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目的探讨原发性纵隔(胸腺)大B细胞性淋巴瘤(PMBL)的临床病理特点、诊断与鉴别诊断及预后。方法回顾性分析3例PMBL的临床病理和免疫表型特点,并复习相关文献。结果 3例PMBL中男性2例,女性1例。其中2例临床主要表现为纵隔肿块,其中1例有颈部淋巴结转移,另1例表现为胸骨肿块。光镜下可见大量异型淋巴细胞弥漫浸润,伴不同程度的硬化性纤维性间质背景,瘤细胞被硬化的胶原纤维束分割;瘤细胞中等偏大,胞质丰富透亮,胞核圆形或椭圆形,其中可见少量呈分叶状异型核的大细胞。免疫组化:肿瘤细胞CD20和CD79a均(+),CD3和CD5均(-)。其中2例CD30(+),1例CD23(+);Ki-67阳性指数>70%。结论 PMBL是一种少见的非霍奇金淋巴瘤,形态学表现多种多样,光镜下易误诊,诊断需依靠组织病理学特点结合相关免疫组化标记。
Objective To investigate the clinicopathological features, diagnosis, differential diagnosis and prognosis of primary mediastinal (thymus) large B cell lymphoma (PMBL). Methods The clinicopathological and immunophenotypic features of 3 cases of PMBL were retrospectively reviewed and the related literatures were reviewed. Results There were 2 males and 1 females in 3 cases of PMBL. Two cases of clinical manifestations of mediastinal masses, including 1 case of cervical lymph node metastasis, the other showed a sternal mass. A large number of diffuse infiltration of atypical lymphocytes was seen under the light microscope, with varying degrees of sclerosing fibrosis interstitial fibroblasts, tumor cells were sclerosis collagen fiber bundle segmentation; tumor cells are too large, abundant cytoplasm translucent, nucleus round or oval Shaped, showing a small number of lobular shaped nuclear macrophages. Immunohistochemistry: CD20 and CD79a tumor cells (+), CD3 and CD5 were (-). Two cases of CD30 (+), one case of CD23 (+); Ki-67 positive index> 70%. Conclusion PMBL is a rare non-Hodgkin’s lymphoma. Morphological manifestations are diverse and easily misdiagnosed under light microscopy. Diagnosis should be based on histopathological features and associated immunohistochemical markers.