中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2015年
9期
775-779
,共5页
孙琦%安刚%刘恩彬%李占琦%张洪菊%杨晴英%孙福军%马跃%缐霂
孫琦%安剛%劉恩彬%李佔琦%張洪菊%楊晴英%孫福軍%馬躍%缐霂
손기%안강%류은빈%리점기%장홍국%양청영%손복군%마약%선목
多发性骨髓瘤%细胞周期蛋白D%病理学%骨髓%原位杂交,荧光
多髮性骨髓瘤%細胞週期蛋白D%病理學%骨髓%原位雜交,熒光
다발성골수류%세포주기단백D%병이학%골수%원위잡교,형광
Multiple myeloma%Cyclin D%Pathology%bone marrow%In situ hybridization,fluorescence
目的 探讨细胞周期蛋白D1 (CCND1)基因阳性多发性骨髓瘤(MM)患者的临床及骨髓病理学特征.方法 回顾性分析158例初诊MM患者资料.所有患者均行骨髓活检及免疫组织化学染色、流式细胞术、FISH检测.CCND1基因阳性患者中有24例同时行细胞遗传学检查.结果 158例患者中CCND1基因阳性者31例,CCND1基因阴性者127例.31例CCND1基因阳性患者中,男19例,女12例,其中IgG型11例,IgA型4例,IgD型4例,IgM型1例,轻链型共6例,不分泌型5例;阳性检出率在IgD(57.1％)、不分泌型(50.0％)中较IgA(12.1％)、IgG型(14.1％)高(P值均＜0.05),在κ和λ型中差异无统计学意义(15.9％对19.0％,P=0.627).31例CCND1基因阳性患者中浆细胞形态为小细胞型者24例(77.4％),为成熟浆细胞型者6例(19.4％),为不成熟浆细胞型者1例(3.2％);流式细胞术检查示均为CD38+CD138+CD19-CD45-,其CD56阳性率较阴性组低(35.5％对61.4％,P=0.009),CD20阳性率较阴性组高(29.0％对4.0％,P＜0.001);免疫组织化学染色示cyclinD1+者22例(71.0％).结论 IgD型和不分泌型MM患者CCND1基因阳性检出率较高,常常表现为小细胞型形态,伴CD20高表达和CD56表达减低,多表达cyclinD1.主要需与淋巴浆细胞淋巴瘤等具有浆细胞样分化特征的小B细胞淋巴瘤相鉴别.
目的 探討細胞週期蛋白D1 (CCND1)基因暘性多髮性骨髓瘤(MM)患者的臨床及骨髓病理學特徵.方法 迴顧性分析158例初診MM患者資料.所有患者均行骨髓活檢及免疫組織化學染色、流式細胞術、FISH檢測.CCND1基因暘性患者中有24例同時行細胞遺傳學檢查.結果 158例患者中CCND1基因暘性者31例,CCND1基因陰性者127例.31例CCND1基因暘性患者中,男19例,女12例,其中IgG型11例,IgA型4例,IgD型4例,IgM型1例,輕鏈型共6例,不分泌型5例;暘性檢齣率在IgD(57.1％)、不分泌型(50.0％)中較IgA(12.1％)、IgG型(14.1％)高(P值均＜0.05),在κ和λ型中差異無統計學意義(15.9％對19.0％,P=0.627).31例CCND1基因暘性患者中漿細胞形態為小細胞型者24例(77.4％),為成熟漿細胞型者6例(19.4％),為不成熟漿細胞型者1例(3.2％);流式細胞術檢查示均為CD38+CD138+CD19-CD45-,其CD56暘性率較陰性組低(35.5％對61.4％,P=0.009),CD20暘性率較陰性組高(29.0％對4.0％,P＜0.001);免疫組織化學染色示cyclinD1+者22例(71.0％).結論 IgD型和不分泌型MM患者CCND1基因暘性檢齣率較高,常常錶現為小細胞型形態,伴CD20高錶達和CD56錶達減低,多錶達cyclinD1.主要需與淋巴漿細胞淋巴瘤等具有漿細胞樣分化特徵的小B細胞淋巴瘤相鑒彆.
목적 탐토세포주기단백D1 (CCND1)기인양성다발성골수류(MM)환자적림상급골수병이학특정.방법 회고성분석158례초진MM환자자료.소유환자균행골수활검급면역조직화학염색、류식세포술、FISH검측.CCND1기인양성환자중유24례동시행세포유전학검사.결과 158례환자중CCND1기인양성자31례,CCND1기인음성자127례.31례CCND1기인양성환자중,남19례,녀12례,기중IgG형11례,IgA형4례,IgD형4례,IgM형1례,경련형공6례,불분비형5례;양성검출솔재IgD(57.1％)、불분비형(50.0％)중교IgA(12.1％)、IgG형(14.1％)고(P치균＜0.05),재κ화λ형중차이무통계학의의(15.9％대19.0％,P=0.627).31례CCND1기인양성환자중장세포형태위소세포형자24례(77.4％),위성숙장세포형자6례(19.4％),위불성숙장세포형자1례(3.2％);류식세포술검사시균위CD38+CD138+CD19-CD45-,기CD56양성솔교음성조저(35.5％대61.4％,P=0.009),CD20양성솔교음성조고(29.0％대4.0％,P＜0.001);면역조직화학염색시cyclinD1+자22례(71.0％).결론 IgD형화불분비형MM환자CCND1기인양성검출솔교고,상상표현위소세포형형태,반CD20고표체화CD56표체감저,다표체cyclinD1.주요수여림파장세포림파류등구유장세포양분화특정적소B세포림파류상감별.
Objective To study the clinical and pathologic features of multiple myeloma (MM) with CCND1.Methods Retrospectively analyzed the clinical and pathologic profiles of 158 patients with MM from 2010 to 2013.The clinical and morphologic features of bone marrow aspiration,biopsy and immunophenotypic analysis which was carried out by flow cytometry and immunohistochemistry were analyzed in all patients with MM respectively.CCND1 translocation was studied by FISH method in all cases.Classical cytogenetic studies of bone marrow were performed in 24 cases whose CCND1 was positive.Results In the 158 patients with MM,CCND1 was detected in 31 patients (19.6％).In 31 patients,type IgA,IgD,IgG,IgM,light-chain only and nonsecretory MM were 4 cases,4 cases,11 cases,1case,6 cases and 5 cases respectively.A high incidence of CCND1 was observed in IgD and nonsecretory MM comparied with IgA and IgG respectively (P＜0.05).but no statistical significance was reached between κ and λ type patients (P=0.627).The morphology of plasma cell in bone marrow biopsies were small Lymphocyte-Like 24 cases,mature plasma cell 6 cases and immature plasma cell 1 case.Immunophenotype of all 31 cases was CD38+CD138+CD19-CD45-,CD56+ in 11 cases,CD20+ in 9 cases,CD117+ in 3 cases.MM with CCND1 showed a strong association with CD20 expression,the lack of CD56 expression.Immunohistochemistry showed positive for cyclinD1 in 22 cases.Conclusions A high incidence of CCND1 was detected in the IgD and nonsecretory MM,and correlated with Small Lymphocyte-Like,higher positive rate of CD20,cyclinD1 and the lack of CD56 expression.MM with CCND1 must be distinguished from LPL and other mature B cell lymphomas which have plasmacytoid differentiation.
