Keicho N, Oka T, Takeuchi K, Yamane A, Yazaki Y, Yotsumoto H
Third Department of Internal Medicine, University of Tokyo, Japan.
Chest. 1994 Feb;105(2):458-62. doi: 10.1378/chest.105.2.458.
We report three cases of pulmonary involvement of non-Hodgkin's lymphoma in which immunophenotypic or gene rearrangement analysis of bronchoalveolar lavage (BAL) cells demonstrated monoclonality of T- or B-cell lineage. The first patient had T-cell lymphoma and developed pulmonary lesions. Surface marker analysis of the BAL cells revealed that CD8-positive lymphoid cells were dominant and Southern blot analysis of T-cell receptor gene detected gene rearrangement demonstrating monoclonality of T-cell lineage. The second patient presented with diffuse micronodular shadows on chest radiograph. Marked B-lymphocytosis in BAL fluid prompted us to analyze their clonality. The third was a case in which recurrence of primary pulmonary lymphoma was suspected. In the second and third case, the finding of marked increase in the number of CD 19-positive B lymphocytes with a single class of light chains proved a monoclonal population in BAL cells. With the review of other cases in our study and the relevant literature, we conclude that the clonal analysis of BAL cells is helpful in establishing the diagnosis of pulmonary involvement of T- or B-cell lymphoma.
我们报告了3例非霍奇金淋巴瘤肺部受累的病例，其中对支气管肺泡灌洗（BAL）细胞进行免疫表型或基因重排分析显示为T或B细胞系单克隆性。首例患者为T细胞淋巴瘤并出现肺部病变。对BAL细胞的表面标志物分析显示CD8阳性淋巴细胞占主导，T细胞受体基因的Southern印迹分析检测到基因重排，证明为T细胞系单克隆性。第二例患者胸部X线片表现为弥漫性微小结节阴影。BAL液中显著的B淋巴细胞增多促使我们分析其克隆性。第三例为疑似原发性肺淋巴瘤复发的病例。在第二例和第三例中，CD19阳性B淋巴细胞数量显著增加且伴有单一轻链类型，这一发现证明BAL细胞中存在单克隆群体。通过回顾我们研究中的其他病例及相关文献，我们得出结论，对BAL细胞进行克隆分析有助于确立T或B细胞淋巴瘤肺部受累的诊断。
