Quintana P G, Kapadia S B, Bahler D W, Johnson J T, Swerdlow S H
Department of Pathology, University of Pittsburgh School of Medicine, PA, USA.
Hum Pathol. 1997 Jul;28(7):850-61. doi: 10.1016/s0046-8177(97)90161-1.
The criteria for distinguishing benign lymphoepithelial lesions (BLEL) from low grade B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) type in salivary glands and the significance of genotypically documented clonality in this setting are controversial. In addition, the clinical implications of a neoplastic diagnosis are unclear. The histopathologic features of 68 specimens from 49 patients with at least one salivary gland biopsy with LEL together with available clinical data were, therefore, reviewed. Paraffin section immunohistochemical (IHC) stains for kappa, lambda, CD3, CD20, and CD43; in situ hybridization (ISH) for kappa and lambda; and polymerase chain reaction (PCR) for immunoglobulin (Ig) HC rearrangement were performed. The 61 salivary gland specimens were classified as BLEL-13, BLEL with monocytoid B-cell (MBC) halos (BLEL-halo-8), low grade B-cell lymphoma of MALT type with confluent zones of MBC or other atypical lymphocytes (ML-MALT-24), low grade B-cell lymphoma of MALT type with monoclonal plasma cells (ML-MALT-PC-12), and high grade B-cell lymphoma of MALT type (MALT-high grade-4). Soft tissue and perineural invasion was not observed in BLEL and was most common in the MALT lymphomas. Lymph node involvement was identified in six patients at the time of their salivary gland MALT lymphomas but in none with BLEL. CD43+ B cells were seen most commonly in ML-MALT but were present in all other categories except MALT-high grade. Clonal B cells were identified by PCR in 5 of 12 BLEL, 5 of 8 BLEL-halo, 17 of 22 ML-MALT, 6 of 10 ML-MALT-PC, and 3 of 3 MALT-high grade biopsies. All ML-MALT-PC were clonal by ISH or IHC. Repeat biopsies in 14 patients most commonly showed a BLEL/ML-MALT lesion in an ipsilateral or contralateral salivary gland with one transformation to a MALT-high grade. Although only a few patients are known to have received chemoradiation or radiation therapy, most patients with low-grade lesions have pursued an indolent course. These data show the presence of two types of borderline lesions within the spectrum of lymphoid proliferations associated with salivary gland LEL. One has clonal B cells without histological features of neoplasia and the other nonconfluent MBC extending beyond the confines of LEL ("halos"). They share some features with the infrequent nonneoplastic BLEL and others with the more common low-grade B-cell lymphomas of MALT. A few high-grade B-cell lymphomas of MALT were also identified including a rare example of transformation from a low- to high-grade lesion. The optimal therapeutic approach for the borderline and low-grade lesions and the reason why so many of the lymphoproliferative lesions associated with LEL remain localized to the neck remain to be defined.
区分涎腺良性淋巴上皮病变（BLEL）与黏膜相关淋巴组织（MALT）型低度B细胞淋巴瘤的标准以及在这种情况下基因分型记录的克隆性的意义存在争议。此外，肿瘤诊断的临床意义尚不清楚。因此，回顾了49例至少有一次涎腺活检显示淋巴上皮病变（LEL）的患者的68份标本的组织病理学特征以及可用的临床数据。进行了石蜡切片免疫组化（IHC）染色检测κ、λ、CD3、CD20和CD43；κ和λ的原位杂交（ISH）；以及免疫球蛋白（Ig）重链（HC）重排的聚合酶链反应（PCR）。61份涎腺标本被分类为BLEL-13例、伴有单核样B细胞（MBC）晕圈的BLEL（BLEL-晕圈-8例）、伴有MBC或其他非典型淋巴细胞融合区的MALT型低度B细胞淋巴瘤（ML-MALT-24例）、伴有单克隆浆细胞的MALT型低度B细胞淋巴瘤（ML-MALT-PC-12例）和MALT型高度B细胞淋巴瘤（MALT-高度-4例）。BLEL中未观察到软组织和神经周围浸润，而在MALT淋巴瘤中最为常见。6例涎腺MALT淋巴瘤患者在诊断时发现有淋巴结受累，但BLEL患者均未出现。CD43+ B细胞最常见于ML-MALT，但除MALT-高度外，在所有其他类别中均有出现。通过PCR在12例BLEL中的5例中鉴定出克隆性B细胞，8例BLEL-晕圈中的5例，22例ML-MALT中的17例，10例ML-MALT-PC中的6例以及3例MALT-高度活检标本中的3例。所有ML-MALT-PC通过ISH或IHC检测均为克隆性。14例患者的重复活检最常见的是在同侧或对侧涎腺出现BLEL/ML-MALT病变，其中1例转变为MALT-高度。尽管已知只有少数患者接受了放化疗或放疗，但大多数低度病变患者病程呈惰性。这些数据表明，在与涎腺LEL相关的淋巴增殖范围内存在两种类型的临界病变。一种具有克隆性B细胞但无肿瘤组织学特征，另一种是不融合的MBC延伸至LEL范围之外（“晕圈”）。它们与罕见的非肿瘤性BLEL有一些共同特征，与更常见的MALT型低度B细胞淋巴瘤也有一些共同特征。还鉴定出了一些MALT型高度B细胞淋巴瘤，包括1例罕见的从低度病变转变为高度病变的病例。临界和低度病变的最佳治疗方法以及与LEL相关的如此多淋巴增殖性病变为何仍局限于颈部的原因仍有待确定。
