Hsi E D, Zukerberg L R, Schnitzer B, Harris N L
Department of Pathology, University of Michigan Hospitals, Ann Arbor, USA.
Mod Pathol. 1995 Oct;8(8):817-24.
Myoepithelial sialadenitis of the salivary gland is associated with an increased risk of lymphoma, but criteria that predict its development have not been clearly defined. We attempted to identify morphologic and immunologic features that correlated with the presence of extrasalivary lymphoma in patients with myoepithelial sialadenitis. Twenty-five patients (20 women, 5 men; median age, 56 yr) were studied with clinical follow-up in 22 patients; 19 were followed for 3 or more yr (median, 8.0 yr overall). Immunostains were done on paraffin sections in 28 of 31 specimens (22 of 25 patients) using antibodies to immunoglobulin light chains, CD20, CD45RO, CD3, and CD43. Morphologic features studied included density of infiltrate, lymphoepithelial lesions, follicle atypia, and pattern of monocytoid B-cells. Twenty-four of 25 patients had dense lymphoid infiltrates expanding and effacing salivary gland architecture with lymphoepithelial lesions and epimyoepithelial islands; all but one of these cases showed monocytoid B-cells in and around ducts, whereas six also had interconnecting broad strands of these cells. One case showed predominantly follicular hyperplasia. Two cases contained follicles with large atypical cells. Plasma cells were monotypic in four patients (18%) and polytypic in 18 (82%); in 18 of 28 specimens (64%) from 15 of 22 patients (68%), monocytoid B-cells coexpressed CD20 and CD43. Seven patients developed extrasalivary lymphoma, one before and six after the diagnosis of myoepithelial sialadenitis (median, 30.5 mo). Monotypic immunoglobulin in plasma cells correlated with past or subsequent extrasalivary lymphoma (P < 0.005); broad strands of monocytoid B-cells correlated with both monotypic plasma cells (P < 0.005) and extrasalivary lymphoma (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
涎腺肌上皮涎腺炎与淋巴瘤风险增加相关，但预测其发展的标准尚未明确界定。我们试图确定与肌上皮涎腺炎患者涎外淋巴瘤存在相关的形态学和免疫学特征。对25例患者（20例女性，5例男性；中位年龄56岁）进行了研究，22例患者进行了临床随访；19例随访3年或更长时间（总体中位时间8.0年）。对31个标本中的28个（25例患者中的22例）石蜡切片进行免疫染色，使用抗免疫球蛋白轻链、CD20、CD45RO、CD3和CD43抗体。研究的形态学特征包括浸润密度、淋巴上皮病变、滤泡异型性和单核样B细胞模式。25例患者中有24例有致密的淋巴样浸润，扩展并取代涎腺结构，伴有淋巴上皮病变和肌上皮岛；除其中1例病例外，所有这些病例在导管内和导管周围均可见单核样B细胞，而6例还具有这些细胞相互连接的宽条索。1例病例主要表现为滤泡增生。2例病例含有具有大的异型细胞的滤泡。4例患者（18%）的浆细胞为单克隆性，18例（82%）为多克隆性；22例患者中的15例（68%）的28个标本中的18个（64%），单核样B细胞共表达CD20和CD43。7例患者发生涎外淋巴瘤，1例在肌上皮涎腺炎诊断之前，6例在诊断之后（中位时间30.5个月）。浆细胞中的单克隆免疫球蛋白与既往或随后的涎外淋巴瘤相关（P<0.005）；单核样B细胞的宽条索与单克隆浆细胞（P<0.005）和涎外淋巴瘤（P<0.02）均相关。（摘要截断于250字）
