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目的 探讨组织形态改变、免疫组织化学、基因重排在淋巴瘤骨髓侵犯的病理诊断和分型中的作用。材料与方法 对62例甲醛固定、石蜡包埋的骨髓活检组织,分别做了组织学、EnVision法观察和免疫球蛋白重链(IgH)基因和TCRγ基因重排检测。结果慢性淋巴细胞性白血病/小淋巴细胞淋巴瘤(CLL/SLL)的异型淋巴细胞呈小梁间结节状或散在分布,有时可见假滤泡结构。滤泡型淋巴瘤(FCL)表现为结节性小梁旁或小梁间的浸润,结节内小淋巴样细胞松散聚集。淋巴浆细胞性淋巴瘤(LPL)主要为小梁间弥散浸润,在小而圆的淋巴细胞间可见散在数量不等的浆细胞样淋巴细胞。边缘区淋巴瘤(MZL)则见模糊的或界限不清的小梁间或小梁旁结节,一些细胞胞质透明。套细胞性淋巴瘤(MCL)异型细胞小到中等大小,缺乏副免疫母细胞和假滤泡。毛细胞性淋巴瘤(HCL)瘤细胞胞膜多清晰,胞质丰富透明,常形成荷包蛋样表现。霍奇金病可见大核瘤细胞,核仁明显。T-非霍奇金淋巴瘤(NHL)浸润骨髓主要为小粱间间质性散在或弥漫分布,胞质多透明,核有芋艿样或脑回状改变,DLBL造血细胞间体积大的瘤细胞散在或弥漫分布。CD3对T细胞来源、CD20和CD79对B细胞来源淋巴瘤有鉴别诊断价值,cyclin D1和CD5阳性对MCL具有诊断性价值,bcl-2和CD10阳性则对FCL具有诊断性意义,而CLL/
Objective To investigate the role of histomorphology, immunohistochemistry and gene rearrangement in pathological diagnosis and classification of lymphoma with bone marrow invasion. Materials and Methods Sixty-two formalin-fixed and paraffin-embedded bone marrow biopsy specimens were histologically examined by EnVision and immunoglobulin heavy chain (IgH) gene and TCRγ gene rearrangements. Results Allogeneic lymphocytes of chronic lymphocytic leukemia / small lymphocytic lymphomas (CLL / SLL) showed nodal nodular or scattered distributions, sometimes with pseudolobular structures. Follicular lymphoma (FCL) is manifested as nodular trabecular or trabecular infiltration, small nodular lymphoid cells loosely aggregated. Lymphoplasmacytic lymphoma (LPL) is mainly interstitial infiltrate between the small, round and round lymphocytes can be seen scattered in varying numbers of plasmacytoid lymphocytes. Marginal zone lymphoma (MZL) see blurred or unclear inter-trabecular or trabecular nodules, some of the cytoplasm transparent. Mantle cell lymphoma (MCL) Heterotypic cells are small to medium sized, lacking paired immunoblasts and pseudobubbles. Hairy cell lymphoma (HCL) tumor cell membrane more clear, abundant and transparent cytoplasm, often forming a poached egg-like performance. Hodgkin’s disease can be seen in large nuclear tumor cells, nucleoli obvious. The infiltrating bone marrow of non-Hodgkin’s lymphoma (NHL) mainly consisted of interstitial interstitial scattered or diffuse distribution of cytoplasm, cytoplasm of translucent cytoplasm, alteration of cytoplasm or cytoplasm of gyrus, DLBL hematopoietic cells with large volume Scattered or diffuse distribution. CD3 on the origin of T cells, CD20 and CD79 on the B-cell lymphoma have differential diagnosis value, cyclin D1 and CD5 positive for the diagnosis of MCL, bcl-2 and CD10 positive FCL has diagnostic significance, and CLL /