5种标记物组套在滤泡辅助性T细胞起源的外周T细胞性淋巴瘤常规诊断中的应用

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  摘要:2017版WHO淋巴瘤新分类中介绍了一种结内滤泡辅助性T细胞起源的外周T细胞淋巴瘤(nodal peripheral T-cell lymphoma with T-follicular helper phenotype,PTCL-TFH),此类淋巴瘤至少可以表达2钟或3种滤泡辅助性T细胞标记物。本研究探讨了5种(CD10, BCL-6,PD-1,CXCL13,ICOS)TFH标记物免疫组化检测在确定血管免疫母细胞性T细胞淋巴瘤(angioimmunoblastic T-cell lymphoma,AITL)及非特指外周T细胞性淋巴瘤(PTCL not otherwise specifified,PTCL-NOS)TFH表型中的应用。我们对22例AITL及29例PTCL-NOS分别进行了以上5种标记物的免疫组化染色,并且回顾了所有病例的AITL样形态学特征。结果显示所有AITL病例均表达了2种或2种以上的TFH标志物,41%原诊断为PTCL-NOS的病例被重新分类为PTCL-TFH。TFH表型阳性符合率分别是PD-1 97%,ICOS 94%,CD10和CXCL13 44%,BCL-6 29%。而TFH表型阴性符合率分别是CD10 100%,BCL-6、CXCL13 和ICOS均为82%,PD-1 71%。AITL病例相较PTCL-TFH更多表现为以下特征:扩大的CD21阳性滤泡树突细胞网、透明胞浆以及多种炎症细胞背景。3个不同诊断组之间所有形态学变量的Kruskal-Wallis趋势性检验均有统计学意义(P<0.005),提示从PTCL-NOS到PTCL-TFH,再到AITL是一个连续的病变谱系。AITL相关形态特征数的中位数与TFH阳性标记物数量也存在显著相关性(Speaman相关分析,ρ= 0.759)。总而言之,此标记物组套的选择有助于PTCL-TFH的诊断,这种病变可能是存在于PTCL-NOS和AITL之间的中间谱系。

  关键词:血管免疫母细胞性T细胞淋巴瘤,外周T细胞性淋巴瘤,ICOS,滤泡辅助性T细胞表型


(Am J Surg Pathol 2019;43:1282-1290)

  美国外科病理学杂志中文版2020年第一期正文NO.2

 (郑晶 杨丞 翻译 翁阳 审校)


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