摘要目的 探讨用细胞病理方法诊断浆膜腔积液中的淋巴造血组织肿瘤的可行性和准确性,避免漏诊和误诊,评估用细胞块切片进行免疫细胞化学染色的作用.方法 收集通过组织活检证实的伴发浆膜腔积液的淋巴造血组织肿瘤33例,对其临床特点、细胞形态、免疫表型特征等进行分析,另外1例结外鼻型NK/T细胞淋巴瘤进行EBER原位杂交检测,3例T淋巴母细胞白血病/淋巴瘤、2例弥漫性大B细胞淋巴瘤(DLBCL)和2例伯基特淋巴瘤进行了基因重排分析.结果 累及浆膜腔的33例淋巴造血组织肿瘤包括T淋巴母细胞白血病/淋巴瘤12例;成熟B细胞肿瘤16例,其中DLBCL 9例,伯基特淋巴瘤2例,浆细胞骨髓瘤2例,慢性淋巴细胞白血病/小B细胞淋巴瘤2例,套细胞淋巴瘤1例;成熟T细胞和NK细胞肿瘤3例,其中血管免疫母细胞性T细胞淋巴瘤、结外鼻型NK/T细胞淋巴瘤、T细胞幼淋巴细胞性白血病各1例;粒细胞肉瘤和肥大细胞肉瘤各1例.8例DLBCL、2例浆细胞骨髓瘤、慢性淋巴细胞白血病/小B细胞淋巴瘤、1例套细胞淋巴瘤、T淋巴母细胞白血病/淋巴瘤、血管免疫母细胞性T细胞淋巴瘤、肥大细胞肉瘤共16例为复发病例,其余17例均以浆膜腔积液为首发表现并由细胞病理初诊.所有病例细胞病理学诊断均与组织病理学诊断结果相符.结论 结合临床特点、细胞形态、免疫表型、原位杂交和基因重排等检测,用细胞病理方法可以对浆膜腔积液中的淋巴造血组织肿瘤,特别是复发病例进行明确诊断和鉴别诊断.

abstractsObjective To study the diagnostic accuracy of hematolymphoid malignancy by using effusion fluid cytology specimens and to evaluate the values of immunocytochemistry for this assay. Methods The cytospin preparations/smears and cell block sections of effusion cytology specimens from 33 cases of hematolymphoid malignancy were retrospectively reviewed. Immunocytochemical study was performed. In selected cases, in-situ hybridization for Epstein-Barr virus-encoded RNA and immunoglobulin and T-cell receptor geue rearrangement study were carried out as indicated. Results There were 33 cases of hematolymphoid malignancy, including 12 cases of T-lymphoblastic leukemia/lymphoma, 16 cases of mature B cell neoplasm ( including 9 cases of diffuse large B-cell lymphoma, 2 cases of Burkitt lymphoma, 2 cases of plasmacytoma/muhiple myeloma, 2 cases of B-small lymphocytic leukemia/lymphoma and 1 case of mantle cell lymphoma), 3 cases of mature T or NK-cell neoplasm ( including 1 case of extranedal nasal NK/T-cell lymphoma, 1 case of angioimmunoblastic T-cell lymphoma and 1 case of T-cell prolymphocytic leukemia), 1 case of myeloid sarcoma and 1 case of mast cell sarcoma. Amongst the 33 cases studied, 16 represented disease relapses, including 8 cases of diffuse large B-cell lymphoma, 2 cases of plasmacytoma/ multiple myeloma, 2 cases of B-small lymphocytic leukemia/lymphoma, 1 case of T-lymphoblastic leukemia/lymphoma, 1 case of angioimmunoblastic T-cell lymphoma, 1 case of mantle cell lymphoma and 1 case of mast cell sarcoma. The remaining 17 cases showed serous effusion as the primary manifestation, with the diagnosis primarily made upon cytologic examination. The cytologic findings seen in all the 33 cases studied were in agreement with the corresponding histologic diagnosis. Conclusions Diagnosis of hematolymphoid malignancy by effusion fluid cytology specimens is possible, especially when coupled with the clinical history, immunophenotype, in-aitu hybridization and gene rearrangement study findings. This is especially so for cases with disease relapses.