Nghiên cứu một số đặc điểm tế bào và miễn dịch ở bệnh nhân Lơ xê mi kinh dòng lympho và u lympho tế bào áo nang giai đoạn leukemia=Studying some features about cytology and immunology on chronic lymphocytic leukemia and mantle cell lymphoma leukemic phase patients

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Tác giả: Hồng Ngọc Đỗ, Ngọc Dũng Nguyễn, Quang Tùng Nguyễn, Thị Nguyệt Anh Phí

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.532-541

Bộ sưu tập: Metadata

ID: 478321

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Chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) are two types of monoclonal B cell neoplasms with CD5 possitive with involvement peripheral blood and bone marrow, causing an increase in white blood cells. Objective: Describe several morphologic and immunologic characters on B cell lymphoproliferative disorder in bone marrow diagnosed CLL or MCL leukemic phase. Patients and methods: 135 patients, descriptive study. Results: the median patient ages were 64.8 in CLL and 66,8 in MCL. Male/ female ratios were 2.2/1 in CLL and 9.6/1 in MCL. The percentage of patients with low hemoglobin in the MCL group was statistically higher than that in the CLL group (62.5% in MCL and 35% in CLL). There was no difference between platelet and white blood cell counts in the two groups. Most of the tumor cells were characterized by small size and coarse nuclei. However, the rate of other abnormal morphologies in the MCL group was higher than in the CLL group. Diffuse distribution was the most common pattern in both types (68.8% in CLL and 68.9% in MCL). CD20 was strongly positive in 100% of MCL patients but a small proportion of CLL patients were CD20 negative (3.9%). CD23 was positive in all CLL cases but a proportion of MCL were CD23 positive (15.6%). Cyclin d1 and SOX11 were positive in most MCL cases but were 100% negative in CLL. The positivity rates of FMC7 and CD22 were higher in MCL patients than in CLL patients (84.4% and 93.8% comparing with 2.9% and 71.9%, respectively). Conclusion: MCL leukemic phase with CD5 and CD23 coexpress can be misdiagnosed as CLL. Therefore, immunohistochemistry staining with cyclin d1 and SOX11 is necessary for distinguish between these two types.Lơ xê mi kinh dòng lympho (CLL) và u lympho tế bào áo nang (MCL) giai đoạn leukemia là 2 phân nhóm bệnh lý ác tính dòng lympho được đặc trưng bởi sự tăng sinh và tích lũy của các tế bào lympho B đơn dòng có CD5 dương tính trong máu và tủy xương, gây ra tình trạng bạch cầu tăng cao. Mục tiêu: Mô tả một số đặc điểm tế bào và miễn dịch ở bệnh nhân tăng sinh đơn dòng lympho B trong tủy xương được chẩn đoán là CLL và MCL pha leukemia. Đối tượng và phương pháp nghiên cứu: 135 bệnh nhân, nghiên cứu mô tả cắt ngang. Kết quả: Tuổi trung bình là 64,8 ở CLL và 66,8 ở MCL. Tỷ lệ nam/nữ ở CLL là 2,2/1 còn ở MCL là 9,6/1. Tỷ lệ bệnh nhân có giảm lượng huyết sắc tố (HST) ở nhóm MCL cao hơn có ý nghĩa thống kê so với nhóm CLL, ( 62,5% ở MCL và 35% ở CLL). Đa phần tế bào u có đặc điểm là kích thước nhỏ, nhân thô. Tuy nhiên tỷ lệ gặp các hình thái bất thường khác ở nhóm MCL cao hơn nhóm CLL. Phân bố lan tỏa là dạng phân bố phổ biến nhất trong cả 2 thể bệnh (68,8% ở CLL và 68,9% ở MCL). CD20 dương tính mạnh trên 100% bệnh nhân MCL nhưng có 1 tỷ lệ nhỏ bệnh nhân CLL có CD20 âm tính (3,9%). CD23 dương tính ở tất cả các trường hợp CLL nhưng chỉ có 15,6% MCL có CD23 dương tính. Cyclin d1 và SOX11 dương tính ở hầu hết các trường hợp MCL nhưng âm tính 100% ở CLL. Tỷ lệ dương tính của FMC7 và CD22 ở bệnh nhân MCL cao hơn so với bệnh nhân CLL (lần lượt là 84,4% và 93,8% so với 2,9% và 71,9%). Kết luận: MCL giai đoạn leukemia có CD5 và CD23 dương tính rất dễ chẩn đoán nhầm với CLL. Vì vậy nhuộm hóa mô miễn dịch mảnh sinh thiết tủy xương với cyclin d1 và SOX11 là rất cần thiết để phân biệt hai thể bệnh này.

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