WHO 分類でのcentrocytes/centroblastの定義:
★ Centroblasts (濾胞中心芽細胞):
大型で,類円形核,水疱状クロマチン,核膜寄りに存在する1〜3個の核小体,狭い細胞質を持つ。典型的には小型リンパ球の3倍の大きさであるがより小さい
場合もある。
Large cells with usually round or oval, but occasionally
indented or multilobated nuclei, vesicular chromatin, one to
three peripheral nucleoli and a narrow rim of cytoplasm.
Typically, they are
at least 3 times the size of lymphocytes, but they may
be smaller in some cases.
★ Centrocytes
(濾胞中心細胞): 小型から中型の細胞でくびれがある核,目立たない核小体,狭い淡明な細胞質を持つ。
Small to medium sized cells with angulated, elongated, twisted
or cleaved nuclei, inconspicuous nucleoli and scant pale
cytoplasm.
★ Follicular
dendritic cells (濾胞樹上細胞):
繊細な核膜,均一なクロマチン,中心性の赤い核小体,ときに二核を持つ。
delicate nuclear membrane, dispersed chromatin, violet-coloured
centrally located nucleoli, often binucleate
Tolksdorf G, Stein H, and Lennert
Kの定義 (Br. J. Cancer 1980, 41; 168-82)
☆ Centroblasts: Medium-sized or large cels with a
round or oval, pale nucleus containing 2-3 nucleoli, usually
located at the nuclear membrane; cytoplasm is sparse and
intensely basophilic (Lennert, 1957, 1961).
☆ Centrocytes: Small or
medium-sized cells with a cleaved or irregularly shaped nucleus;
cytoplasm is usually sparse and very weakly basophilic and thus
difficult to recognize in sections (Lennert,1964).
Except in newly formed germinal centres, centrocytes are the
predominant cells.
Follicular lymphomaの
Grading 7視野中のcentroblastの数 (/hpf)の平均で決める
視
野数22の場合,7視野を数え,10で割った数で判定(WHO
分類)
Grade 1-2 (low grade): 0〜15
centroblasts/hpf G1, 0-5; G2,
6-15
Grade 3A > 15 centroblasts/hpf, centrocytes present
Grade 3B Solid sheets of centroblasts
Grade
1-2の部分がdiffuseにある場合
意義は明らかではないが,下記の報告が推奨されている。
Reporting pattern
Follicular lymphoma,
Follicular
(>75% follicular)
Follicular and diffuse (25〜75% follicular)
Focally
follicular (<25% follicular)
Diffuse 0%
follicular
ただし
Grade3に相当する部分がびまん性に広がっていたら,診断は DLBCL with follicular lymphomaとなる
Diffuseの定義:
CD21/CD23
/FDC+の完全消失として定義される,ただし濾胞間に広がることはよくあるので,そこはびまん性と捉えない。
Diffuse areas may be
present, often with sclerosis, particularly in mesenteric and
retroperitoneal infiltrates
CYTOGENETICS
t(14;18) 80% (= BCL2 rearranged) 80-90%
3q27-28 (= BCL6) 5-15%, grade 3Bに多い
kappa/lambda thresholds
Iancuらの検討によると,FCMでkappa/lambda比が
4以上ないし0.3以下がモノクロー
ナリティの証拠として最適
(Iancu D, et al. Arch Pathol Lab Med. 2007 ;131:282-287)