Prasad M L, Charney D A, Sarlin J, Keller S M
Department of Pathology, The New York Hospital-Cornell Medical Center, New York 10021, USA.
Am J Surg Pathol. 1998 Sep;22(9):1148-53. doi: 10.1097/00000478-199809000-00015.
An unusual immunocytoma (lymphoplasmacytoid lymphoma) composed predominantly of sheets of globoid and spindle-shaped crystal-storing histiocytes was detected incidentally in the right lung of a 72-year-old woman. Scattered lymphoplasmacytic aggregates within the tumor had monoclonality with anti-kappa immunoglobulin (Ig) M antibodies. The crystals were outlined positively by the same antibodies. They stained an intense blue with phosphotungstic acid-hematoxylin (PTAH) and were found during electron microscopy to be membrane bound and also within type I pneumocytes and the extracellular space. Excessive production of kappa IgM by neoplastic low-grade lymphoplasmacytoid cells of B-cell origin in an altered intra- or extracellular milieu may lead to crystallization and phagocytosis by reactive histiocytes. Review of the literature revealed seven more cases: four in the head and neck, and one each in the skin, the lymph node, and the lung. IgM was the most frequently crystallizing immunoglobulin (four of seven) and all had kappa light chains. The lesion needs to be differentiated from neoplastic and nonneoplastic histiocytic and lymphoplasmacytic disorders. The difference with bronchial mucosa-associated lymphoid tissue lymphoma and marginal zone lymphoma is, perhaps, semantic.
在一名72岁女性的右肺中偶然发现了一种不寻常的免疫细胞瘤（淋巴浆细胞样淋巴瘤），主要由成片的球状和梭形含晶体组织细胞组成。肿瘤内散在的淋巴浆细胞聚集物与抗κ免疫球蛋白（Ig）M抗体呈单克隆性。这些晶体被相同的抗体阳性勾勒。它们用磷钨酸苏木精（PTAH）染色呈深蓝色，在电子显微镜下发现它们被膜包裹，也存在于I型肺泡细胞和细胞外间隙中。在改变的细胞内或细胞外环境中，B细胞来源的肿瘤性低度淋巴浆细胞样细胞过度产生κ IgM可能导致结晶，并被反应性组织细胞吞噬。文献回顾发现还有另外7例：4例位于头颈部，1例分别位于皮肤、淋巴结和肺部。IgM是最常结晶的免疫球蛋白（7例中的4例），且均具有κ轻链。该病变需要与肿瘤性和非肿瘤性组织细胞及淋巴浆细胞疾病相鉴别。与支气管黏膜相关淋巴组织淋巴瘤和边缘区淋巴瘤的区别或许只是语义上的。
