浅谈免疫组化标记结果的解读与淋巴瘤的诊断

目的 提高对正确解读免疫组化结果的重要性的认识.方法 对3例淋巴瘤误诊病例进行复习,并增加相关抗体标记予以鉴别诊断.结果 例1,滤泡性淋巴瘤(FL)误诊为淋巴结淋巴组织反应性增生,与形态学观察忽略肿瘤性滤泡及对免疫表型Bc12表达的认识不足有关.例2,经典型富于淋巴细胞型霍奇金淋巴瘤(LRCHL).①误诊为FL,与形态学观察遗漏R-S细胞,以及误判免疫组化标记Bcl2、CD20有关,即将Bcl2、CD20阳性的非肿瘤细胞,误判为肿瘤细胞.②误诊为结节性淋巴细胞为主型霍奇金淋巴瘤(NLPHL)与免疫组化标记的错误解读有关,把围绕瘤细胞的背景小淋巴细胞CD20阳性,误判为R-S细胞CD20阳性；将CD30阳性的R-S细胞,误判为活化性B淋巴细胞.例3,AML误诊为T-LBL.主要是对瘤细胞表达非特异性抗体TDT、CD7、CD43的意义认识不足有关.结论 淋巴瘤的诊断是建立在形态学、免疫组化标记、临床资料和遗传学之上的,而且,免疫组化标记结果的正确解读对淋巴瘤的诊断至关重要.

Interpreting the results of immunohistochemical staining and diagnosing lymphoma

Objective To improve the analysis of the results of immunohistochemical staining. Methods Wereviewed 3 misdiagnosed cases, exploring the causes of misdiagnosis by reviewing their histopathology and immunohistochemistry. Results In case1, Follicular lymphoma（FL） was misdiagnosed as reactive lymphoid hyperplasia because of overlooking neoplastic follicles and immunophenotyping Bcl 2. case2, LRCHL was initially misdiagnosed as FL , because of overlooking R-S cells and wrongly determining Bcl 2 and CD20-positive cells as tumor cells; it was also misdiagnosed as NLPHL because the CD20-negative R- S cells were misjudged as positive, case3, AML tumor cells expressed TdT, CD7 and CD43 unspecifically, So it was misdiagnosed as T-LBL. Conclusion The diagnosis of lymphoma should be based on morphology, immunohistochemistry,clinical, and genetics. Moreover, the correct interpretation of immunohistochemieal staining is essential to making correct diagnosis, which is shown in our study.