Cytological tumour cell characteristics and reactive small lymphocytes influence patient prognosis in acute and lymphoma type adult T-cell leukaemia/ lymphoma,
Cytological tumour cell characteristics and reactive small lymphocytes influence patient prognosis in acute and lymphoma type adult T-cell leukaemia/ lymphoma,
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细胞学肿瘤细胞特征和反应性小淋巴细胞影响急性和淋巴瘤型成人 T 细胞白血病/淋巴瘤的患者预后，
作者：
Kobata K;Mihashi Y;Nonaka S;et al.
急性和淋巴瘤型成人T细胞白血病/淋巴瘤（ATLL）患者表现出侵袭性临床病程。虽然一些临床症状表明预后良好，明确的细胞组织学预后因素尚未被描述。MethodsWe分类65 ATLL患者分为三组，肿瘤细胞大小和核多形性细针穿刺和肿瘤触摸涂片样本。对背景小淋巴细胞、反应性CD 20阳性B细胞和CD 8阳性T细胞进行了半定量分析。结果31例患者患有以中等大小细胞和粗颗粒细胞核为主的多形淋巴瘤。另24例为多形性大细胞淋巴瘤，染色质呈斑点状。其余10例表现为单形大淋巴瘤细胞，染色质呈细颗粒状。中等细胞型多形性淋巴瘤患者血清乳酸脱氢酶水平显著高于其他两组，淋巴瘤细胞CD 30和C-MYC表达显著低于其他两组（P= 0.0216，P < 0.01）。多形性中等大小ATLL患者在常规形态学检查中观察到很少常见的小淋巴细胞，同时检测到的CD 20阳性B细胞和CD 8阳性T细胞较少，均低于其他两组（分别为P =.006，P =.019）。此外，以中等大小淋巴细胞为主的ATLL患者的预后比多形性大细胞患者更差（P = 0.0197）。背景小淋巴细胞和同时检测CD 20阳性B细胞和CD 8阳性T细胞可能是良好的预后因素（P = 0.011，P = 0.021，respectively）.ConclusionsMorphological features，肿瘤细胞的大小和背景非肿瘤淋巴细胞（B细胞和CD 8阳性T细胞）的体积似乎影响侵袭型ATLL患者的预后。
ObjectiveAcute and lymphoma type adult T‐cell leukaemia/lymphoma (ATLL) patients show an aggressive clinical course. While some clinical signs indicate good prognosis, definitive cytohistological prognostic factors have yet to be described.MethodsWe classified 65 ATLL patients into three groups by tumour cell size and nuclear pleomorphism on fine‐needle aspiration and tumour touch smear samples. Semi‐quantitative analysis of background small lymphocytes, reactive CD20‐positive B cells and CD8‐positive T cells was performed.ResultsThirty‐one patients had pleomorphic lymphoma with predominantly medium‐sized cells and coarse granular nuclei. Another 24 patients showed pleomorphic large cell lymphoma with stippled chromatin. The remaining 10 demonstrated monomorphic large lymphoma cells with fine granular chromatin. Patients with pleomorphic lymphoma with medium‐sized cells showed significantly higher serum lactate dehydrogenase and lower CD30 and C‐MYC expression in lymphoma cells than the other two groups (P= .0216,P< 0.01, respectively). Patients with pleomorphic medium‐sized ATLL had few usual small lymphocytes observed on routine morphological examination and showed less concurrent detection of CD20‐positive B cells and CD8‐positive T cells, both of which were lower than in the other two groups (P =.006,P =.019, respectively). Furthermore, ATLL patients with predominantly medium‐sized lymphocytes exhibited a worse prognosis than patients with pleomorphic large cells (P =.0197). Background small lymphocytes and concurrent detection of CD20‐positive B cells and CD8‐positive T cells may thus be good prognostic factors (P =.011,P =.021, respectively).ConclusionsMorphological features, size of neoplastic cells and background non‐neoplastic lymphocyte (B cells and CD8‐positive T cells) volume appear to influence the prognosis of patients with aggressive‐type ATLL.