Monteverde A, Sabattini E, Poggi S, Ballarè M, Bertoncelli M C, De Vivo A, Briskomatis A, Roncador G, Falini B, Pileri S A
Seconda Divisione di Medicina Generale, Ospedale Maggiore della Carità, Novara, Italy.
Leuk Lymphoma. 1995 Dec;20(1-2):119-24. doi: 10.3109/10428199509054762.
One-hundred-sixteen consecutive bone-marrow biopsies were taken from 76 patients with essential mixed cryoglobulinemia type II (type II cryo), whose median follow-up was 97 months. Fifty-four out of fifty-six subjects who underwent ELISA and RIBA tests for HCV, were found to be positive. At conventional light microscopic examination, 64/76 patients showed discrete lymphoid infiltrates consisting of small elements with plasmacytoid differentiation and with frequent paratrabecular location. Thirty-nine biopsies were studied by immunohistochemistry that revealed the B-cell nature of the infiltrates (CD20+, CD45RA+, CD79 alpha+, CD3-, CD45RO-), with demonstrable monotypic Ig light-chain restriction in 22 cases. It is worthy of note that the lymphoid elements usually appeared protected against apoptosis, because of the strong expression of the bcl-2 oncogene product, and provided with a very low proliferative capacity, the Ki-67 index being lower that 3%. The latter findings are in keeping with the indolent behaviour of the clonal lymphoid population observed in type II cryo and allow some speculation as to the need for environmental stimuli for its maintenance as well as further mutagenic events for its eventual transformation into an overt lymphoma.
对76例II型原发性混合性冷球蛋白血症（II型冷球蛋白血症）患者进行了116次连续骨髓活检，其中位随访时间为97个月。在接受丙型肝炎病毒（HCV）酶联免疫吸附测定（ELISA）和重组免疫印迹分析（RIBA）检测的56名受试者中，有54名结果呈阳性。在传统光学显微镜检查中，76例患者中有64例显示离散的淋巴细胞浸润，由具有浆细胞样分化的小细胞组成，且常位于小梁旁。对39份活检标本进行免疫组织化学研究，结果显示浸润细胞具有B细胞性质（CD20 +、CD45RA +、CD79α +、CD3 -、CD45RO -），22例可见单型Ig轻链限制。值得注意的是，由于bcl-2癌基因产物的强烈表达，淋巴细胞通常似乎受到凋亡保护，并且增殖能力非常低，Ki-67指数低于3%。后一发现与II型冷球蛋白血症中观察到的克隆性淋巴细胞群体的惰性行为一致，并引发了一些推测，即维持该群体需要环境刺激以及其最终转化为明显淋巴瘤需要进一步的诱变事件。
