病史介绍
(资料图片仅供参考)
临床表现
男，31岁，颈部淋巴结肿大。大体所见
右颈部淋巴结穿刺活检标本，灰白条索样组织3条，体积：0.6cm×0.3cm×0.1cm。镜下形态
图1
低倍镜下可见少许游离肿瘤片状分布。图2
高倍镜肿瘤细胞黏附性差，胞浆嗜碱性，细胞异型性明显，细胞核偏位，可见大核仁，可见较多凋亡。图3
高倍镜下瘤细胞弥漫分布，细胞黏附性差，胞浆嗜酸性、核偏位。图4
免疫组化显示瘤细胞不表达CD20。图5
免疫组化显示瘤细胞不表达CD3。图6
免疫组化显示瘤细胞CD30阴性。图7
免疫组化显示瘤细胞表达PAX5。图8
免疫组化显示肿瘤细胞弥漫表达ALK，胞浆着色免疫组化结果
阳性：ALK，Pax5，EMA，CD138，CD79a（弱 ）阴性：CD20，CD3，CD30最终诊断
ALK阳性大B细胞淋巴瘤。讨论
定义
ALK阳性大B细胞淋巴瘤浆母细胞性淋巴瘤：两者肿瘤细胞形态一致，浆母细胞性淋巴瘤EBER原位杂交阳性，ALK和HHV8阴性。HHV8阳性弥漫大B细胞淋巴瘤：肿瘤细胞同时表达HHV8和EBER，ALK和MUM1/IRF4阴性。参考：
向上滑动阅览
1、Ioachim"s Lymph Node Pathology, 5th edition.
2、Delsol G, Lamant L, Mariamé B, et al. A new subtype of large B-cell lymphoma expressing the ALK kinase and lacking the 2; 5 translocation. Blood. 1997 Mar;89(5):1483-90.
3、Onciu M, Behm FG, Downing JR, et al. ALK-positive plasmablastic B-cell lymphoma with expression of the NPM-ALK fusion transcript: report of 2 cases. Blood. 2003 Oct;102(7):2642-4.
4、Stachurski D, Miron PM, Al-Homsi S, et al. Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma with a complex karyotype and cryptic 3" ALK gene insertion to chromosome 4 q22-24. Hum Pathol. 2007 Jun;38(6):940-5.
5、Laurent C, Do C, Gascoyne RD, et al. Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma: a rare clinicopathologic entity with poor prognosis. J Clin Oncol. 2009 Sep;27(25):4211-6.
6、Rossky PJ, Walker GC. Retrospective. Paul F. Barbara (1953-2010). Science. 2010 Nov;330(6008):1191.
7、Takeuchi K, Soda M, Togashi Y, et al. Identification of a novel fusion, SQSTM1-ALK, in ALK-positive large B-cell lymphoma. Haematologica. 2011 Mar;96(3):464-7.
8、Valera A, Colomo L, Martínez A, et al. ALK-positive large B-cell lymphomas express a terminal B-cell differentiation program and activated STAT3 but lack MYC rearrangements. Mod Pathol. 2013 Oct;26(10):1329-37.
作者
高宇慧住院医师
陕西省西安市红会医院病理科
西临床病理 住培医师
审校
吴建锋主治医师
附属西病理科
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