호지킨씨병의 조직학적 및 면역조직화학적 연구

Abstract

[한글]

호지킨씨병은 특징적인 종양세포와 반응성의 림프구, 호산구, 형질세포등의 침윤을 보이며, 주로 면역기관에 침범하는 질환이다. 본 연구는 1977년 1월부터 1986년 12월까지 만 10년간 연세대학교 의과대학 병리학 교실, 영동 세브란스병원 및 원주 의과대학 부속

원주 기독병원 병리과에서 호지킨씨병으로 진단된 58예를 Rye 분류법에 따라 조직학적으로 재검토하고 임상기록을 검토하여, 각 유형별 임상적인 특징을 조사 분석하였으며, 종양세포로 알려진 Reed-Sternberg (이하 R-S로 약함) 세포와 호지킨씨 세포의 면역학적인

특성을 알아보고자 면역 글로불린 kappa와 lambda light chain, lysozyme, s-100 단백 및 α^^1 - antichymotrypsin에 대한 면역 과산화효소 염색을 시행하여 다음과 같은 결론을 얻었다.

1. 총 58예의 조직막적 유형으로는 mixed cellularity (이하 MC로 약함)형이 26예로 가장 많았고, lymphocyte depletion (이하 LD로 약함)형 16예, nodular sclerosis (이하 NS로 약함)형 12예, lymphocyte predominance (이하 LP로 약함)형 4예의 순이었다.

2. 서울과 원주간의 유형별 분포를 보면, 비교적 예후가 좋은 NS형의 비율은 서울에서 약간 더 높고, 예후가 나쁜 LD형의 비율은 원주가 더 높았다.

3. 호지킨씨병 환자의 연령은 6세에서 70세까지였으나 주로 21세에서 50세 사이에 호발하였고, 평균 연령은 37세였다. 남자 43예, 여자 15예로 남녀비는 2.9:1이었다.

4. 조직막적 유형과 임상 병기와의 관계를 보면 LP형과 MC형 그리고 NS형에서는 75∼87.5%가 병기 Ⅰ이나 Ⅱ였고, LD형에서는 81.3%가 병기 Ⅲ이나 Ⅳ였다.

5. 침범부위로는 말초 림프절이 54예로 대부분을 차지하였고, 종격동 림프절, 흉선, 편도선, 위장이 각각 1예씩이었다.

6. 호지킨씨병 초기의 주증상으로는 말초 림프절 종창이 60.3%로 가장 많았고, 그 이외에 발열, 기침, 호흡곤란, 식욕부진, 전신쇠약, 토혈등이 있었다.

7. R-S 세포와 호지킨씨 세포에 대해 면역 과산화효소 염색을 시행한 32예중 18예 (56.2%)는 kappa와 lambda light chain에 대해 동시에 양성 반응을 나타내었고, α^^1 - antichymotrypsin에 대해서는 13예, lysozyme에 대해서는 1예가 양성반응을 보였으며, S-100단백에 대해서는 모두 음성 반응을 나타내어 R-S 세포는 조직구 기원으로 생각되었다.

Histopathologic and immunocytochemical study of Hodgkin's disease

Soo Im Choi, M.D.

Yonsei University

Graduate School

(Directed by Professor In Joon Choi, M.D.)

Hodgkin's disease mainly involves the lymphoreticular system with characteristic

tumor celLs and infiltration efreactive Lymphocytes? eosinophiLs and plasma cells.

The present study investigates the incidence of the disease by subtypes and by

geographic differences? its clinicopathologic features and properties of the tumor

cells.

The materials were obtained from the Department of Pathology, Yonsei University,

Youngdong Severance Hospital and Yonsei University Wonju College of Medicine. A

total of 58 cases of Hodgkin's disease during a 10 year period (January 1977 to

December 1986) were retrospectively reviewed.

These cases were reclassified according to the Rye classification with a review

of the clinical record. The distribution of age and sex, subtype, initial symptoms,

sites of involvement and clinical stage were assessed. For an evaluation of the

properties of the Reed -Sternberg cells and Hodgkin's cells, immunoperoxidase

stairs using the Kappa and Lambda light chains of the immunoglobulin, lysozyme,

S-100 protein and α^^1 -antichy-motrpsin were done.

The results were as follows:

1) Histopathologic classification by Rye modification were; lymphocyte

predominance (LP) 4 cases, mixed cellularity (MC) 26 cases, lymphocyte depletion

(LD) 16 cases and nodular sclerosis (NS) 12 cases.

2) The geographic difference in the distribution of subtypes of Hodgkin's disease

between Seoul and the Wonju areas was noted. In Seoul, the ratio of NS was higher

than Wonju, and the ratio of LD was higher in Wonju than Seoul.

3) Age distribution was between 6 and 70 years with a mean age of 37 years. The

peak incidence was seen between the 3rd and5th decades. The male to female ratio

was 2.9:1 with 43 male patients and 15 female.

4) Utilizing the Ann Arbor staging method, 75-87.5% of LP, MC and NS were

classified as stage I or Ⅱ and 81.3% of 7D were stage Ⅲ or Ⅳ.

5) The initial biopsy sites most commonly seen were in the peripheral lymph nodes

(54 cases) and one case each in the mediastinal lymph node, thymus , tonsil and

stomach.

6) The most frequent initial chief complaint was a palpable mass(60.3%), other

complaints included fever, cough, dyspnea, anorexia, general weakness and

hematemesis.

7) Among 58 oases, 32 cases were studied using an immunoperoxidase stain. The R-S

cells and/of Hodgkin's cells were positive for Kappa and Lambda light chains,

simultaneously. One case was positive for lysozyme and all were negative for S-100

protein. For the α^^l -antichymotrypsin, 13 cases exhibited a positive reaction.

These findings suggest that R-S cells might be the histiocytic origin.

[영문]

Hodgkin's disease mainly involves the lymphoreticular system with characteristic tumor celLs and infiltration efreactive Lymphocytes? eosinophiLs and plasma cells.

The present study investigates the incidence of the disease by subtypes and by geographic differences? its clinicopathologic features and properties of the tumor cells.

The materials were obtained from the Department of Pathology, Yonsei University, Youngdong Severance Hospital and Yonsei University Wonju College of Medicine. A total of 58 cases of Hodgkin's disease during a 10 year period (January 1977 to

December 1986) were retrospectively reviewed.

These cases were reclassified according to the Rye classification with a review of the clinical record. The distribution of age and sex, subtype, initial symptoms,

sites of involvement and clinical stage were assessed. For an evaluation of the properties of the Reed -Sternberg cells and Hodgkin's cells, immunoperoxidase stairs using the Kappa and Lambda light chains of the immunoglobulin, lysozyme, S-100 protein and α^^1 -antichy-motrpsin were done.

The results were as follows:

1) Histopathologic classification by Rye modification were; lymphocyte predominance (LP) 4 cases, mixed cellularity (MC) 26 cases, lymphocyte depletion (LD) 16 cases and nodular sclerosis (NS) 12 cases.

2) The geographic difference in the distribution of subtypes of Hodgkin's disease between Seoul and the Wonju areas was noted. In Seoul, the ratio of NS was higher than Wonju, and the ratio of LD was higher in Wonju than Seoul.

3) Age distribution was between 6 and 70 years with a mean age of 37 years. The peak incidence was seen between the 3rd and5th decades. The male to female ratio was 2.9:1 with 43 male patients and 15 female.

4) Utilizing the Ann Arbor staging method, 75-87.5% of LP, MC and NS were classified as stage I or Ⅱ and 81.3% of 7D were stage Ⅲ or Ⅳ.

5) The initial biopsy sites most commonly seen were in the peripheral lymph nodes (54 cases) and one case each in the mediastinal lymph node, thymus , tonsil and stomach.

6) The most frequent initial chief complaint was a palpable mass(60.3%), other complaints included fever, cough, dyspnea, anorexia, general weakness and hematemesis.

7) Among 58 oases, 32 cases were studied using an immunoperoxidase stain. The R-S cells and/of Hodgkin's cells were positive for Kappa and Lambda light chains, simultaneously. One case was positive for lysozyme and all were negative for S-100

protein. For the α^^l -antichymotrypsin, 13 cases exhibited a positive reaction.

These findings suggest that R-S cells might be the histiocytic origin.