Department of Pathology, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel,
Department of Pathology, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Acta Haematol. 2022;145(3):310-317. doi: 10.1159/000520791. Epub 2021 Nov 9.
Splenic micronodular T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is derived from diffuse large B-cell lymphoma N.O.S., perhaps with some affinity with nodal THRLBCL. Of note, in contrast with the latter, the only lymph nodes involved in association with the splenic micronodular pattern of the disease are the splenic hilar lymph nodes. The possibility that corticosteroids, when prescribed prior to splenectomy, cause histopathological and functional modulations, apoptosis, necrosis, tissue shrinkage, which may obscure the diagnostic morphological features of this variant lymphoma and cause an underdiagnosis of this condition. The indications for glucocorticoid therapy are either related to the lymphoma itself, or else to other comorbidities, like asthma and autoimmune disorders. We propose that patients with the splenic subset of the disease are likely to have been prescribed corticosteroids prior to histopathologic examination of the involved spleen, causing disparate morphologies. However, a reviewer might accidentally dismiss the corticosteroid pretreatment which is thus overlooked. Apoptosis, induced by corticosteroids, is hypothesized as the major mechanism initiating the histopathological and functional changes in the splenic micronodular variant of the lymphoma.
脾脏小结节性 T 细胞/组织细胞丰富的大 B 细胞淋巴瘤（THRLBCL）来源于弥漫性大 B 细胞淋巴瘤非特指型，可能与结内 THRLBCL 具有一定的亲缘关系。值得注意的是，与后者不同的是，与疾病脾脏小结节模式相关的唯一受累淋巴结是脾门淋巴结。在脾切除术前使用皮质类固醇可能会引起组织病理学和功能调节、细胞凋亡、坏死、组织收缩，从而掩盖这种变异淋巴瘤的诊断形态学特征，并导致这种情况的诊断不足。皮质类固醇治疗的适应证与淋巴瘤本身有关，也与其他合并症有关，如哮喘和自身免疫性疾病。我们提出，患有该疾病脾脏亚型的患者在对受累脾脏进行组织病理学检查之前，很可能已经接受了皮质类固醇治疗，导致形态学上的差异。然而，审稿人可能会不小心忽略皮质类固醇预处理，从而忽略了这一点。细胞凋亡是由皮质类固醇诱导的，被假设为启动淋巴瘤脾脏小结节型组织病理学和功能变化的主要机制。
