Abstract
Cutaneous lymphomas of both B cells and less commonly T cells can exceptionally exhibit spindle-cell morphology. Less than 30 spindle-cell B-cell lymphomas of the skin have been described, mostly before the adoption of detailed immunohistochemistry, and thus initially interpreted as variants of diffuse large B-cell lymphoma (DLBCL). Furthermore, some authors suggest that cutaneous spindle-cell B-cell lymphomas (cSCBCLs) may behave more aggressively than their conventional morphologic counterparts and may thus merit more aggressive treatment. Herein we describe the largest case series of cSCBCL analyzed to date to characterize their clinicopathologic and immunohistochemical features and clarify their subtype according to the current WHO/EORTC classification scheme. Twenty-four cSCBCLs arose in 18 male and 6 female individuals with a mean age of 55 years, mostly on the head (12/24), trunk (8/24), and lower extremities (4/24). Histopathologic features were similar for all cases. Neoplasms involved the entire dermis and focally the subcutis. The neoplastic infiltrates comprised a mixture of medium-sized, visually prominent spindled cells (15%; up to 85% of the infiltrate) arranged in a fascicular pattern around nodular aggregates and admixed in a random manner between centrocyte/centroblast-like cells within these nodular collections. Immunohistochemical support for a follicular center cell origin was present in 22/24 cases, 1 was consistent with DLBCL-leg type and 1 defied precise classification, best fitting with intermediate-grade DLBCL-other. Our findings reinforce the concept that most cSCBCLs are variants of low-grade B-cell lymphomas of follicle center cell origin and not intermediate-grade variants of DLBCL.
摘要
所有的皮肤B细胞性淋巴瘤和少见的皮肤T细胞性淋巴瘤都可以表现为梭形细胞形态。文献报道的皮肤梭形细胞性B细胞性淋巴瘤不到30例,绝大多数是在详尽应用免疫组化之前报道的,因而最初被解释为弥漫性大B细胞淋巴瘤(DLBCL)的变异亚型。此外,一些作者认为皮肤梭形细胞性B细胞淋巴瘤(cSCBCLs)可能相比常规形态B细胞淋巴瘤来说,表现更激进,因此可能需要更积极的治疗。本文收集了截止目前最大样本cSCBCL,分析其临床病理及免疫组化特征,并根据最新WHO/ EORTC分类方案进行分类。24例cSCBCLs中,男性18例,女性6例;平均年龄55岁;大多发生于头部(12 / 24),躯干(8 / 24)和下肢(4 / 24)也可见。所有病例组织病理学特征相似。肿瘤细胞浸润整个真皮层,局部浸润皮下组织。浸润的肿瘤细胞中等大小、中心细胞/中心母细胞样,排列呈结节状;或是显著(15%—85%)的梭形细胞呈束状排列围绕结节周围并在结节之间杂乱无章分布。免疫组化结果显示22/24例支持滤泡中心细胞来源,1例为腿型DLBCL,另例1无法精确分类,介于中级别DLBCL和其它肿瘤之间。我们的研究结果再次证实,绝大多数cSCBCLs是滤泡中心细胞起源的低度恶性B细胞淋巴瘤的变异,而不是中级别DLBCL亚型。
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