NK/T细胞淋巴瘤的病理组织学,免疫表型及基因研究

Abstract

目的筛选高效、方便、经济的对NK/T细胞淋巴瘤更进一步分类与诊断的检测方法.方法收集了诊断为NK/T细胞淋巴瘤的34例患者石腊包埋标本,27例发生于结外,7例发生在淋巴结.用多种抗体研究其免疫表型.EB病毒EBER探针原位杂交方法检测病毒感染.PCR方法检测T细胞受体β和γ基因的克隆性重排.结果在34例结外淋巴瘤患者中,18例CD56阳性,16例TIA-1阳性. 2例皮肤淋巴瘤患者中所有的瘤细胞Ki-67均阳性.在EB病毒RNA检测中,12例发生于上呼吸消化道的病例阳性,包括鼻部的9例, 以及鼻外的3例.同样在2例胃肠道淋巴瘤及1例皮肤淋巴瘤患者中检测到EBER.22例上呼吸消化道淋巴瘤患者中有2例检测到了TCRβ或γ基因克隆性重排,所有胃肠道和皮肤淋巴瘤患者均检测到了TCR基因重排.2例其他部位结外淋巴瘤及7例结内淋巴瘤患者中有5例显示TCR基因的克隆性重排.结论大多数上呼吸消化道NK/T细胞淋巴瘤起源于NK细胞,只有一小部分为T细胞来源.然而,在皮肤及胃肠道中,NK样T细胞肿瘤更多见.在淋巴结中,NK细胞淋巴瘤很少.由于NK及NK样T细胞淋巴瘤的组织学改变相似,在进行NK细胞标志物、细胞毒性颗粒蛋白检测的同时必须检测TCR基因重排才会得到准确诊断.TCR的基因重排检测仍是鉴别NK和NK样T细胞淋巴瘤的重要标准.

To study the NK/T-cell lymphoma, search for a more efficacious and simpler method and establish a standard guideline for distinguishing the NK-like T-cell lymphoma from the NK-cell lymphoma.Thirty-four NK or T-cell lymphomas from the upper aerodigestive tract (n = 22), skin (n = 2), gastrointestinal (GI) tract (n = 2), lymph nodes (n = 7), and other sites (n = 1) were studied. Immunophenotype was analyzed by immunohistochemistry. In situ hybridization with EBER 1/2 RNA probes was performed. T-cell receptor (TCR)-beta and -gamma gene rearrangement was analyzed by polymerase chain reaction (PCR).Eighteen cases were positive for CD(56) and 16 for TIA-1 in 34 lymphomas cases. All tumor cells in the skin cases were positive for Ki-67. Epstein-Barr virus (EBV) mRNA was detected in 12 upper aerodigestive tumors including 9 of 12 nasal and 3 extranasal tumors. EBER was also detected in 1 of 2 skin lymphomas and both of the 2 GI lymphomas. Clonal TCR-beta and -gamma gene rearrangement was detected in 2 of 22 upper aerodigestive, all of the skin and GI lymphomas, and 6 of 9 nodal and other site lymphomas.Most upper aerodigestive NK/T-cell lymphomas are genotypically NK derivation, and a few belong to T lineage. However, NK-like T-cell lymphomas more frequently seen in skin and GI tract. Nodal NK-cell lymphoma are quite rare. These two kinds of lymphomas can only be diagnosed with additional immunohistochemical markers, EBER detection by ISH, TCR gene rearrangement or NK-cell receptors (NKRs) RNA detection. Detection of TCR rearrangement remains the important standard for the diagnosis of T-cell lymphoma.