Almanaseer I Y, Kosova L, Pellettiere E V
Am J Clin Pathol. 1986 Jan;85(1):111-4. doi: 10.1093/ajcp/85.1.111.
A 50-year-old male with a history of tonsillar and right axillary lymph node enlargement due to atypical lymphoid hyperplasia presented two years later with marked bilateral axillary and inguinal lymphadenopathy. The lymph node biopsy showed a composite lymphoma (follicular, mixed, small and large cell plus B-immunoblastic sarcoma) with associated focal Langerhans' cell granulomatosis (LCG) (Histiocytosis X). The diagnosis of composite lymphoma was supported by the immunohistochemical demonstration of two different monoclonal patterns in the follicular and diffuse areas. The typical Birbeck's granules were demonstrated ultrastructurally in LCG areas, which also stained with S-100 protein. LCG may coexist with malignant lymphoma, however, it appears to be confined to the neoplastic nodes with no tendency to systemic spread. It is important to recognize this association so that the impact of this apparently benign lesion (LCG) not be overestimated and that the subsequent management of the patient be directed according to the type of the coexisting malignant lymphoma.
一名50岁男性，曾因非典型淋巴样增生导致扁桃体和右腋窝淋巴结肿大，两年后出现双侧腋窝和腹股沟淋巴结明显肿大。淋巴结活检显示为复合性淋巴瘤（滤泡性、混合性、小细胞和大细胞加B免疫母细胞肉瘤），伴有局灶性朗格汉斯细胞肉芽肿病（LCG）（组织细胞增多症X）。滤泡区和弥漫区免疫组化显示两种不同的单克隆模式，支持复合性淋巴瘤的诊断。在LCG区域超微结构显示出典型的伯贝克颗粒，其也能用S-100蛋白染色。LCG可能与恶性淋巴瘤共存，然而，它似乎局限于肿瘤性淋巴结，无全身播散倾向。认识到这种关联很重要，这样就不会高估这种明显良性病变（LCG）的影响，并且患者随后的治疗应根据共存恶性淋巴瘤的类型进行。
