系统性种痘水疱病样皮肤T细胞淋巴瘤1例及文献复习

目的:通过分析系统性种痘水疱病样淋巴瘤病例1例,结合文献回顾,分析其临床特点、诊断治疗进展及预后,以提高临床医生对该病的认识。方法:报道1例有7年种痘水疱病史并转化为系统性T细胞淋巴瘤病例,通过皮肤活检、病理及免疫组化、TCR基因重排、实验室、MRI及影像学检查,确定诊断及治疗方案,并观察预后。后进行文献回顾。结果:本例患者的主要临床表现为多年的面部红斑、丘疱疹及水疱改变,最初诊断为"种痘水疱病",初期治疗有效,病情反复并进展,皮肤改变加重,病变逐渐累及鼻中隔及下鼻甲,出现坏死及缺损,同时伴有发热及淋巴结肿大等系统症状。皮肤病理及免疫组化提示真皮弥漫性淋巴细胞、浆细胞浸润,CD3+,CD4+,CD8散在细胞+,CD30局部细胞+,CD56局部细胞+,EBER杂交(+),Ki-67增殖指数为60%。TCR基因克隆性重排。经干扰素及激素治疗初期病情控制尚可,持续约7年时间,后病情进行性加重,表现系统性种痘水疱病样皮肤T细胞淋巴瘤症状,给予MESA方案化疗1次。化疗后病情稳定,鼻部症状明显改善。后病情进展,患者出现神经系统症状并死亡。结论:种痘水疱病样淋巴瘤早期临床表现易与种痘样水疱病相混淆,但根据其病变部位病理活检及免疫组化分析可得到确诊,早期单纯皮肤病变期可持续数年,部分对激素及干扰素治疗有效。当发展为系统性种痘水疱病样淋巴瘤期时,病情进展迅速,常可累及中枢神经系统,对于化疗反应差,预后不佳,死亡率极高。化疗对于该病的有效性有待进一步观察。     

嵌合抗原受体T细胞免疫疗法治疗B细胞淋巴瘤的研究进展

B细胞淋巴瘤(B cell lymphoma)因其异质性,患者极易复发,因此成为肿瘤治疗的难题之一。嵌合抗原受体T细胞(chimeric antigen receptor T-cell, CAR-T)免疫疗法有良好的治疗效果且具精准、快速和高效的特点,成为最具前景的治疗癌症的方法之一。目前,CAR-T免疫疗法在治疗B细胞淋巴瘤上得以成功的应用,同时,FDA已批准相关产品应用于治疗B细胞淋巴瘤,一定程度上弥补了常规治疗B细胞淋巴瘤的方法。现就CAR-T免疫疗法的发展历程、主要靶点及其策略研究作一概述,为治疗B细胞淋巴瘤提供可参考的思路。     

EB病毒诱导胸腺恶性T细胞淋巴瘤的研究

为研究EB病毒在恶性T细胞淋巴瘤发生中的作用,将EB病毒感染的人胚胸腺细胞移植于Scid鼠皮下,于移植后第3日起在移植处对侧皮下注射TPA50ng／只,每周1次。于移植后第4周起,移植处皮下有结节状隆起形成,并逐渐增大。于6－15周内行病理学检查和免疫组织化学染色,证实为T细胞淋巴瘤8例。其中实验组胸腺细胞＋EBV的成瘤率为25％（1／4）,胸腺细胞＋EBV＋TPA组的成瘤率为53.8%（7／13）,对照组胸腺细胞＋TPA的成瘤率为0（0／5）。PCR和 闰杂交在诱导肿瘤可可检测到EB病毒的基因EBERs、LMP1和BARF1,并有病毒基因LMP1蛋白编码产物的表达。EB病毒可感染人胚胸腺细胞,并使其发生恶性转化,EB病毒可能在恶性T细胞淋巴瘤的发生中起病因作用。     

淋巴细胞发育相关基因在鼻腔NK/T细胞淋巴瘤中表达的研究

探索鼻腔NK/T细胞淋巴瘤(N-NK/T-L)中淋巴细胞发育相关基因的表达及意义。方法:通过对EOMEs,ETS-1和MEF基因进行克隆、探针制备和组织芯片制备,对25例N-NK/T-L以及同部位11例B细胞淋巴瘤(BCL)、6例T细胞淋巴瘤(TCL)、3例正常脾组织和5例慢性炎性鼻黏膜组织进行了原位杂交检测。结果:EOMES、ETS-1、MEF基因在N-NL/T-L、BCL、TCL、脾和鼻粘膜中均有表达,但阳性率和表达强度不同。EOMES基因在N-NK/T-L的表达强度与BCL和TCL间有差异,MEF基因在N-NK/T-L的表达阳性率和强度与TCL间有差异,而ETS-1基因在N-NK/T-L与对照组间的表达无差异。T-bet、EOMES和MEF基因在N-NK/T-L的表达具有相关性。结论EOMES和MEF基因在N-NK/T-L中高表达,可能在该肿瘤发生和组织坏死中起重要作用,而ETS-1因在N-NK/T-L和对照组中普遍表达,提示其可能在淋巴造血系统的发育和功能中起基础性的共同通路。     

细胞芯片诊断胸腔液中淋巴瘤细胞的初步评价

目的探讨细胞芯片诊断胸腔液中淋巴瘤细胞的应用价值。方法应用一种目前国内外尚未见报道的细胞芯片,对33例胸腔液中淋巴瘤细胞和对照组-4例胸腔液中小细胞型癌细胞进行了免疫杂交。结果阳性杂交点细胞呈圆形分布,界限清楚,细胞形态显示良好;B-NHLC占72．7％(24／33),T-NHLC占18．2％(6／33)。CD79a对B-NHLC捕获阳性率达100％,CD3对T-NHLC捕获阳性率为75％,两均未见交叉反应。结论细胞芯片对胸腔液中淋巴瘤细胞的诊断和鉴别诊断具有重要的临床应用价值。     

脂筏与T细胞信号转导

抗原提呈细胞将抗原加工处理后通过MHCⅠ/MHCⅡ类分子提呈供T细胞识别。TCR对抗原的识别引起一系列下游信号事件的发生,最终使T细胞激活,但对TCR复合物结合抗原后引起胞内区磷酸化的早期事件机制还不是很清楚。最近的研究揭示脂筏参与了这一早期信号事件的发生。脂筏是一种膜脂双层内含有的特殊微区,T细胞膜表面参与T细胞激活的各种关键信号分子都定位于脂筏。T细胞激活过程中脂筏通过聚集和重分配形成一个信号转导的平台。     

EPOCH-L方案治疗复发难治性T细胞淋巴瘤的临床研究

目的:探讨EPOCH-L方案治疗复发难治性T细胞淋巴瘤的疗效及安全性。方法:回顾性分析解放军某医院2012年1月至2017年1月收治的12例复发难治性T细胞淋巴瘤患者的临床资料,均采用EPOCH-L方案化疗(依托泊苷50 mg/m2第1～4天、吡柔比星10 mg/m2第1～4天、长春地辛1 mg/d第1～4天、环磷酰胺750 mg/m2第5天、泼尼龙60 mg/m2第1～5天、培门冬酶2500 iu/m2第6天)3～6个周期,并随机选取同期进行异基因造血干细胞移植治疗的12例复发难治性T细胞淋巴瘤患者为对照组,比较两组的临床疗效及不良反应的发生情况。结果:随访至2018年1月,EPOCH-L方案组患者取得完全缓解4例(33.3%),部分缓解4例(33.3%),总有效率为66.7%,中位生存期为23.7(7～65)个月,随访期间总生存率为25%;对照组患者中位生存期为9.2(3～60)个月,无病生存率为41.7%,总体生存时间分布差异无统计学意义(P=0.683)。实验组没有患者死于化疗合并症(0.0%),对照组4例死于移植合并症(33.3%),差异有统计学意义(P=0.028)。结论:EPOCH-L方案治疗复发难治性T细胞淋巴瘤的临床效果与异基因造血干细胞移植治疗相当,且安全性较高。     

肛周坏死性筋膜炎抗感染治疗12例报告

目的探讨坏死性筋膜炎诊断及有效治疗方法。方法回顾性分析总结12例坏死性筋膜炎的临床表现及治疗过程（包括彻底扩创引流,全身抗感染治疗及营养支持治疗）。结果12例患者痊愈。结论早期明确诊断,尽早切开引流,抗感染及营养支持的方法,是治疗坏死性筋膜炎的有效方法。     

天然调节T 细胞与诱导调节T 细胞的生物学特性

CD4+CD25+FOXP3+的调节T细胞(regulatory T cells,Treg)在维持机体免疫平衡方面起着重要的作用。体外扩增Treg细胞用于治疗自身免疫病、哮喘及诱导器官移植免疫耐受引起人们极大的兴趣。Treg细胞可分为2个亚群,分别为nTreg和iTreg,两者有不同的生物学特性。nTreg在特定条件下,可以分泌具有促进炎症的IL-17;iTreg在体内可丢失FOXP3,失去其免疫抑制功能。Treg细胞用于临床治疗,还有许多问题需要研究解决。     

Cytotoxic peripheral T cell lymphoma arising in a patient with nodular lymphocyte predominant Hodgkin lymphoma: a case report

In this paper, we describe a case of nodular lymphocyte predominant Hodgkin lymphoma with the subsequent development of a peripheral T cell lymphoma. This case is unusual in that the sheets of atypical and small to intermediate-sized T cells in the diffuse component were CD8 positive and expressed cytotoxic proteins. The diagnosis of peripheral T cell lymphoma was supported by the demonstration of a clonal T cell receptor beta chain gene rearrangement by Southern blot analysis. Peripheral T cell lymphoma with a cytotoxic phenotype is a rare entity with an aggressive clinical behavior. As such, this report emphasizes the need to consider a diagnosis of coexisting peripheral T cell lymphoma in cases of nodular lymphocyte predominant Hodgkin lymphoma with atypical features, such as few or poorly defined B cell macronodules and diffuse T cell areas. The examination of both T cell receptor gamma and beta chain gene rearrangements should be performed to confirm such cases.     

T-cell therapies for T-cell lymphoma

T-cell lymphomas represent a subpopulation of non-Hodgkin lymphomas with poor outcomes when treated with conventional chemotherapy. A variety of novel agents have been introduced as new treatment strategies either as first-line treatment or in conjunction with chemotherapy. Immunotherapy has been demonstrated to be a promising area for new therapeutics, including monoclonal antibodies and adoptive cellular therapeutics. T-cell therapeutics have been shown to have significant success in the treatment of B-cell malignancies and are rapidly expanding as potential treatment options for other cancers including T-cell lymphomas. Although treating T-cell lymphomas with T-cell therapeutics has unique challenges, multiple targets are currently being studied both preclinically and in clinical trials.     

NK cell lymphoma, nasal type, with massive lung involvement: a case report

Extranodal NK/T cell lymphoma, nasal type, is an Epstein–Barr virus-associated lymphoma that most commonly involves the nasal cavity and upper respiratory tract. Lung involvement by NK/T cell lymphoma is rare and seldom reported in the literature. We describe the unusual case of a 41-year-old male with NK cell lymphoma, nasal type, who presented with massive secondary lung involvement 2.5 years after the detection of a retroperitoneal mass. The diagnosis was made by open lung biopsy. Despite aggressive treatment, the patient died shortly after the initiation of therapy. Lung involvement by NK/T cell lymphoma occurs most commonly as part of widely disseminated disease and carries a poor prognosis for the patient. Novel agents and innovative therapies need to be developed for this aggressive lymphoma.     

Cytologic diagnosis of peripheral T-cell lymphoma manifesting as ascites. A case report

BACKGROUND: Patients with malignant lymphoma seldom present with effusions without a known history of malignancy. Because of this, initial diagnosis of malignant lymphoma by effusion cytology is uncommon, with few reported cases. CASE: A 75-year-old male presented with fatigue, decreased appetite and progressively increasing abdominal girth over five weeks. Cytologic examination of ascitic fluid obtained by paracentesis revealed non-Hodgkin's lymphoma with a T-cell phenotype, confirmed by immunophenotypic and molecular studies. Approximately one week later, histologic examination of liver and bone marrow revealed involvement by lymphoma, demonstrating immunophenotypic and molecular profiles identical to those obtained from neoplastic lymphocytes recovered from the ascites fluid. CONCLUSION: This case demonstrates a rare presentation of peripheral T-cell lymphoma, clinically manifesting as ascites. In cases such as ours, where the effusion consists predominantly of small to intermediate-sized lymphocytes, distinguishing lymphoma from reactive lymphocytosis may be difficult. This case not only demonstrates the value of effusion cytology for lymphoma diagnosis but also illustrates how the use of various immunophenotypic and molecular techniques may assist the pathologist in properly diagnosing these difficult cases.     

Impairment of T-cell functions with the progressive ascitic growth of a transplantable T-cell lymphoma of spontaneous origin

It has been observed that the progressive ascitic growth of a transplantable T-cell lymphoma of spontaneous origin, designated Dalton's lymphoma (DL), in a murine host induces inhibition of various immune responses and is associated with an involution of thymus accompanied by a massive depletion of the cortical region and alteration in the distribution of thymocytes caused by tumour serum-dependent induction of apoptosis with a decrease of CD4(+)CD8(+), CD4(+)CD8(-) and CD4(-)CD8(+) thymocytes. Here, we report that thymocytes of DL-bearing mice are defective in their proliferative ability and in their response to non-specific mitogenic stimulus in vitro. Also, antigen-specific T-cell proliferative ability representing the fundamental T(H) function declines under DL-bearing conditions and upon treatment with serum of DL-bearing mice. Moreover, a significant inhibition of T-cell cytolytic activity with a decreased ability to produce interferon gamma is shown by the T cells of DL-bearing mice and by the T cells treated with DL-ascitic fluid, DL-conditioned medium or serum of DL-bearing mice. Further, addition of interleukin-2 and anti-interleukin-10 to the cultures of thymocytes treated with serum of DL-bearing mice is found to inhibit the induction of apoptosis in thymocytes, a phenomenon associated with the progression of DL growth. Analysis of the results indicates an immune deviation with the predominance of a T(H2)-type response with the progression of tumour. We further discuss the possible mechanisms that may explain the observed tumour-induced diminution of T-cell immunity.     

Primary malignant lymphoma of the uterine cervix: report of a case with cytologic and immunohistochemical diagnosis

A non‐Hodgkin's lymphoma initially diagnosed on the cervical smear in a 69‐year‐old asymptomatic female is described. The cytologic findings strongly suggested the presence of a malignant lymphoid neoplasm: neoplastic cells were round, loosely arranged, with scanty cytoplasm and cleaved nuclei. Histological evaluation of the cervical biopsy revealed a diffuse lymphoid proliferation of mononucleated cleaved cells beneath an ulcerated epithelium. Immunohistochemically, the tumour cells were positive for B cell markers. Reports on cytologic features of primary malignant lymphoma of the cervix are not frequent in the literature. We emphasize the importance of their recognition and the differential diagnosis of cervical lymphoma from other neoplastic and non‐neoplastic lesions.     

Serous effusion cytology of extranodal natural killer/T-cell lymphoma

X.‐Y. Su, J. Huang, Y. Jiang, Y. Tang, G.‐D. Li and W.‐P. Liu Serous effusion cytology of extranodal natural killer/T‐cell lymphoma Objective: Extranodal natural killer/T‐cell lymphoma, nasal type (ENKTCL‐N), is a rare form of lymphoma that typically occurs at extranodal sites. It is one of the most common extranodal lymphomas in China. Literature on effusions and cytological findings relating to ENKTCL‐N is limited. We studied five consecutive cases of ENKTCL‐N effusions collected over a 3‐year period. The cytomorphological, immunocytochemical and molecular biological features were evaluated with literature review. The purpose of this study is to discuss how to diagnose ENKTCL‐N cytologically in effusions. Methods: Smears and cell block sections were reviewed for each case. Immunocytochemistry was performed on 4‐μm paraffin sections. Antibodies used were as follows: cCD3 (intracytoplasmic CD3), CD45RO, surface CD3, CD20, CD79a, CD56, TIA‐1, granzyme B, CD30, CD99, TdT and Ki‐67. In situ hybridization for EBER1/2 (EBER‐ISH) and T‐cell receptor γ (TCRγ) gene rearrangement were performed for all cases. Results: Large to medium‐sized tumour cells with pleomorphic nuclei and coarse chromatin were found in a necrotic background in all cases. The cytoplasm of the tumour cells was scant to moderately abundant with occasional cytoplasmic projections; in Giemsa‐stained smears, fine granules were present in some tumour cells. Mitotic figures were frequent. The tumour cells were all positive for CD56, granzyme B, TIA‐1 and cCD3, and were negative for surface CD3, CD20 or CD79a, CD99 and TdT. The MIB index was 50–80%. Epstein‐Barr virus‐encoded RNA (EBER) hybridizing signals were detected for most neoplastic cells. The T‐cell receptor gamma gene rearrangement analysis showed germ‐line configuration, except for one case. Conclusions: Effusion cytology may be appropriate for establishing the diagnosis of ENKTCL‐N, particularly for patients in whom tissue biopsy is not possible.     

Fatal primary diffuse large B‐cell lymphoma of the maxillary sinus initially treated as an infectious disease in an elderly patient: A clinicopathologic report

Objective

To report a case of primary diffuse large B‐cell lymphoma (DLBCL) of the maxillary sinus in an 82‐year‐old Caucasian woman.

Background

Diffuse large B‐cell lymphoma of the maxillary sinus has non‐specific signs and symptoms that may be confused with benign inflammatory conditions and upper respiratory infections.

Methods

An incisional biopsy was performed. CD20⁺/CD3^–/Ki‐67: 95% cells were observed.

Conclusion

A good medical history, clinical and imaging evaluations and immunohistochemical reactions are crucial to establish a correct and early diagnosis of DLBCL.