Clinicopathological Features of the Nodal Marginal Zone B-cell Lymphoma Involving Spleen Combined with Promi-nent Granulomatous Reaction

WANG Yao-hui; LI Hui; SHEN Long-shu; LIU Chun-yang; ZHANG Yi-fen

doi:10.3969/j.issn.1002-3429.2018.01.036

Abstract：Objective To investigate the clinical and pathological features of nodal marginal zone B-cell lymphoma involving spleen combined with prominent granulomaous reaction. Methods The histopathological features, immunopheno-type and gene rearrangement characteristics were utilized to analyze one case of nodal marginal zone B-cell lymphoma involving spleen with combined prominent granulomatous reaction retrospectively. Results This patient was a male, 34 years old. The spleen was resected due to hypersplenism accompanied with fever, weight loss, night sweat for 16 months, systemic lymph node and spleen enlarged for 14 months. Under the microscope and immunohistochemical staining: There are many nodules distributed in the spleen tissue, surround by small-medium size lymphocytes and histocytes, and the lymphocytes distributed between some nodules and even invade red pulp. The nodules of spleen expressed CD68, CD163 but not CD10, CD21. The small-medium size lymphocytes around the nodules were CD20 positive, and the Ki-67 index was about 30％. Low grade B cell lymphoma was supposed. Right neck lymph node showed lymph node structure was destroyed by diffusely distributed small-medium size lymphocytes with only a small amount of residual lymph follicles. The immunohistochemical staining showed the small-medium size lymphocytes were CD20, CD43 positive, Bcl-2 partial positive, and the Ki-67 index was about 40％. Clonal rearrangement detected by lymph node gene detection. Diagnosis:marginal zone B cell lymphoma of right neck lymph node, and involve spleen with combined prominent granulomatous reaction. Conclusion Besides exclusion of specific infec-tions of the lymph node granulomas, the possibility of lymphoma should be ruled out by carefully analysis of clinical, morpho-logical, immunohistochemical and molecular genetics characteristics.