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Intraparotid Classical and Nodular Lymphocyte-predominant Hodgkin Lymphoma: Pattern Analysis With Emphasis on Associated Lymphadenoma-like Proliferations.

腮腺内经典型和结节性淋巴细胞为主型霍奇金淋巴瘤:重点在相关淋巴瘤样增生的模式研究

Agaimy A,Wild V,Märkl B,Wachter DL,Hartmann A,Rosenwald A,Ihrler S

Abstract

Most of the lymphoproliferative diseases involving the salivary glands represent indolent non-Hodgkin B-cell lymphoma (marginal zone lymphoma) related to chronic autoimmune sialadenitis (Sjögren disease). Other types of non-Hodgkin lymphomas involve the salivary glands less frequently. On rare occasions, classical Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) present initially as a primary salivary gland mass. We analyzed a series of CHL (n=3) and NLPHL (n=6) presenting initially as parotid gland tumors concerning their pattern (parenchymal vs. intraparotid lymph node) and the presence of salivary inclusions and epithelial proliferations within the lymphoma infiltrate. The pattern of infiltration was determined on hematoxylin and eosin-stained slides assisted by immunostaining for pancytokeratin to highlight lobular salivary gland parenchyma. Patients included 6 male and 3 female individuals with a mean age of 62 years (range, 36 to 88 y). Lymphoma was localized within intraparotid lymph nodes in 8 cases and was limited to salivary parenchyma in 1 case. Parenchymal involvement in nodal-based cases was scored as absent (3) or minimal (5). Salivary inclusions (acini and ductules) within affected lymph nodes were noted in 6 cases (4/5 NLPHLs and 2/3 CHLs). In 3/6 NLPHL cases, salivary inclusions showed variable proliferative changes ranging from prominent lymphoepithelial lesions to cystic and oncocytic (Warthin-like) epithelial changes. Scanty small lymphoepithelial lesions were seen in 1 of the 3 CHL cases. One NLPHL in the intraparotid lymph node was accompanied by prominent lymphoepithelial sialadenitis in the absence of clinical signs of Sjögren disease. This study highlights that a majority of parotid gland Hodgkin lymphomas arise within intraparotid lymph nodes. Frequent entrapment and proliferation of salivary ducts and acini within the lymphoma infiltrate might mimic a variety of benign lymphoepithelial mass-forming lesions (nonsebaceous lymphadenoma, Warthin tumor, and autoimmune sialadenitis). Pancytokeratin stain is helpful for reliable assessment of the background architecture.

摘要

累及涎腺的淋巴增殖性疾病大多为与慢性自身免疫性涎腺炎(Sjögren病)相关的惰性B细胞非霍奇金淋巴瘤(边缘区淋巴瘤)。其他类型非霍奇金淋巴瘤累及涎腺较少见。罕见情况下,经典型霍奇金淋巴瘤(CHL)和结节性淋巴细胞为主型霍奇金淋巴瘤(NLPHL)可表现为涎腺原发性肿块。我们分析了最初表现为腮腺肿块的CHL(N = 3)和NLPHL(n =6),重点关注其生长模式(腺体实质VS涎腺内淋巴结)及浸润性淋巴瘤内包涵涎腺上皮岛的存在及上皮的增生。浸润模式依据HE染色并以PCK免疫组化染色突出涎腺实质小叶结构辅助识别。患者包括6例男性和3例女性,平均年龄62岁(36岁-88岁)。淋巴瘤局限于腮腺内淋巴结8例,局限于腮腺实质内1例。局限于淋巴结的病例实质受累评分为无(3例)或最小(5例)。6例可见受累淋巴结内包涵涎腺上皮岛(腺泡和腺管)(4/5NLPHL 和2/3CHL)。3/6NLPHL病例包涵涎腺上皮岛显示不同程度增生性改变,从明显的淋巴上皮病变到囊性和嗜酸细胞(Warthin样)改变。1/3CHL可见散在少量淋巴上皮病变。腮腺内淋巴结的1例NLPHL没有Sjögren病的临床表现,却伴有显著的淋巴上皮性涎腺炎。本研究提示,大多数腮腺霍奇金淋巴瘤起源于腮腺内淋巴结。淋巴瘤内常见的涎腺导管和腺泡陷入和增生可模仿各种良性淋巴上皮样形成肿块的病变(非皮脂腺淋巴瘤、Warthin瘤和自身免疫性涎腺炎)。PCK免疫组化染色有助于背景结构的准确评估。
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