Monoclonality of lymphoproliferative lesions in cardiac-transplant recipients. Clonal analysis based on immunoglobulin-gene rearrangements.
Monoclonality of lymphoproliferative lesions in cardiac-transplant recipients. Clonal analysis based on immunoglobulin-gene rearrangements.
复制标题
心脏移植受者淋巴增殖性病变的单克隆性。
DOI：
10.1056/nejm198402233100801
复制
发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Sklar,J
中科院分区：
文献类型：
--
作者：
Cleary,ML;Warnke,R;Sklar,J
在器官移植免疫抑制受者中出现的淋巴增生性疾病本质上主要是肿瘤还是增生性是一个有争议的问题。这些病变中多克隆b细胞增殖的报道提示增生的存在，但这些疾病在组织学上类似淋巴瘤，临床上具有侵袭性，通常迅速致命，正如恶性肿瘤疾病所预期的那样。我们检查了10例发生在免疫抑制心脏移植受者的淋巴增生性疾病的组织标本。其中9例患者的标本缺乏细胞免疫球蛋白；然而，从这些组织中提取的DNA分析显示，每个病变都含有大量具有免疫球蛋白基因DNA均匀、克隆重排的细胞。因此，当首次临床观察到这些增生时，它们包含了一个显著的单克隆细胞群，这是传统b细胞淋巴瘤的典型特征，与免疫抑制无关。因此，我们认为心脏移植受者的淋巴增生性疾病在可检测疾病的早期阶段是肿瘤性的。（中华医学杂志1984；31:477 - 482）
Whether lymphoproliferative disorders arising in immunosuppressed recipients of organ transplants are primarily neoplastic or hyperplastic in nature is a matter of controversy. Reports of polyclonal B-cell proliferations in these lesions suggest the presence of hyperplasia, but these disorders resemble lymphoma histologically and are clinically aggressive and often rapidly fatal, as expected of a malignant neoplastic disease. We examined tissue specimens from 10 cases of lymphoproliferative disease that occurred in immunosuppressed recipients of cardiac transplants. Specimens from nine of these patients lacked cellular immunoglobulin; however, analysis of DNA extracted from these tissues revealed that each lesion contained large numbers of cells possessing uniform, clonal rearrangements of immunoglobulin-gene DNA. Therefore, when first seen clinically these proliferations contained a notable monoclonal-cell population typical of conventional B-cell lymphomas that are not associated with immunosuppression. We therefore suggest that lymphoproliferative disorders in recipients of cardiac transplants are neoplastic at the earliest stages of detectable disease. (N Engl J Med 1984;310:477–82.)