Kaddu S, Smolle J, Cerroni L, Kerl H
Department of Dermatology, University of Graz, Austria.
J Cutan Pathol. 1996 Dec;23(6):487-94. doi: 10.1111/j.1600-0560.1996.tb01440.x.
The relationship between numerous histologic variables and survival was investigated in 54 consecutive lesions of specific skin infiltrates of B-cell chronic lymphocytic leukemia (B-CLL) from 27 patients (16 males and 11 females, mean age 65 years, range 42-83 years). All patients were followed for up to 204 months or until death. Histopathologically, the infiltrates showed a patchy perivascular (35%), diffuse (31.5%), nodular (31.5%) or bandlike (1.9%) pattern. In 28% of the cases, an admixture of reactive cells within the infiltrate including eosinophils, histiocytes, neutrophils and plasma cells was observed. Cytomorphologically, small B-lymphocytes with condensed chromatin predominated in most infiltrates. However, some biopsies showed a small but significant number of medium- or large-sized neoplastic cells of the B-lymphocyte lineage with variable cytomorphological features. In a multivariate analysis, several histologic parameters within the infiltrates were found to show a significant association with long survival, namely, an infiltrate of moderate density, a nodular pattern, involvement of the lower dermis only, and presence of predominantly small B-lymphocytes (more than 95%) with condensed chromatin. Histologic variables that independently correlated with relatively short survival included an infiltrate of severe intensity, a diffuse pattern, epidermal changes (especially acanthosis and ulceration), medium-sized and large B-lymphocyte (more than 5%), and reactive cells within the infiltrate (neutrophils, eosinophils, and plasma cells). Overall analysis of our results showed two histologic patterns with a significant prognostic impact (p < 0.01; z = 5.4). Pattern I (33 biopsies) correlated with relatively long survival (2-year survival rate; 97%) and consisted of infiltrates showing predominantly small B-lymphocytes (more than 95%) without reactive cells or epidermal changes. Pattern II (21 biopsies) indicated short survival (2-year survival rate; 49%) and included all the rest of the biopsies i.e., infiltrates with medium- and large-sized B-lymphocytes (more than 5%), admixture of reactive cells, and epidermal changes. Results from our study suggest that histologic features in specific skin infiltrates of B-chronic lymphocytic leukemia may be helpful in identifying prognostically different subgroups of patients and planning therapeutic schedules.
对27例患者（16例男性，11例女性，平均年龄65岁，年龄范围42 - 83岁）的54处连续性B细胞慢性淋巴细胞白血病（B - CLL）特异性皮肤浸润病变进行了多种组织学变量与生存率关系的研究。所有患者均随访长达204个月或直至死亡。组织病理学上，浸润表现为斑片状血管周围型（35%）、弥漫型（31.5%）、结节型（31.5%）或带状型（1.9%）。28%的病例中，浸润内可见包括嗜酸性粒细胞、组织细胞、中性粒细胞和浆细胞在内的反应性细胞混合存在。细胞形态学上，大多数浸润中以染色质浓缩的小B淋巴细胞为主。然而，一些活检显示存在少量但数量可观的具有不同细胞形态特征的B淋巴细胞系中等大小或大的肿瘤细胞。在多变量分析中，发现浸润内的几个组织学参数与长期生存显著相关，即中等密度浸润、结节型、仅累及真皮下部以及主要为染色质浓缩的小B淋巴细胞（超过95%）的存在。与相对较短生存独立相关的组织学变量包括重度浸润、弥漫型、表皮改变（尤其是棘皮症和溃疡）、中等大小和大的B淋巴细胞（超过5%）以及浸润内的反应性细胞（中性粒细胞、嗜酸性粒细胞和浆细胞）。对我们结果的总体分析显示两种具有显著预后影响的组织学模式（p < 0.01；z = 5.4）。模式I（33例活检）与相对较长生存相关（2年生存率；97%），由主要显示小B淋巴细胞（超过95%）且无反应性细胞或表皮改变的浸润组成。模式II（21例活检）提示生存较短（2年生存率；49%），包括其余所有活检，即具有中等大小和大的B淋巴细胞（超过5%）、反应性细胞混合以及表皮改变的浸润。我们研究的结果表明，B慢性淋巴细胞白血病特异性皮肤浸润的组织学特征可能有助于识别预后不同的患者亚组并制定治疗方案。
