协和医学杂志

2012, v.3(03) 273-278

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原发中枢神经系统淋巴瘤的脑脊液细胞学诊断
Role of Cerebrospinal Fluid Cytology in Diagnosis of Primary Central Nervous System Lymphoma

关鸿志;陈琳;梁智勇;钟定荣;李剑;崔巍;钱敏;任海涛;凌庆;汪玄;赵燕环;郭玉璞;
GUAN Hong-zhi1,CHEN Lin1,LIANG Zhi-yong2,ZHONG Ding-rong2,LI Jian3,CUI Wei4,QIAN Min1,REN Hai-tao1,LING Qing2,WANG Xuan3,ZHAO Yan-huan1,GUO Yu-pu1 1Department of Neurology,2Department of Pathology,3Department of Hematology,4Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的研究脑脊液细胞学方法对原发中枢神经系统淋巴瘤(primary central nervous system lymphoma,PC-NSL)的诊断意义。方法回顾性分析21例脑脊液细胞学阳性的PCNSL患者的临床资料,PCNSL的诊断综合应用脑脊液细胞学、脑脊液免疫细胞化学、脑脊液淋巴细胞基因分析和流式细胞分析等方法。结果 21例患者临床-神经影像学分型包括脑脊膜型13例,实质型4例,室管膜(下)型3例,眼型1例。脑脊液细胞学检查21例均见淋巴瘤细胞或异型淋巴细胞。脑脊液免疫细胞化学检查17例呈B淋巴细胞优势,符合B淋巴细胞来源淋巴瘤,10例Ki67阳性细胞比例在40%~60%。7例流式细胞分析中5例以B细胞为主,B细胞比例66%~87%;1例以NK/T细胞为主。脑脊液淋巴细胞基因重排检测3例为IgH单克隆,1例为T细胞受体单克隆。最终6例行脑活检并确诊PCNSL。综合上述结果,21例确诊PCNSL,其中B细胞型19例,T细胞型2例。结论综合应用脑脊液细胞学、免疫细胞化学、细胞基因重排检测和流式细胞分析的脑脊液学方法,是诊断PCNSL的重要途径。
Objective To study the diagnostic value of cerebrospinal fluid(CSF) cytology in the diagnosis of primary central nervous system lymphoma(PCNSL).Methods We retrospectively analyzed the clinical data of 21 PCNSL patients with positive CSF cytological findings.Conventional CSF cytology,immunocytochemistry,flow cytometric immunophenotypic analysis(FCA),and PCR of the rearranged IgH and TCR genes of CSF were performed.Results The clinical and neuroimaging types of 21 patients included meningeal type(n=13),parenchymal type(n=4),ependymal type(n=3),and optic type(n=1).The CSF of all the 21 patients had a number of blast cells or atypical lymphocytes,suspected of lymphoma on conventional cytology.Of the 20 patients undergoing the immunocytochemical studies of the CSF,17 showed B-lymphocyte predominance,which was consistent with the diagnosis of B cell lymphoma.FCA of 7 cases showed a significant increase in the percentage of B cells in 5 patients,indicating B cell lymphoma,and NK/T-lymphocyte predominance in 1 case,indicating an NK/T lymphoma.On analysis of the IgH and TCR genes in the CSF of 4 patients,IgH monoclonal was found in 3 cases and TCR monoclonal in 1 case.Conclusion CSF cytology,immunocytochemistry,FCA,and PCR of the rearranged IgH and TCR genes of CSF are useful in the diagnosis of PCNSL.

关键词(KeyWords): 淋巴瘤;中枢神经系统;脑脊液;细胞学;免疫细胞化学
lymphoma;central nervous system;cerebrospinal fluid;cytology;immunocytochemistry

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基金项目(Foundation): 北京协和医院科研基金(2009160)

作者(Author): 关鸿志;陈琳;梁智勇;钟定荣;李剑;崔巍;钱敏;任海涛;凌庆;汪玄;赵燕环;郭玉璞;
GUAN Hong-zhi1,CHEN Lin1,LIANG Zhi-yong2,ZHONG Ding-rong2,LI Jian3,CUI Wei4,QIAN Min1,REN Hai-tao1,LING Qing2,WANG Xuan3,ZHAO Yan-huan1,GUO Yu-pu1 1Department of Neurology,2Department of Pathology,3Department of Hematology,4Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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