Guinee D G, Perkins S L, Travis W D, Holden J A, Tripp S R, Koss M N
Department of Pathology, University of Utah, Salt Lake City, USA.
Am J Surg Pathol. 1998 Sep;22(9):1093-100. doi: 10.1097/00000478-199809000-00008.
Pulmonary involvement by lymphomatoid granulomatosis (LYG) is characterized by nodules of a polymorphous lymphoreticular infiltrate with necrosis, angioinvasion, and variable numbers of large, atypical cells. Using combined immunohistochemistry, the authors compared the expression of a marker of proliferation (DNA topoisomerase IIalpha) between B cells, T cells, and histiocytes. Sixteen cases of LYG were stained by combined immunohistochemistry for DNA topoisomerase IIalpha and CD-20, CD-3, CD-68, and CD-57. A proliferation index was determined for B cells, T cells, histiocytes, and natural killer cells by dividing the number of cells with coexpression of DNA topoisomerase IIalpha and CD-20, CD-3, CD-68, or CD-57 by the total number of CD-20+, CD-3+, CD-68+, or CD-57+ cells, respectively. A significantly higher proliferation index was present in B cells compared to T cells, histiocytes, or natural killer cells (p < 0.002). The average proliferation index for B cells was 0.25+/-0.24 (range, 0.00-0.76), for T cells was 0.02+/-0.01 (range, 0.00-0.04), for histiocytes was 0.00+/-0.01 (range, 0-0.02), and for natural killer cells was 0.00+/-0.00 (range, 0.0-0.02). The average proliferation index of CD-20+ cells was greater in grade III LYG (0.36) than in grade II LYG (0.17) or the single case of grade I LYG (0.00). The authors conclude that (1) there is a spectrum of B-cell proliferation in LYG that roughly correlates with histologic grade, (2) T cells, histiocytes, and natural killer cells do not proliferate but are recruited, and (3) the average B-cell proliferation index in grade III LYG is similar to that observed in large cell non-Hodgkin's B-cell lymphomas. These observations provide a possible rationale for the use of chemotherapy for grade III LYG and observation or immunologic adjuvants for LYG with grade I or grade II histology.
淋巴瘤样肉芽肿病（LYG）的肺部受累表现为多形性淋巴网状浸润伴坏死、血管侵袭及数量不等的大的非典型细胞形成的结节。作者采用联合免疫组织化学方法，比较了增殖标志物（DNA拓扑异构酶IIα）在B细胞、T细胞和组织细胞中的表达情况。对16例LYG病例进行了DNA拓扑异构酶IIα与CD-20、CD-3、CD-68和CD-57的联合免疫组织化学染色。通过分别将共表达DNA拓扑异构酶IIα与CD-20、CD-3、CD-68或CD-57的细胞数除以CD-20+、CD-3+、CD-68+或CD-57+细胞总数，确定B细胞、T细胞、组织细胞和自然杀伤细胞的增殖指数。与T细胞、组织细胞或自然杀伤细胞相比，B细胞的增殖指数显著更高（p < 0.002）。B细胞的平均增殖指数为0.25±0.24（范围，0.00 - 0.76），T细胞为0.02±0.01（范围，0.00 - 0.04），组织细胞为0.00±0.01（范围，0 - 0.02），自然杀伤细胞为0.00±0.00（范围，0.0 - 0.02）。III级LYG中CD-20+细胞的平均增殖指数（0.36）高于II级LYG（0.17）或I级LYG的单个病例（0.00）。作者得出结论：（1）LYG中存在一系列B细胞增殖情况，大致与组织学分级相关；（2）T细胞、组织细胞和自然杀伤细胞不增殖而是被募集；（3）III级LYG中B细胞的平均增殖指数与大细胞非霍奇金B细胞淋巴瘤中观察到的相似。这些观察结果为III级LYG使用化疗以及I级或II级组织学的LYG采用观察或免疫佐剂治疗提供了可能的理论依据。
