病史介紹
(資料圖片僅供參考)
臨床表現(xiàn)
男，31歲，頸部淋巴結(jié)腫大。大體所見
右頸部淋巴結(jié)穿刺活檢標(biāo)本，灰白條索樣組織3條，體積：0.6cm×0.3cm×0.1cm。鏡下形態(tài)
圖1
低倍鏡下可見少許游離腫瘤片狀分布。圖2
高倍鏡腫瘤細(xì)胞黏附性差，胞漿嗜堿性，細(xì)胞異型性明顯，細(xì)胞核偏位，可見大核仁，可見較多凋亡。圖3
高倍鏡下瘤細(xì)胞彌漫分布，細(xì)胞黏附性差，胞漿嗜酸性、核偏位。圖4
免疫組化顯示瘤細(xì)胞不表達(dá)CD20。圖5
免疫組化顯示瘤細(xì)胞不表達(dá)CD3。圖6
免疫組化顯示瘤細(xì)胞CD30陰性。圖7
免疫組化顯示瘤細(xì)胞表達(dá)PAX5。圖8
免疫組化顯示腫瘤細(xì)胞彌漫表達(dá)ALK，胞漿著色免疫組化結(jié)果
陽性：ALK，Pax5，EMA，CD138，CD79a（弱 ）陰性：CD20，CD3，CD30最終診斷
ALK陽性大B細(xì)胞淋巴瘤。討論
定義
ALK陽性大B細(xì)胞淋巴瘤漿母細(xì)胞性淋巴瘤：兩者腫瘤細(xì)胞形態(tài)一致，漿母細(xì)胞性淋巴瘤EBER原位雜交陽性，ALK和HHV8陰性。HHV8陽性彌漫大B細(xì)胞淋巴瘤：腫瘤細(xì)胞同時(shí)表達(dá)HHV8和EBER，ALK和MUM1/IRF4陰性。參考：
向上滑動(dòng)閱覽
1、Ioachim"s Lymph Node Pathology, 5th edition.
2、Delsol G, Lamant L, Mariamé B, et al. A new subtype of large B-cell lymphoma expressing the ALK kinase and lacking the 2; 5 translocation. Blood. 1997 Mar;89(5):1483-90.
3、Onciu M, Behm FG, Downing JR, et al. ALK-positive plasmablastic B-cell lymphoma with expression of the NPM-ALK fusion transcript: report of 2 cases. Blood. 2003 Oct;102(7):2642-4.
4、Stachurski D, Miron PM, Al-Homsi S, et al. Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma with a complex karyotype and cryptic 3" ALK gene insertion to chromosome 4 q22-24. Hum Pathol. 2007 Jun;38(6):940-5.
5、Laurent C, Do C, Gascoyne RD, et al. Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma: a rare clinicopathologic entity with poor prognosis. J Clin Oncol. 2009 Sep;27(25):4211-6.
6、Rossky PJ, Walker GC. Retrospective. Paul F. Barbara (1953-2010). Science. 2010 Nov;330(6008):1191.
7、Takeuchi K, Soda M, Togashi Y, et al. Identification of a novel fusion, SQSTM1-ALK, in ALK-positive large B-cell lymphoma. Haematologica. 2011 Mar;96(3):464-7.
8、Valera A, Colomo L, Martínez A, et al. ALK-positive large B-cell lymphomas express a terminal B-cell differentiation program and activated STAT3 but lack MYC rearrangements. Mod Pathol. 2013 Oct;26(10):1329-37.
作者
高宇慧住院醫(yī)師
陜西省西安市紅會(huì)醫(yī)院病理科
西臨床病理 住培醫(yī)師
審校
吳建鋒主治醫(yī)師
附屬西病理科
關(guān)鍵詞：
