Wechsler J, Bagot M, Henni T, Le Couedic J P, Gaulard P, Zafrani E S
Département d'Anatomie et de Cytologie Pathologiques, CHU Henri Mondor, Créteil, France.
Arch Pathol Lab Med. 1995 Feb;119(2):157-62.
Patients with cutaneous lymphoid infiltrates that appear reactive histologically and immunophenotypically may develop clinically overt cutaneous lymphoma, suggesting the possibility of misdiagnosis by classical methods. We investigated DNA rearrangement in such cases of lymphoid infiltrates of uncertain significance to determine whether this more sensitive method could detect an occult monoclonal lymphoid proliferation.
Skin biopsy specimens were taken from 18 cutaneous lymphoid infiltrates diagnosed as reactive on the basis of clinical, histopathological, and immunohistochemical criteria. Specimens included 12 cases with mixed lymphoid infiltrates rich in polytypic B cells and inconstant follicle formation and 6 cases with exclusive T-lymphoid infiltrates. Southern blot analysis for immunoglobulin and T-cell-receptor beta-chain gene rearrangements was performed in all cases.
No specimen showed T-cell-receptor beta-chain gene rearrangement. Clonal immunoglobulin gene rearrangement was demonstrated in one case with polytypic B cells, but no clinical malignancy has appeared 19 years after disease onset duration and 7 years after detection of the B-cell clone.
In the present series, the results suggest that histological and immunohistological criteria are appropriate to establish the diagnosis of most cases of cutaneous lymphoid infiltrates. The detection of a B-cell clone is remarkable by absence of clinical malignancy, suggesting that such a discovery does not necessarily mean an aggressive evolution. Nevertheless, there is presently no way to predict the prognosis of a clonal lymphoid proliferation, indicating that a long-term follow-up is necessary.
组织学和免疫表型显示为反应性的皮肤淋巴细胞浸润患者可能会发展为临床明显的皮肤淋巴瘤，这表明经典方法存在误诊的可能性。我们研究了此类意义未明的淋巴细胞浸润病例中的DNA重排，以确定这种更敏感的方法是否能检测到隐匿的单克隆淋巴细胞增殖。
对18例根据临床、组织病理学和免疫组化标准诊断为反应性的皮肤淋巴细胞浸润进行皮肤活检。标本包括12例富含多型性B细胞且有不恒定滤泡形成的混合淋巴细胞浸润病例和6例单纯T淋巴细胞浸润病例。所有病例均进行免疫球蛋白和T细胞受体β链基因重排的Southern印迹分析。
所有标本均未显示T细胞受体β链基因重排。在1例多型性B细胞病例中发现了克隆性免疫球蛋白基因重排，但在疾病发病19年后以及检测到B细胞克隆7年后均未出现临床恶性病变。
在本系列研究中，结果表明组织学和免疫组织学标准适用于大多数皮肤淋巴细胞浸润病例的诊断。在无临床恶性病变的情况下检测到B细胞克隆值得关注，这表明此类发现不一定意味着病情会侵袭性进展。然而，目前尚无预测克隆性淋巴细胞增殖预后的方法，这表明长期随访是必要的。
