中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2014年
1期
8-14
,共7页
周军%夏春%沈勤%印洪林%张新华%石群立%周晓军%马捷
週軍%夏春%瀋勤%印洪林%張新華%石群立%週曉軍%馬捷
주군%하춘%침근%인홍림%장신화%석군립%주효군%마첩
胃肠肿瘤%淋巴瘤,大B-细胞,弥漫性%伯基特淋巴瘤%基因,myc%原位杂交,荧光%免疫组织化学
胃腸腫瘤%淋巴瘤,大B-細胞,瀰漫性%伯基特淋巴瘤%基因,myc%原位雜交,熒光%免疫組織化學
위장종류%림파류,대B-세포,미만성%백기특림파류%기인,myc%원위잡교,형광%면역조직화학
Gastrointestinal neoplasms%Lymphoma,large B-cell,diffuse%Burkitt lymphoma%Genes,myc%In situ hybridization,fluorescence%Immunohistochemistry
目的 探讨胃肠道侵袭性B细胞淋巴瘤即弥漫性大B细胞淋巴瘤(DLBCL)、Burkitt淋巴瘤(BL)、特征介于DLBCL和BL之间不能分类型的淋巴瘤(DLBCL/BL)的组织学特点,及其临床病理参数、免疫组织分型与预后的相关性.重点讨论c-myc抗体在胃肠道侵袭性B细胞淋巴瘤中的表达特点,及预测其基因易位的价值和意义.方法 对54例胃肠道侵袭性B细胞淋巴瘤的临床资料、组织学、免疫组织化学(EnVision法)进行观察分析并随访;荧光原位杂交(FISH)检测所有病例c-myc和部分病例的bcl-2的基因状态;免疫组织化学检测c-myc、Tcl-1及CD38 3种c-myc基因预测抗体的表达;统计分析各临床病理参数间及其与预后的关系,并对基因易位预测指标c-myc进行准确性检验(ROC曲线).结果 54例胃肠道侵袭性B细胞淋巴瘤,包括49例DLBCL(免疫分型:生发中心B细胞型11例,活化B细胞型38例)、4例DLBCL/BL、1例BL,中位年龄56岁,男女之比为1.6:1.0,中位生存时间42个月,其中11例在97个月内死亡.组织学观察可见异型的大细胞弥漫浸润胃肠道壁全层,部分伴有核碎裂及星空现象(18/54).瘤细胞CD20、CD79a均阳性,CD43(4/54)、CD5 (7/54)、bcl-2 (26/54)、Tcl-1 (17/54)、CD38(15/54)部分阳性,CD3、CD30均阴性,Ki-67阳性指数40％ ～ 100％.FISH检测显示部分病例出现bcl-2(1/19)和c-myc(4/54)易位,后者免疫组织化学c-myc均阳性(阳性百分数为80％ ～ 100％).单因素分析显示B症状、行为状态、乳酸脱氢酶、国际预后指数、远处转移、临床分期、c-myc阳性百分数90％以上、c-myc易位在内的8个因素与预后相关,CD5阳性的DLBCL预后不良,其中乳酸脱氢酶、远处转移、c-myc易位是独立的预后因素.ROC曲线显示c-myc抗体阳性百分数预测c-myc基因易位的最佳阈值为75％.结论 胃肠道侵袭性B细胞淋巴瘤预后受多方面临床病理因素影响;DLBCL(多为生发中心B细胞型)、DLBCL/BL可出现c-myc易位,组织学上可伴有Burkitt样的形态学特征和Ki-67高表达,且该基因易位是影响预后的独立因素,其检测对于患者的治疗和预后的判断均有重要意义;较高的c-myc抗体阳性百分数有助于预测c-myc易位.
目的 探討胃腸道侵襲性B細胞淋巴瘤即瀰漫性大B細胞淋巴瘤(DLBCL)、Burkitt淋巴瘤(BL)、特徵介于DLBCL和BL之間不能分類型的淋巴瘤(DLBCL/BL)的組織學特點,及其臨床病理參數、免疫組織分型與預後的相關性.重點討論c-myc抗體在胃腸道侵襲性B細胞淋巴瘤中的錶達特點,及預測其基因易位的價值和意義.方法 對54例胃腸道侵襲性B細胞淋巴瘤的臨床資料、組織學、免疫組織化學(EnVision法)進行觀察分析併隨訪;熒光原位雜交(FISH)檢測所有病例c-myc和部分病例的bcl-2的基因狀態;免疫組織化學檢測c-myc、Tcl-1及CD38 3種c-myc基因預測抗體的錶達;統計分析各臨床病理參數間及其與預後的關繫,併對基因易位預測指標c-myc進行準確性檢驗(ROC麯線).結果 54例胃腸道侵襲性B細胞淋巴瘤,包括49例DLBCL(免疫分型:生髮中心B細胞型11例,活化B細胞型38例)、4例DLBCL/BL、1例BL,中位年齡56歲,男女之比為1.6:1.0,中位生存時間42箇月,其中11例在97箇月內死亡.組織學觀察可見異型的大細胞瀰漫浸潤胃腸道壁全層,部分伴有覈碎裂及星空現象(18/54).瘤細胞CD20、CD79a均暘性,CD43(4/54)、CD5 (7/54)、bcl-2 (26/54)、Tcl-1 (17/54)、CD38(15/54)部分暘性,CD3、CD30均陰性,Ki-67暘性指數40％ ～ 100％.FISH檢測顯示部分病例齣現bcl-2(1/19)和c-myc(4/54)易位,後者免疫組織化學c-myc均暘性(暘性百分數為80％ ～ 100％).單因素分析顯示B癥狀、行為狀態、乳痠脫氫酶、國際預後指數、遠處轉移、臨床分期、c-myc暘性百分數90％以上、c-myc易位在內的8箇因素與預後相關,CD5暘性的DLBCL預後不良,其中乳痠脫氫酶、遠處轉移、c-myc易位是獨立的預後因素.ROC麯線顯示c-myc抗體暘性百分數預測c-myc基因易位的最佳閾值為75％.結論 胃腸道侵襲性B細胞淋巴瘤預後受多方麵臨床病理因素影響;DLBCL(多為生髮中心B細胞型)、DLBCL/BL可齣現c-myc易位,組織學上可伴有Burkitt樣的形態學特徵和Ki-67高錶達,且該基因易位是影響預後的獨立因素,其檢測對于患者的治療和預後的判斷均有重要意義;較高的c-myc抗體暘性百分數有助于預測c-myc易位.
목적 탐토위장도침습성B세포림파류즉미만성대B세포림파류(DLBCL)、Burkitt림파류(BL)、특정개우DLBCL화BL지간불능분류형적림파류(DLBCL/BL)적조직학특점,급기림상병리삼수、면역조직분형여예후적상관성.중점토론c-myc항체재위장도침습성B세포림파류중적표체특점,급예측기기인역위적개치화의의.방법 대54례위장도침습성B세포림파류적림상자료、조직학、면역조직화학(EnVision법)진행관찰분석병수방;형광원위잡교(FISH)검측소유병례c-myc화부분병례적bcl-2적기인상태;면역조직화학검측c-myc、Tcl-1급CD38 3충c-myc기인예측항체적표체;통계분석각림상병리삼수간급기여예후적관계,병대기인역위예측지표c-myc진행준학성검험(ROC곡선).결과 54례위장도침습성B세포림파류,포괄49례DLBCL(면역분형:생발중심B세포형11례,활화B세포형38례)、4례DLBCL/BL、1례BL,중위년령56세,남녀지비위1.6:1.0,중위생존시간42개월,기중11례재97개월내사망.조직학관찰가견이형적대세포미만침윤위장도벽전층,부분반유핵쇄렬급성공현상(18/54).류세포CD20、CD79a균양성,CD43(4/54)、CD5 (7/54)、bcl-2 (26/54)、Tcl-1 (17/54)、CD38(15/54)부분양성,CD3、CD30균음성,Ki-67양성지수40％ ～ 100％.FISH검측현시부분병례출현bcl-2(1/19)화c-myc(4/54)역위,후자면역조직화학c-myc균양성(양성백분수위80％ ～ 100％).단인소분석현시B증상、행위상태、유산탈경매、국제예후지수、원처전이、림상분기、c-myc양성백분수90％이상、c-myc역위재내적8개인소여예후상관,CD5양성적DLBCL예후불량,기중유산탈경매、원처전이、c-myc역위시독립적예후인소.ROC곡선현시c-myc항체양성백분수예측c-myc기인역위적최가역치위75％.결론 위장도침습성B세포림파류예후수다방면림상병리인소영향;DLBCL(다위생발중심B세포형)、DLBCL/BL가출현c-myc역위,조직학상가반유Burkitt양적형태학특정화Ki-67고표체,차해기인역위시영향예후적독립인소,기검측대우환자적치료화예후적판단균유중요의의;교고적c-myc항체양성백분수유조우예측c-myc역위.
Objective To study the histological features,diagnosis,differential diagnoses of aggressive B-cell lymphomas of the gastrointestinal tract and to correlate clinical prognosis with pathologic parameters and immunophenotypes with an emphasis on c-myc,Tcl-1 and CD38 expression and their values in predicting the status of c-myc gene translocation.Methods Fifty-four cases of aggressive B-cell lymphomas of the gastrointestinal tract with complete clinical and pathologic data were retrospectively collected.The clinical data,histologic and immunohistochemical findings and follow-up results were analyzed.Predictive immunohistochemical stains including c-myc,Tcl-1 and CD38 were performed and ROC curve analysis was used to confirm the accuracy of these markers in predicting c-myc translocation.Results Of54 cases,there were 33 males and 21 females with median age of 56 years.Histological types of lymphomas included 49 cases of DLBCL (11 cases of germinal central B cell like and 38 cases of activated B cell like by Hans classification),4 cases of DLBCL/BL and 1 case of BL.Eleven of 54 patients died within 97 months,with median survival of 42 months.Histologically,full-thickness infiltration of the gastrointestinal tract by large atypical cells with evident phagocytosis of karyorrhexis by macrophages (“ starry sky”) were seen in 18/54 cases.The lymphoma cells were positive for CD20 (54/54),CD79a (54/54),CD43 (4/54),CD5 (7/54),bcl-2 (26/54),Tcl-1 (17/54) and CD38 (15/54),but all negative for CD3 and CD30.The proliferative index by Ki-67 ranged from 40％ to 100％.The univariate survival analysis indicated that B symptoms,general performance,high LDH,high IPI,distant metastasis,high clinical stage and tumors with over 90％ of cells positive for c-myc were negative predictors for the patient's survival.In addition,cases of DLBCL positive for CD5 had an unfavorable prognosis.Cox regression analysis showed c-myc translocation,distant metastasis and high LDH were independent predictors for unfavorable prognosis.ROC curve revealed the percentage of c-myc positivity predicted the presence of c-myc gene translocation,with 75％ as the optimal threshold.Conclusions Aggressive B-cell lymphomas of the gastrointestinal tract with a prognosis influenced by variable clinicopathologic factors.DLBCL and DLBCL/BL may possess c-myc translocation and tend to be Burkitt-like or atypical Burkitt lymphoma.As independent prognostic indicator,c-myc expression may be used for selection of therapeutic regimens and prognostication.High percentage of tumor cells with c-myc positivity may be used to predict the presence of c-myc gene translocation.
