Weisenberg E, Anastasi J, Adeyanju M, Variakojis D, Vardiman J W
Department of Pathology, University of Chicago, IL 60637, USA.
Am J Clin Pathol. 1995 Apr;103(4):479-84. doi: 10.1093/ajcp/103.4.479.
Several reports of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and of coexisting or subsequent Hodgkin's disease (HD) have raised the question how these two disorders are related. The authors have identified eight new cases of B-cell low-grade lymphoproliferative disorders (LGLPD) and HD. Six of these cases were similar to those previously reported on by others in that the HD were mixed cellularity, nodular sclerosing, and lymphocyte depleted subtypes. The morphology in these cases was typical of HD, as was the immunohistochemical profile. However, the two remaining cases were notable in that the HD was of the nodular lymphocyte predominant type (NLPHD). To our knowledge, this association has not been well documented previously. In the two cases in this study, CLL and NLPHD were found simultaneously when each patient presented with lymphadenopathy and a lymphocytosis that was comprised of small monoclonal B lymphocytes coexpressing CD5. Lymph node biopsies in each case revealed typical NLPHD, with large, indistinct nodules containing scattered lymphocytic-histiocytic (L&H) cells. Focal, but distinct areas of CLL/SLL were also present. Immunostaining of the lymph node biopsy specimens showed the L&H cells to be CD20- and CD45 positive, and to lack CD15 or evidence of light chain restriction. In one of these patients, a NLPHD-associated large cell lymphoma developed 8 months later. The large cells were CD20- and CD45 positive, with lambda light chain restriction. In contrast, the original CLL cells in this patient expressed kappa light chains. This report indicates that LGLPD can be associated with all subtypes of HD, including the NLP type. The discordant light chain restriction between the CLL and the NLPHD-associated large cell lymphoma in one of these cases indicates that the CLL and HD were probably not derived from the same clone.
几篇关于慢性淋巴细胞白血病（CLL）/小淋巴细胞淋巴瘤（SLL）以及同时存在或后续发生霍奇金淋巴瘤（HD）的报告引发了这两种疾病如何相关的问题。作者鉴定出8例B细胞低度淋巴细胞增殖性疾病（LGLPD）合并HD的新病例。其中6例与其他人先前报道的病例相似，即HD为混合细胞型、结节硬化型和淋巴细胞消减型亚型。这些病例的形态学表现以及免疫组化特征均为HD的典型表现。然而，其余2例值得注意的是，HD为结节性淋巴细胞为主型（NLPHD）。据我们所知，这种关联此前尚未得到充分记录。在本研究的这2例病例中，每位患者出现淋巴结病和淋巴细胞增多症（由共表达CD5的小单克隆B淋巴细胞组成）时，同时发现了CLL和NLPHD。每例的淋巴结活检均显示典型的NLPHD，有大的、界限不清的结节，内含散在的淋巴细胞-组织细胞（L&H）细胞。也存在局灶性但明显的CLL/SLL区域。淋巴结活检标本的免疫染色显示L&H细胞CD20和CD45呈阳性，且缺乏CD15或轻链限制性证据。在其中1例患者中，8个月后发生了与NLPHD相关的大细胞淋巴瘤。大细胞CD20和CD45呈阳性，有λ轻链限制性。相比之下，该患者原来的CLL细胞表达κ轻链。本报告表明，LGLPD可与HD的所有亚型相关，包括NLP型。其中1例病例中CLL与NLPHD相关大细胞淋巴瘤之间轻链限制性不一致，表明CLL和HD可能并非来自同一克隆。
