Characteristics and clinical implications of reactive germinal centers in the bone marrow
Characteristics and clinical implications of reactive germinal centers in the bone marrow
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DOI：
10.1016/j.humpath.2017.03.024
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发表时间：
2017-10-01
期刊：
影响因子：
3.3
通讯作者：
Loghavi, Sanam
中科院分区：
文献类型：
--
作者：
Agbay, Rose Lou Marie C.;Medeiros, L. Jeffrey;Loghavi, Sanam
骨髓（BM）中的反应性生发中心（GC）已在自身免疫性疾病、感染、恶性肿瘤和某些药物治疗后的患者中描述，或作为无明显基础疾病的孤立发现。在这项研究中，我们描述了反应性GC发生在BM样本中的临床条件，以及它们的地形图和伴随的实验室和辅助结果，在癌症中心的设置。我们确定了32个BM标本与反应性GC的估计频率小于0.02%，在12年的时间。15例（46.9%）BM标本有并发血淋巴样肿瘤：最常见的是各种小B细胞淋巴瘤，但也有骨髓增生异常综合征。转移性黑色素瘤1例（3.1%）。在16例（50%）患者中观察到孤立的反应性GC。大多数BM标本（n = 25; 78.1%）仅显示一个反应性GC，大小范围为20 - 500，大多数GC（29/32）为非小梁旁型。GC对CD 10和BCL 6呈阳性，对BCL 2呈阴性。CD 3和CD 5显示T细胞围绕GC和CD 21，CD 23突出滤泡树突状细胞。反应性胃癌并不常见，可与血淋巴样肿瘤和其他类型的肿瘤相关或作为孤立的发现。反应性GC通常位于非小梁旁分布。一组免疫组化染色有助于确认这些GC的非肿瘤性质，以避免误诊为淋巴瘤或作为骨髓小B细胞淋巴瘤患者转化的组织学证据。(C)2017爱思唯尔公司All rights reserved.
Reactive germinal centers (GCs) in the bone marrow (BM) have been described in patients with autoimmune disorders, infections, malignancies, and following certain drug therapies, or as an isolated finding without obvious underlying disease. In this study, we describe the clinical conditions in which reactive GCs occur in BM samples, and their topography and accompanying laboratory and ancillary findings in the setting of a cancer center. We identified 32 BM specimens with reactive GCs with an estimated frequency less than 0.02% over a 12-year period. Fifteen (46.9%) BM specimens had concurrent hematolymphoid neoplasms: most often a variety of small B-cell lymphomas, but also myelodysplastic syndromes. One (3.1%) case was involved by metastatic melanoma. Isolated reactive GCs were observed in 16 (50%) patients. Most BM specimens (n = 25; 78.1%) showed only one reactive GC with a size ranging from 20 to 500 and most GCs (29/32) were nonparatrabecular. GCs were positive for CD 10 and BCL6, and were negative for BCL2. CD3 and CD5 demonstrated T cells surrounding the GC and CD21, and CD23 highlighted follicular dendritic cells. Reactive GCs are uncommon and can be seen in association with hematolymphoid and other types of neoplasms or as an isolated finding. Reactive GCs are usually located in a nonparatrabecular distribution. A panel of imrnunohistochemical stains is useful to confirm the nonneoplastic nature of these GCs to avoid misdiagnosis as lymphoma or as histologic evidence of transformation in a patient with small B-cell lymphoma in the bone marrow. (C) 2017 Elsevier Inc. All rights reserved.