TDT阴性T淋巴母细胞淋巴瘤一例及文献报道

A Case of Terminal Deoxynucleotidyl Transferase-Negative T-Lymphoblastic Lymphoma and Literature Review

摘要: 目的：报道一例TDT阴性T淋巴母细胞淋巴瘤。方法：采用HE染色、免疫组织化学和原位杂交EBER检测等方法回顾性分析陕西省人民医院确诊的1例TDT阴性T淋巴母细胞瘤患者，并复习相关文献。结果：患者女性，51岁，活检部位右侧胸膜，镜下粘膜内弥漫性淋巴样细胞浸润，细胞小至中等大，胞浆少，核圆形或卵圆形，核染色质细，核分裂象易见，组织挤压严重，纤维组织增生。免疫组织化学染色结果LCA，CD43，CD34，CD7阳性表达；CK，TDT，TTF-1，Syn，CgA，NSE，CD56，CD3，CD20，CD5，CD30，PAX-5、CD2，bcl-6，CD10，CD117，CD1α、ALK阴性表达；CD21未见FDC网，Ki67指数约60%。原位杂交EBER阴性。病理诊断：(胸膜)小块组织符合T淋巴母细胞淋巴瘤(TDT阴性)。结论：TDT阴性的T淋巴母细胞瘤罕见，诊断需要结合临床、形态、免疫表型等判断分析，避免误诊。

Abstract: Objective: To report a case of terminal deoxynucleotidyl transferase-negative T-lymphoblastic lymphoma. Methods: A case of terminal deoxynucleotidyl transferase-negative lymphoma diag-nosed in Shaanxi Provincial People’s Hospital was analyzed by HE staining, immunohistochemistry and EBER in situ hybridization, and reviewed related literature. Results: The female patient was 51 years old. The biopsy site is the right pleura. Under the microscope, there is diffuse lymphoid cell infiltration in the mucosa. The cells are small to medium large, the cytoplasm is few, the nucleus is round or oval, the nucleus chromatin is fine, the mitotic image is easy to see, the tissue is severely compressed, and the fibrous tissue is proliferative. Immunohistochemistry showed that these tumor cells were positive for LCA, CD43, CD34, CD7. Immunohistochemical staining negative expression includes CK, TDT, TTF-1, Syn, CgA, NSE, CD56, CD3, CD20, CD5, CD30, PAX-5, CD2, bcl-6, CD10, CD117, CD1α, ALK. CD21 showed no FDC network. Ki67 index was about 60%. EBER in situ hybridization was negative. Pathological diagnosis: (Pleural) small tissue conforms to T-lymphoblastic lymphoma (TDT negative). Conclusion: Terminal deoxynucleotidyl transferase- negative T-lymphoblastic lymphoma is rare, and the diagnosis should be combined with clinical, morphological, immunophenotypic and genetic analysis to avoid misdiagnosing as other lymphohematopoietic tumors.