Malignant lymphoma, well differentiated lymphocytic. Its relationship with chronic lymphocytic leukemia and macroglobulinemia of Waldenström
Malignant lymphoma, well differentiated lymphocytic. Its relationship with chronic lymphocytic leukemia and macroglobulinemia of Waldenström
复制标题
恶性淋巴瘤，高分化淋巴细胞与慢性淋巴细胞白血病和华氏巨球蛋白血症的关系。
作者：
G. Pangalis;B. Nathwani;H. Rappaport
对108例原发于淋巴结的高分化淋巴细胞型恶性淋巴瘤进行临床病理分析。活组织切片显示，在41名患者中，绝对淋巴细胞增多症和单克隆丙种球蛋白病均不明显（组I）。20例患者存在单克隆血清免疫球蛋白，其中18例无绝对红细胞增多症（组II）。其余47例患者有绝对淋巴细胞增多症（高于4，000/mm 3），无单克隆丙种球蛋白病（III组）。在41名I组患者中，11名在1.n时没有骨髓受累。在24至150个月的随访期内，35名患者从未发生淋巴细胞增多症。我们的观察表明，高分化淋巴细胞型（WDL）恶性淋巴瘤可能是慢性淋巴细胞白血病（CLL）的组织表现，但也可能作为非霍奇金淋巴瘤的一种独特形式存在。在20例单克隆丙种球蛋白病患者（第II组）中，90%的组织切片中有浆细胞样淋巴细胞和/或浆细胞。然而，这些细胞也存在于9.7%的WDL患者（I组）和7%的CLL患者（III组）中，而没有明显的单克隆丙种球蛋白病。我们的研究结果表明，虽然WDL，CLL和分化良好的淋巴组织增生性疾病与单克隆丙种球蛋白病的组织学相似，其临床和血液学表现的差异足以证明他们的分离成三个不同的实体。同时，它们可以很好地代表相同基本过程的不同血液病理学表达，即通常为B-细胞类型的小淋巴细胞增殖。
A clinicopathologic analysis of 108 patients originally diagnosed as malignant lymphoma, well differentiated lymphocytic type on the basis of lymph node (l.n.) biopsy sections showed that in 41 patients neither absolute lymphocytosis nor monoclonal gammopathy was evident (Group I). A monoclonal serum immunoglobulin was present in 20 patients, 18 of whom had no absolute lympocytosis (Group II). The remaining 47 patients had absolute lymphocytosis (above 4,000/mm3) and no monoclonal gammopathy (Group III). Of the 41 Group I patients, 11 had no bone marrow involvement at the time of 1.n. biopsy and 35 never developed lymphocytosis over follow‐up periods ranging from 24 to 150 months. Our observations indicate that malignant lymphoma of the well differentiated lymphocytic type (WDL) may be a tissue manifestation of chronic lymphocytic leukemia (CLL) but may also exist as a distinct form of non‐Hodgkin's lymphoma. Of the 20 patients with monoclonal gammopathy (Group II) 90% had plasmacytoid lymphocytes and/or plasma cells in tissue sections. However, these cells were also present in 9.7% of patients with WDL (Group I) and in 7% of patients with CLL (Group III) without demonstrable monoclonal gammopathy. Our findings suggest that although WDL, CLL and well differentiated lymphoproliferative diseases with monoclonal gammopathy are histologically similar, their clinical and hematological presentations differ sufficiently to justify their separation into three distinct entities. At the same time they could well represent different hematopathologic expressions of the same basic process, namely a proliferation of small lymphocytes usually of the B‐cell type.