目的：探讨免疫球蛋白重链/T细胞受体（IgH/TCR）基因重排检测联合EB病毒（EBV）原位杂交在淋巴瘤诊断中的应用，分析EBV+-B细胞淋巴瘤的细胞学及基因组学特征、鉴别诊断要点，以缩短诊断时间，减少误诊。方法采用IgH/TCR基因重排与EB原位杂交联合分析诊断EBV+-B细胞淋巴瘤1例，分析其免疫组化特征、EBV原位杂交、基因重排结果。结果 EBV+-B细胞淋巴瘤临床上主要表现为淋巴结增大，常伴骨髓和外周血浸润。淋巴结活检显示其结构破坏，淋巴滤泡减少，淋巴结高度增生性病变，可见轻至中度异型淋巴细胞，淋巴窦扩张，组织细胞增生。免疫组化证实EBV感染的细胞毒性B细胞构成病变主体；EBV原位杂交显示部分淋巴细胞核阳性；基因重排提示IgH、免疫球蛋白轻链（Igκ）基因发生克隆性重排，TCRγ无克隆性重排。结论 EBV+-B细胞淋巴瘤从形态学上难以与伯基特淋巴瘤、慢性淋巴细胞白血病等淋巴瘤区分，早期诊断困难。联合应用IgH/TCR基因重排与EBV原位杂交技术对EBV+-B细胞淋巴瘤的诊断有较高准确性。%Objective To investigate the application of immunoglobulin heavy chain/T cell receptor (IgH/TCR) gene re-arrangement and epstein-barr virus(EBV) in situ hybridization in diagnosing lymphoma,analyzing cytological feature and genomic features of EBV+-B cell lymphoma and discriminating the points of diagnosis ,in order to shorten the diagnostic time and avoid misdiagnosis. Methods A total of 1 case with diagnosis of EBV+-B cell lymphoma by IgH/TCR gene rearrangements combined with EB in situ hybridization analysis was performed to analyze its immunohistochemical characteristics ,EBV situ hybridization and results of gene rearrangement. Results The major clinical manifestation of EBV+-B cell lymphoma was lymphadenopathy , which often accompanied by infiltration of the bone marrow and peripheral blood. Lymph node biopsy showed its structural dam-age,lymphoid follicles decreasing,T zone expanding significantly,mild-moderate atypical lymphocyte,lymphatic sinus dilation and histiocytosis. Immunohistochemistry confirmed that cytotoxic B cells infected by EBV constituted the main body;EBV situ hy-bridization showed lymphocyte nuclei positive;gene rearrangement revealed IgH,Igκgene clonal rearrangement,TCRγno clonal rearrangement. Conclusion It is difficult to distinguish EBV+-B-cell lymphoma from burkitt′s lymphoma,chronic lymphocytic leukemia and other lymphomas morphologically with difficult diagnosis in early. Conjoint application of IgH/TCR gene rearrange-ment and EBV in situ hybridization in lymphoma diagnosis has a high diagnostic accuracy.
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