Heimann R, Ray M B, Desmet V J
J Clin Pathol. 1977 Sep;30(9):817-21. doi: 10.1136/jcp.30.9.817.
This study reports the incidence of HBsAg in a series of chronic lymphoproliferative disorders in which a high incidence of cirrhoses had been previously observed. Twenty-three cases were collected from the necropsy records. The type of lymphoma was reviewed in the light of the new functional classifications of non-Hodgkin malignant lymphomas introduced by Lennert and Lukes. The presence of HBsAg in the liver was investigated by the indirect immunofluorescence technique. Eleven cases showed plasmocytoid features and were considered as immunocytomas. Seven cases showed cirrhosis of the liver; six of them belonged to the immunocytoma group. Four cases were positive for HBsAg. Three of them were found among the group combining cirrhosis and immunocytoma. They presented the abundant nodular distribution of HBsAg typical of inactive cirrhosis.A parallel is drawn between the often reported association of Waldenström's syndrome and cirrhosis and the association of immunocytoma and cirrhosis observed in this study. The analogy is all the more justified since most of the lymphomas associated with Waldenström's syndrome happen to be immunocytomas. Therefore the association between HB virus infection and cirrhosis on the one hand and chronic lymphoproliferative disorders on the other may not be purely coincidental. A chronic antigenic stimulus such as persisting HBsAg could trigger the proliferation of a malignant lymphoid clone.
本研究报告了一系列慢性淋巴细胞增生性疾病中乙肝表面抗原（HBsAg）的发生率，此前在这些疾病中已观察到肝硬化的高发生率。从尸检记录中收集了23例病例。根据Lennert和Lukes提出的非霍奇金恶性淋巴瘤新功能分类，对淋巴瘤类型进行了回顾。采用间接免疫荧光技术研究肝脏中HBsAg的存在情况。11例表现为浆细胞样特征，被视为免疫细胞瘤。7例有肝硬化；其中6例属于免疫细胞瘤组。4例HBsAg呈阳性。其中3例在肝硬化合并免疫细胞瘤组中发现。它们呈现出非活动性肝硬化典型的HBsAg丰富结节状分布。本研究观察到的免疫细胞瘤与肝硬化的关联，与经常报道的瓦尔登斯特伦综合征与肝硬化的关联进行了对比。这种类比更有依据，因为大多数与瓦尔登斯特伦综合征相关的淋巴瘤恰好是免疫细胞瘤。因此，一方面乙肝病毒感染与肝硬化之间的关联，另一方面与慢性淋巴细胞增生性疾病之间的关联可能并非纯粹巧合。持续存在的HBsAg等慢性抗原刺激可能引发恶性淋巴克隆的增殖。
