nk细胞淋巴瘤讲义 .pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * Intestine Testis Muscle 结外NK/T细胞淋巴瘤的免疫表型 CD2 + 表面 CD3 -; 胞浆 CD3 + (polyclonal CD3?; PS1) CD56 +, CD57和CD16常- CD4, CD5, CD7, CD8: 常- CD43, CD45RO: 常+ 细胞毒颗粒 + Ki67 : 高 CD25和 CD30偶尔+ TCR-; CD3 CD5 CD56 Granzyme B Extranodal NK/T cell lymphoma: Genotype TCR genes: germline in most cases studied EBV Present in clonal episomal form Nasal: 95% positive, irrespective of ethnic origin Extra-nasal: 90% positive in Asians, but lower % in Caucasians Extranodal NK/T cell lymphoma: Main problems in diagnosis Biopsies may show extensive coagulative necrosis, rendering it impossible to make a definitive diagnosis. Repeat biopsy is required. Some examples comprise small cells with minimal cytologic atypia: distinction from reactive lymphoid infiltrate very difficult BEWARE: Mucosal small lymphoid cells often appear slightly larger than small lymphocytes, and can show irregular nuclei Histologic features favoring a neoplastic process Abnormal architecture: Dense expansile infiltrate with wide separation and loss of mucosal glands Tissue ulceration and necrosis Evidence of invasion: Angiocentric growth Cytologic atypia: Clear cytoplasm Medium-sized; nuclear irregularities; granular chromatin Readily found mitotic figures in a small cell lesion Immunohistochemical analysis:First-tier panel CD20, CD3, CD56, (Ki67) Nodular aggregates of B cells separated by T cells; few CD56+ cells Reactive lymphoid infiltrate Dense sheets of B cells B cell lymphoma Dense sheets of CD3+ CD56+ cells NK/T cell lymphoma Dense sheets of CD3+ CD56- cells Reactive or CD56- NK/T lymphoma or T cell lymphoma How to confirm a suspicion ofNK/T cell lymphoma? Immunostain for CD56: large clusters or sheets of positive cells strongly support diagnosis of lymphoma [Pitfall: herpes infection] In-situ hybridization for EBER: large groups of positive cells support diagnosis of lymphoma Immunostain for Ki67: High index (80%) for a small cell-predominant lesion