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Abstract：
Background: Typically, lymphatic tissue proliferative lesions include either benign lesions or lymphoma. However, not all lymphatic lesions can currently be accurately classified into one category, particularly in mucosal areas that are in contact with the external environment.Aims: To explore the morphology, immunophenotype, and molecular changes of Non-neoplastic B-cell predominant lymphoid proliferations (NBPLP) in pathological areas that are exposed to external surroundings which mimicked lymphoma.Methods and Results: 18 cases of Atypical lymphoid hyperplasia (AtLP) were retrieved in this study. The biopsy samples were mucosal samples obtained from areas exposed to external surroundings, including intestines, urethra, cervix, tonsils, and tongue. Microscopically, there is a different level of B cell hyperplasia accompanied by morphological atypia. We categorized the morphology into 4 groups: type A (7/18), type B (3/18), type C (3/18), type D (5/18). Part of the AtLP was found positive for BCR gene rearrangement (6/15), and TCR gene rearrangement (1/4). The follow-up period ranged from 14.2 to 70 months. No evidence of lymphoma was found. Therefore, we diagnosed all of the presented cases as NBPLP. We illustrated the key differential points and provided valuable diagnostic experience on each subtype.Conclusions: Areas exposed to the external environment are commonly exposed to antigen and easily present with AtLP of NBPLP, accompanying with positive IGH rearrangement. Therefore, a comprehensive evaluation of macroscopic, morphology, immunophenotype, and molecular diagnostics is required to prevent the overdiagnosis of lymphoma.
摘要：
背景:通常,淋巴组织增生性病变包括良性病变或淋巴瘤。然而,目前并不是所有的淋巴损伤都能准确地归入一类,特别是在与外部环境接触的粘膜区域。目的：探索形态学，免疫表型,以及暴露于模仿淋巴瘤的外部环境的病理区域中非肿瘤B细胞主导的淋巴样增殖（NBPLP）的分子变化。方法与结果：本研究共检索到18例非典型淋巴样增生（AtLP）。活检样本是从暴露于外部环境的区域获得的粘膜样本，包括肠子,尿道,子宫颈,扁桃体,和舌头。微观上,有不同程度的B细胞增生并伴有形态不典型。我们将形态学分为4组：A型（7/18），B型（3/18），C型(3/18),D型（5/18）。部分AtLPBCR基因重排呈阳性（6/15），和TCR基因重排(1/4)。随访时间为14.2至70个月。没有发现淋巴瘤的证据。因此,我们将所有出现的病例诊断为NBPLP。我们说明了关键的差异点，并为每个子类型提供了宝贵的诊断经验。结论：暴露于外部环境的区域通常暴露于抗原，并且容易携带NBPLP的AtLP。伴随着积极的IGH重排。因此,综合评价宏观，形态学,免疫表型,需要分子诊断来防止淋巴瘤的过度诊断。
