I临床与实验病理学杂志JClinExpPathol2010Jun;26(3)·325·胃肠道原发性间变性大细胞淋巴瘤临床病理分析朱晓静,安晓静,马恒辉,吴波,石群立摘要:目的探讨胃肠道原发性间变性大细胞淋巴瘤(anaplasticlargecelllymphoma,ALCL)的病理形态、免疫表型特征及临床预后。方法对5例胃肠道原发ALCL进行形态观察,免疫组化标记及随访,并结合相关文献进行讨论。结果本组ALCL男女之比为1.5:1,平均年龄40.6岁。发生部位包括胃2例,胰、十二指肠1例,回盲部1例,结肠1例。所有病例均经外科手术切除,2例术后进行化疗。5例中有4例随访3至12个月,其中1例死亡,3例健在。ALCL形态表现多样,细胞呈多形性,大小不等,胞质丰富,细胞核大而不规则,呈扭曲、肾形、马蹄形及花环状,甚至见多核及巨核瘤细胞。免疫表型:5例ALCL均阳性表达CD30,部分表达EMA、CD3和CD45RO,而不表达CKpan、CD20、HMB45、CD68、CD15和CD117。结论ALCL是一种少见的非霍奇金淋巴瘤,发生在胃肠道罕见,有必要与霍奇金淋巴瘤、弥漫性大B细胞淋巴瘤、低分化腺癌、胃肠道上皮样间质瘤、恶性纤维组织细胞瘤等进行鉴别。关键词:胃肠道肿瘤;间变性大细胞淋巴瘤;免疫组织化学;鉴别诊断中图分类号:R735;R733.41文献标识码:A文章编号:1001—7399(2010)03—0325—04ClinicopathologicalanalysisofprimarygastrOintestinalanaplasticlargecelllymphomaZHUXiao-jing,ANXiao-jing,MAHeng—hui,wuBo,SHIQun—li(DepartmentofPathology,NanjingGeneralHospitalofNanjingMilitaryCommand,Nanjing210002,China)Abstract:PurposeToexplorethehistological,immunohistochemicalcharactersandprognosisofprimarygastrointestinalanaplasticlargecelllymphoma(ALCL).MethodsHistology,immunohistochemicalmarkersandfollow—upinformationoffiveprimarygastroin。testinalALCLcaseswereanalyzedandthecorrelatedliteraturewasreviewed.ResetsTheALCLoffivepatientshad1.5:1male/fe—maleratiowithanaverageageof40.6(range,22~62years).2caseswerelocatedinthestomach,1inpancreasandduodenum,1inileocecaljunction,1incolon.Allpatientsunderwentoperationandtwopatientsreceivedchemotherapyaftersu~ery.Fourpatientsweresubjectedtofollow.upof3to12months,onediedandthreesurvived.ALCLshoweddistinctivemorphologicalcharacters.Thetumorsweremainlycomposedoflargeandpleomorphiccellswithabundantcytoplasm.Thenucleiwerelargeandiregularwithshapeoftwist,horseshoedandwreathlike.Multiplenucleiorhugenucleiwereseensometimes.AllfivecasesexpressedCD30andpartlyex—pressedCD3,EMAandCD45RO.AllfivecaseswerenegativeforCKpan,CD20,HMB45,CD68,CD15andCD117.ConclusionsPrimarygastrointestinalALCLisextremelyrare.ItisnecessarytodifferentiateitfromothertypeoftumorssuchasthediffuselargeBcelllymphoma,Hodgkinlymphoma,poordifferentiatedcarcinomas,epithelioilgastrointestinalstromaltumorsandmalignantfibroushistiocytoma.Keywords:gastrointestinalneoplasms;anaplasticlargecelllymphoma;immunohistochemistry;differentialdiagnosis间变性大细胞淋巴瘤(anaplasticlargecelllym—phoma,ALCL)最初是由Stein和Colleagues于1985年提出,被认为是一类包括T细胞型和裸细胞型的非霍奇金淋巴瘤⋯,该肿瘤较为少见,主要发生在淋巴结内和结外的皮肤及皮下组织,发生在胃肠道的ALCL罕见,为了了解胃肠道原发ALCL的临床病理特点和预后,现将我院诊治的5例原发于胃肠道的ALCL病例报道如下。收稿时间:2009—09—15作者单位:南京军区南京总医院病理科,南京210002作者简介:朱晓静,女,硕士,进修医师,现在江苏省中西医结合医院工作石群立,男,主任医师,教授,硕士生导师。通讯作者。Tel:(025)80860192,E-mail:shiqunli2005@yahoo.tom.ca1材料与方法1.1临床资料收集我院自2000年至2009年诊治的5例胃肠道原发ALCL,其中男性3例,女性2例,男女性别比...