CAJ | 학술논문

目的观察睾丸弥漫性大B细胞淋巴瘤(DLBCL)的临床病理及免疫表型特点,探讨其病理诊断及预后.方法对58例睾丸DLBCL进行回顾性临床病理研究,包括形态学复习、免疫组织化学(EnVision法)染色、EB病毒编码小RNA(EBER) 1/2原位杂交以及预后相关因素分析.结果 58例睾丸DLBCL患者平均年龄62.1岁,中位年龄65岁.多数病程较短,51例(87.9％)就诊时处于临床Ⅰ～Ⅱ期；48例(82.8％)为单侧睾丸受累.12例(20.7％)伴同侧腹股沟淋巴结肿大,少有其他器官累及.52例(89.7％)病理形态学表现为中心母细胞样细胞在睾丸间质内弥漫性浸润,并浸润曲细精管.睾丸白膜受侵、血管浸润分别见于14例(24.1％)和10例(17.2％).Hans分型以非生发中心B细胞型为主(48/58,82.8％).缺乏EB病毒感染.所有病例行病变睾丸切除,35例(60.3％)接受了术后化疗和(或)放疗.随访率为82.8％ (48/58),其中28例(58.3％)患者死亡；1、3、5年总体生存率分别为55.7％、31.6％和27.6％.年龄＞60岁、B症状、血清乳酸脱氢酶水平升高、高临床分期及未接受术后联合治疗者预后差.结论睾丸DLBCL确诊时以局部病变为主,低临床分期,有一定的病理形态学特征,多为非生发中心型DLBCL,预后不良；术后联合化疗可延长患者的生存期.
목적 관찰고환미만성대B세포림파류(DLBCL)적림상병리급면역표형특점,탐토기병리진단급예후.방법 대58례고환DLBCL진행회고성림상병리연구,포괄형태학복습、면역조직화학(EnVision법)염색、EB병독편마소RNA(EBER) 1/2원위잡교이급예후상관인소분석.결과 58례고환DLBCL환자평균년령62.1세,중위년령65세.다수병정교단,51례(87.9％)취진시처우림상Ⅰ～Ⅱ기；48례(82.8％)위단측고환수루.12례(20.7％)반동측복고구림파결종대,소유기타기관루급.52례(89.7％)병리형태학표현위중심모세포양세포재고환간질내미만성침윤,병침윤곡세정관.고환백막수침、혈관침윤분별견우14례(24.1％)화10례(17.2％).Hans분형이비생발중심B세포형위주(48/58,82.8％).결핍EB병독감염.소유병례행병변고환절제,35례(60.3％)접수료술후화료화(혹)방료.수방솔위82.8％ (48/58),기중28례(58.3％)환자사망；1、3、5년총체생존솔분별위55.7％、31.6％화27.6％.년령＞60세、B증상、혈청유산탈경매수평승고、고림상분기급미접수술후연합치료자예후차.결론 고환DLBCL학진시이국부병변위주,저림상분기,유일정적병리형태학특정,다위비생발중심형DLBCL,예후불량；술후연합화료가연장환자적생존기.
Objective To investigate the clinicopathologic features,immunophenotype,diagnosis and differential diagnosis,and prognostic factors of testicular diffuse large B-cell lymphoma (DLBCL).Methods The clinical and pathologic profiles of 58 cases of testicular DLBCL were investigated.Immunohistochemical stainings and EBER1/2 in situ hybridization were performed on formalin fixed tissues.Results The average age of the patients was 62.1 years,and the median age was 65 years.The course of disease was short in most of the cases.Clinical stages at diagnosis were mainly stage Ⅰ or Ⅱ (87.9％,51/58).Forty eight patients (82.8％) had unilateral testis involvement.Inguinal lymphadenopathy was observed in 12 (20.7％) patients and the other organs were seldom involved.Morphologically,centroblast-like neoplastic cells infiltrated interstitial tissue of testis diffusely and invaded into seminiferous tubules.Tunica albuginea and vessels were involved in 14 (24.1％) and 10 (17.2％)patients,respectively.Immunophenotype analysis showed predominant non-GCB type of DLBCL (48/58,82.8％) by Hans classification.No EBV infection was detected.Follow-up data were available in 48 (82.8％) patients.Twenty eight patients (58.3％) died of the disease.One-year,3-year,and 5-year overall survivals were 55.7％,31.6％ and 27.6％,respectively.Age (older than 60 years),B-symptoms,high serum level of LDH,advanced Ann Arbor stage as well as lack of combination of therapy were associated with a poor prognosis.Conclusions This large series of testicular DLBCL mainly present with local disease at diagnosis.Most cases show non-GCB immunophenotype.Despite early clinical stage at presentation,the prognosis is poor.Combined chemotherapy postoperation may prolong survival of the patients.