Weirich G, Sandherr M, Fellbaum C, Richter T, Schmidt L, Kinjerski T, Dietzfelbinger H, Rastetter J, Höfler H
National Cancer Institute, Frederick Research and Development Center, Laboratory of Immunobiology, MD 21702, USA.
Hum Pathol. 1998 Jul;29(7):761-5. doi: 10.1016/s0046-8177(98)90289-1.
We describe the case of a middle-aged man with long indolent course of generalized Tgammadelta lymphoma. The onset of secondary myelofibrosis made cytological monitoring of the bone marrow infiltrates impossible. As during progression of the disease splenectomy revealed typical histological features of a high-grade hepatosplenic Tgammadelta lymphoma, the low-grade bone infiltrate was considered a secondary lymphoma. The use of the polymerase chain reaction helped to detect a constant and identical monoclonal rearrangement pattern of the T-cell receptor gamma-chain gene in both bone marrow and splenic T-cell infiltrates. The notion of a secondary spread of malignant T-cells to the bone marrow was thereby confirmed despite striking cytological differences between bone marrow and splenic infiltrates. This is the first report of a diagnostic DNA-based molecular approach using fixed decalcified bone marrow. This method may provide a major tool when dealing with myelofibrosis, which normally hampers sampling of cytological specimens.
我们描述了一例患有长期惰性病程的全身性γδ T细胞淋巴瘤的中年男性病例。继发性骨髓纤维化的出现使得对骨髓浸润进行细胞学监测变得不可能。在疾病进展过程中，脾切除术显示出高级别肝脾γδ T细胞淋巴瘤的典型组织学特征，则低级别骨浸润被认为是继发性淋巴瘤。聚合酶链反应的应用有助于在骨髓和脾脏T细胞浸润中检测到T细胞受体γ链基因恒定且相同的单克隆重排模式。尽管骨髓和脾脏浸润在细胞学上存在显著差异，但恶性T细胞向骨髓继发性扩散的概念由此得到证实。这是首次报道使用固定脱钙骨髓进行基于DNA的诊断性分子方法。当处理通常会妨碍细胞学标本采样的骨髓纤维化时，该方法可能会提供一个重要工具。
