Dubus P, Vergier B, Beylot-Barry M, Delaunay M M, Goussot J F, Beylot C, de Mascarel A, Farcet J P, Merlio J P
Department of Pathology and Histology, Centre Hospitalo-Universitaire de Bordeaux, Université de Bordeaux II, France.
Mod Pathol. 1996 Dec;9(12):1147-55.
To evaluate the value of morphologic, immunohistochemical and molecular analyses, we studied 21 skin biopsy specimens from 19 patients with primary cutaneous B-cell infiltrates. Morphologic review by two independent dermatopathologists confirmed the consensus diagnoses of lymphoma (n = 6) or benign lymphoid hyperplasia (n = 6). A discordant diagnosis was made for the other samples (n = 9), which were thereafter considered as unclassified lymphoid infiltrates. Immunohistochemical analysis showed either a monotypic expression of immunoglobulin light chain or a positive staining with anti-bcl-2 antibodies in three and four samples, respectively, of lymphoma. Polymerase chain reaction was used to analyze immunoglobulin heavy chain and T-cell receptor gamma chain gene rearrangement and to amplify t(14;18) and t(11;14) break points. A clonal molecular marker was detected in 12 of 19 patients. Among these 12 patients, a final diagnosis of lymphoma was confirmed in 8 patients, including the 6 with a morphologic diagnosis of lymphoma. Two patients with clonal benign lymphoid hyperplasia and two with clonal unclassified lymphoid infiltrate presented a benign clinical outcome; one patient was lost to follow-up. Alternatively, no clonal molecular marker was found in two of the patients with lymphoma. The morphologic and molecular criteria, therefore, provided complementary and partially overlapping information for the diagnosis of cutaneous B-cell infiltrates. We proposed a practical use for these data.
为评估形态学、免疫组织化学及分子分析的价值，我们研究了19例原发性皮肤B细胞浸润患者的21份皮肤活检标本。两名独立的皮肤病理学家进行的形态学复查证实了淋巴瘤（n = 6）或良性淋巴样增生（n = 6）的一致诊断。对其他样本（n = 9）做出了不一致的诊断，这些样本随后被视为未分类的淋巴样浸润。免疫组织化学分析显示，在淋巴瘤的三个和四个样本中，分别有免疫球蛋白轻链的单型表达或抗bcl-2抗体阳性染色。采用聚合酶链反应分析免疫球蛋白重链和T细胞受体γ链基因重排，并扩增t(14;18)和t(11;14)断点。在19例患者中的12例检测到克隆性分子标志物。在这12例患者中，8例最终确诊为淋巴瘤，包括6例形态学诊断为淋巴瘤的患者。两名克隆性良性淋巴样增生患者和两名克隆性未分类淋巴样浸润患者呈现良性临床结局；1例患者失访。另外，在两名淋巴瘤患者中未发现克隆性分子标志物。因此，形态学和分子标准为皮肤B细胞浸润的诊断提供了互补且部分重叠的信息。我们提出了这些数据的实际应用。
