Schleiffenbaum B, Fehr J
Abteilung für Hämatologie, Departement für Innere Medizin, Universitätsspital Zürich.
Ther Umsch. 1996 Feb;53(2):117-22.
Low-grade malignant non-Hodgkin lymphoma [NHL] and chronic lymphocytic leukemia [CLL] as its special form are slowly progressing malignancies which may present with lymphadenopathy, splenomegaly or, more rarely, hepatomegaly. The diagnosis is made by bone marrow or lymph node histology, while laboratory tests are relatively unspecific and may only hint towards the diagnosis. In contrast to high-grade malignant lymphoma, low-grade malignant NHL is often associated with the appearance of malignant lymphoma cells in peripheral blood. These malignant lymphocytes may be differentiated microscopically from normal lymphocytes, so that the diagnosis of NHL may be suspected not only because of clinical symptoms or lymphocytosis, which may present late in the natural history of the disease, but also on morphological grounds. Three types of low-grade malignant NHL cells may be recognized in peripheral blood: A mature appearing lymphocytic type with only slight alterations of the nucleus, a lymphoplasmocytic type, and a lymphocytic type with prominent alterations of the nucleus. The appearance of smudge cells and a monotony in lymphocyte morphology may serve as further diagnostic aids. Once the diagnosis has been suspected on morphological grounds, it may be verified in the case of B-cell lymphomas by flow cytometry. The clonality of T-cell lymphoproliferative disorders in addition has to be proven by demonstrating a clonal rearrangement of the T-cell receptor in Southern blots. An early diagnosis of low-grade malignant NHL may not only provide new insights into the natural history of monoclonal cytopathies but may also be of importance in the clinical management of patients.
低级别恶性非霍奇金淋巴瘤（NHL）及其特殊形式慢性淋巴细胞白血病（CLL）是进展缓慢的恶性肿瘤，可能表现为淋巴结病、脾肿大，较少见的是肝肿大。诊断通过骨髓或淋巴结组织学检查做出，而实验室检查相对缺乏特异性，可能仅提示诊断。与高级别恶性淋巴瘤不同，低级别恶性NHL常伴有外周血中出现恶性淋巴瘤细胞。这些恶性淋巴细胞在显微镜下可与正常淋巴细胞区分开来，因此NHL的诊断不仅可基于临床症状或淋巴细胞增多症（这可能在疾病自然史后期出现），还可基于形态学依据怀疑。在外周血中可识别出三种类型的低级别恶性NHL细胞：核仅有轻微改变的成熟淋巴细胞型、淋巴浆细胞型以及核有明显改变的淋巴细胞型。涂抹细胞的出现和淋巴细胞形态的单一性可作为进一步的诊断辅助。一旦基于形态学依据怀疑诊断，对于B细胞淋巴瘤可通过流式细胞术进行验证。此外，T细胞淋巴增殖性疾病的克隆性必须通过Southern印迹法证明T细胞受体的克隆重排来证实。低级别恶性NHL的早期诊断不仅可为单克隆细胞病变的自然史提供新见解，对患者的临床管理也可能具有重要意义。
