White V A, Gascoyne R D, McNeil B K, Chang W Y, Brewer L V, Rootman J
Department of Pathology, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
Mod Pathol. 1996 Nov;9(11):1052-61.
We report the reclassification according to recently described histologic categories of 48 patients with ocular adnexal lymphoproliferative lesions with long-term follow-up (mean, 8.1 yr). We used available formalin-fixed, paraffin-embedded, and frozen tissues to assess the frequency of immunoglobulin heavy chain gene rearrangement detectable by polymerase chain reaction in these lesions. We reviewed patient records, obtained follow-up data, and examined hematoxylin- and eosin-stained slides. DNA extracted from tissues was amplified with consensus V- and J-region primers to detect immunoglobulin heavy chain gene rearrangement. We examined 28 orbital, 10 lacrimal, and 10 conjunctival lesions, of which 2 lesions were lymphoid hyperplasias, 3 were indeterminate, and 43 were lymphomas. Of the 44 patients with follow-up, systemic lymphoma developed in 24 (55%), of whom 11 died of the disease, and 6 are alive with disease. Thirty-one patients had sufficient DNA for polymerase chain reaction analysis; 9 specimens were nonclonal, 21 were clonal, and 1 failed to amplify. The nonclonal lesions included one hyperplasia, one indeterminate lesion, and seven lymphomas; two of these patients died of the disease, and one is alive with disease. The clonal lesions included 1 indeterminate lesion and 20 lymphomas. Systemic lymphomas developed in 16 patients; 8 died of the disease, and 4 are alive with disease. Of the lesions histologically classified as lymphoma, 74% were clonal. We conclude that most ocular adnexal lymphoproliferative lesions can be histologically classified as lymphomas, that systemic lymphoma will develop in at least 50% of these patients if they are followed for sufficient time, and that most lesions classified as lymphomas will be clonal using polymerase chain reaction techniques. Lack of amplification using a consensus primer strategy may account for the inability to detect clonality by polymerase chain reaction in some histologically identified lymphomas.
我们报告了48例眼附属器淋巴增殖性病变患者根据最近描述的组织学分类进行的重新分类，并进行了长期随访（平均8.1年）。我们使用现有的福尔马林固定、石蜡包埋和冷冻组织，通过聚合酶链反应评估这些病变中可检测到的免疫球蛋白重链基因重排频率。我们查阅了患者记录，获取了随访数据，并检查了苏木精和伊红染色的切片。从组织中提取的DNA用共有V区和J区引物进行扩增，以检测免疫球蛋白重链基因重排。我们检查了28例眼眶病变、10例泪腺病变和10例结膜病变，其中2例为淋巴组织增生，3例为性质不确定病变，43例为淋巴瘤。在44例有随访的患者中，24例（55%）发生了全身性淋巴瘤，其中11例死于该疾病，6例仍患有该疾病存活。31例患者有足够的DNA用于聚合酶链反应分析；9份标本为非克隆性，21份为克隆性，1份未能扩增。非克隆性病变包括1例增生、1例性质不确定病变和7例淋巴瘤；这些患者中有2例死于该疾病，1例仍患有该疾病存活。克隆性病变包括1例性质不确定病变和20例淋巴瘤。16例患者发生了全身性淋巴瘤；8例死于该疾病，4例仍患有该疾病存活。在组织学分类为淋巴瘤的病变中，74%为克隆性。我们得出结论，大多数眼附属器淋巴增殖性病变在组织学上可分类为淋巴瘤，如果对这些患者进行足够长时间的随访，至少50%的患者会发生全身性淋巴瘤，并使用聚合酶链反应技术，大多数分类为淋巴瘤的病变将是克隆性的。使用共有引物策略缺乏扩增可能解释了在一些组织学确定的淋巴瘤中无法通过聚合酶链反应检测到克隆性的原因。
