van de Rijn M, Kamel O W, Chang P P, Lee A, Warnke R A, Salhany K E
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
Am J Surg Pathol. 1997 Feb;21(2):187-94. doi: 10.1097/00000478-199702000-00008.
We describe three cases of primary low-grade B-cell lymphoma of the endometrium and contrast the histological, immunohistochemical, and molecular features with two examples of benign endometrial lymphoid infiltrates. The first case was an incidental finding in a curettage specimen, confirmed on a subsequent hysterectomy. The other two cases of lymphoma were incidental findings on hysterectomy procedures performed for prolapse and cervical dysplasia, respectively. All three lymphomas occurred in patients in their sixties; none formed gross tumors. Histologic examination revealed lymphoid nodules adjacent to endometrial glands. The lymphoid cells showed mild nuclear enlargement and slight irregularities of the nuclear contour. None of the three patients had evidence of disease outside the endometrium by physical examination, bone marrow biopsy, or sampling of pelvic lymph nodes. Immunohistochemistry demonstrated a B-cell phenotype of the lymphoid cells (CD20 positive, CD79a positive) with aberrant coexpression of the T-cell-associated marker CD43. Polymerase chain reaction (PCR) amplification of the VDJ region of the immunoglobulin heavy-chain was performed on DNA isolated from paraffin sections. These studies demonstrated a clonal proliferation of B-lymphocytes in two cases. In the third case, a faint band was found superimposed on a background smear, suggesting the presence of a B-cell clone. In contrast, the two examples of histologically benign lymphoid aggregates of the endometrium consisted predominantly of T cells with rare B-lymphocytes; there was no evidence of coexpression of CD43 by B-cells. The PCR amplification from the benign lymphoid aggregates did not support a clonal process. Primary lymphoid neoplasms of the endometrium are rare, and all cases described so far have been high-stage, high-grade neoplasms. To our knowledge, this is the first report of primary low-grade B-cell lymphoma of the endometrium, presumably arising from endometrial lymphoid tissue.
我们描述了三例子宫内膜原发性低度B细胞淋巴瘤，并将其组织学、免疫组化和分子特征与两例良性子宫内膜淋巴浸润进行对比。第一例是在刮宫标本中偶然发现的，随后子宫切除标本证实。另外两例淋巴瘤分别是在因子宫脱垂和宫颈发育异常而进行的子宫切除术中偶然发现的。所有三例淋巴瘤均发生于60多岁的患者；均未形成肉眼可见的肿瘤。组织学检查显示子宫内膜腺体旁有淋巴结节。淋巴细胞显示核轻度增大，核轮廓略有不规则。通过体格检查、骨髓活检或盆腔淋巴结取样，三名患者均无子宫内膜外疾病证据。免疫组化显示淋巴细胞为B细胞表型（CD20阳性，CD79a阳性），伴有T细胞相关标志物CD43的异常共表达。对从石蜡切片中分离的DNA进行免疫球蛋白重链VDJ区域的聚合酶链反应（PCR）扩增。这些研究在两例中显示了B淋巴细胞的克隆增殖。在第三例中，在背景涂片上发现一条模糊带，提示存在B细胞克隆。相比之下，两例组织学上良性的子宫内膜淋巴聚集主要由T细胞组成，B淋巴细胞罕见；没有证据表明B细胞共表达CD43。良性淋巴聚集的PCR扩增不支持克隆过程。子宫内膜原发性淋巴肿瘤罕见，迄今为止描述的所有病例均为高分期、高级别肿瘤。据我们所知，这是子宫内膜原发性低度B细胞淋巴瘤的首例报告，推测起源于子宫内膜淋巴组织。
