霍奇金淋巴瘤规范化治疗课件.pptVIP

霍奇金淋巴瘤规范化治疗 上海交通大学附属第一人民医院血液科高彦荣 淋巴瘤 1、经典型霍奇金淋巴瘤（HL） 在炎症浸润性背景上找到RS细胞。 Reed一Sternberg 氏（ R-S）细胞,也称镜影细胞，即HD真正的肿瘤细胞。 炎症细胞背景：淋巴细胞、中性粒细胞、嗜酸性粒细胞、浆细胞、组织细胞及胶元纤维均属组织反应。 Classic Reed-Sternberg cells are large (15-45 m) with abundant pale cytoplasm and two or more oval lobulated nuclei containing prominent owl-eye eosinophilic (HE) nucleoli In some R-S cell variants the cytoplasm shrinks during formalin fixation and processing of tissue, leaving an empty space around the nucleus. Such R-S variants are known as lacunar cells. 腔隙型R-S cell Another R-S variant is the LH or popcorn cell with a fluffy, lobulated nucleus having fine chromatin and small nucleoli. Reed-Sternberg (R-S) cells are essential to the diagnosis of Hodgkin lymphoma. but as R-S cells are not unique to HDR-S cells alone are not sufficient for the diagnosis.在缺乏HD其他组织学改变时，单独见到HD细胞，不能确诊HD。 R-S细胞的来源 尚不清楚 B细胞 T细胞 树突状细胞 富于淋巴细胞典型HLClassic R-S cells are rare and difficult to find, but mononuclear LH Hodgkin cells with popcorn shaped nuclei and inconspicuous nucleoli are present against a background of small lymphocytes. 结节硬化型Lacunar R-S variants and sclerosing bands of collagenous fibrosis forming a nodular pattern are characteristic features 混合细胞型Mixed cellularity Hodgkin Lymphoma has numerous R-S cells in a mixed inflammatory background that obliterates the normal architecture. Plasma cells and eosinophils are frequent 淋巴细胞消减型 淋巴瘤 霍奇金淋巴瘤的病理组织学分为四型： （Rye会议，1965年） （1）淋巴细胞为主型（LP）--- 预后好 （2）结节硬化型（NS）----预后可 （3）混合细胞型（MC）---预后较差 （4）淋巴细胞消减型（LD）---预后差 （WHO（2001）造血和淋巴组织肿瘤分型霍奇金淋巴瘤 一、结节性淋巴细胞为主型（NLPHL)--- 预后好 二、经典型霍奇金淋巴瘤 （1）富于淋巴细胞经典型霍奇金淋巴瘤(LPHL)--- 预后好 （2）结节硬化型霍奇金淋巴瘤(NSHL)----预后可 （3）混合细胞型霍奇金淋巴瘤(MCHL)---预后较差 （4）淋巴细胞消减型霍奇金淋巴瘤(LDHL)---预后差 结节性淋巴细胞为主型：占5%HL(西方国家） 病理特征：存在淋巴细胞和组织细胞，缺乏R-S细胞。 结节性（B细胞），弥漫性（T细胞） often vaguely nodular. good prognosis with a 5-year survival of approximately 90%.