于反应性增生（中位数 0.5 vs. 0.2/mm；p<0.01）。此外，肿瘤性滤泡明显更大（中位数直径 756.9 与 479.7 μm；p<0.01）。滤泡到表面上皮的最短距离在 PI-FL 中趋于更近（104.7 与 177.8 μm，p=0.056），但无统计学意义。
在这项研究中，我们发现，在 PI-FL 中，从 WSI 测量的淋巴滤泡的密度和直径与肠道反应性淋巴组织增生明显不同。在常规实践中面对这两种实体之间的诊断挑战时，病理学家可能会被这些形态学线索所警觉，并要求进行免疫组织化学检查以进行鉴别诊断。
