CAJ | 학술논문

目的分析新疆维吾尔自治区汉族、维吾尔族老年人EB病毒(EBV)阳性弥漫大B细胞淋巴瘤(DLBCL)的临床特征及预后影响因素.方法回顾性分析新疆维吾尔自治区人民医院病理科250例DLBCL患者中EBV阳性患者的临床资料,应用免疫组织化学技术和原位杂交方法分别进行组织学分型和EBV检测.结果 250例DLBCL患者中,EBV阳性DLBCL老年患者36例(年龄≥60岁28例),其中汉族21例,维吾尔族15例,男女比为2:1;结内病变23例,结外13例.Ann Arbor分期中Ⅰ、Ⅱ期7例,Ⅲ、Ⅳ期29例;血清乳酸脱氢酶升高30例,国际预后指数中-高危险度22例.组织形态学观察:淋巴结及结外组织正常结构破坏,炎性背景中可见弥漫浸润的中心母细胞、免疫母细胞及R-S样巨细胞.免疫组织化学分析:CD20/CD79a强阳性,Ki-67高表达.依据CD10、bcl-6、Mum-1进行组织学分型,非生发中心型31例.新疆维吾尔自治区汉族、维吾尔族老年人EBV阳性DLBCL的年龄和发病部位差异具有统计学意义(P＜0.05),其余临床指标及组织学分型差异均无统计学意义(P＞0.05).结论新疆维吾尔自治区汉族、维吾尔族老年人EBV阳性DLBCL发病率低,具有DLBCL独特的临床病理亚型,预后不良,且发病与EBV有一定关系.
목적 분석신강유오이자치구한족、유오이족노년인EB병독(EBV)양성미만대B세포림파류(DLBCL)적림상특정급예후영향인소.방법 회고성분석신강유오이자치구인민의원병이과250례DLBCL환자중EBV양성환자적림상자료,응용면역조직화학기술화원위잡교방법분별진행조직학분형화EBV검측.결과 250례DLBCL환자중,EBV양성DLBCL노년환자36례(년령≥60세28례),기중한족21례,유오이족15례,남녀비위2:1;결내병변23례,결외13례.Ann Arbor분기중Ⅰ、Ⅱ기7례,Ⅲ、Ⅳ기29례;혈청유산탈경매승고30례,국제예후지수중-고위험도22례.조직형태학관찰:림파결급결외조직정상결구파배,염성배경중가견미만침윤적중심모세포、면역모세포급R-S양거세포.면역조직화학분석:CD20/CD79a강양성,Ki-67고표체.의거CD10、bcl-6、Mum-1진행조직학분형,비생발중심형31례.신강유오이자치구한족、유오이족노년인EBV양성DLBCL적년령화발병부위차이구유통계학의의(P＜0.05),기여림상지표급조직학분형차이균무통계학의의(P＞0.05).결론 신강유오이자치구한족、유오이족노년인EBV양성DLBCL발병솔저,구유DLBCL독특적림상병리아형,예후불량,차발병여EBV유일정관계.
Objective To analysis the clinical features of elderly diffuse large B-cell lymphoma (DLBCL) patients with Epstein-Barr virus (EBV) infection and their prognostic factors.Methods 250 cases of DLBCL were retrospectively studied by in situ hybridization (ISH) to detect the EBV and by immunohistochemical to evaluate the histological type and Ki-67 protein.Results 36 cases with EBVpositive included 28 elderly (aged ≥ 60 years), of which 21 cases were Han, 15 cases were Uygur, male/ female ratio was 2 : 1.There were 23 cases with nodal presentation only, 13 cases with extra-nodal presentation.Twenty-nine patients presented with advanced disease (Ann Arbor stage Ⅲ/Ⅳ), 30 patients were found with high lactate dehydrogenase (LDH), 22 patients with high IPI score (3-5).Histological observation showed a diffuse and polymorphic proliferation of large lymphoid cells with varying degrees of reactive components.These tumor cells were frequently characterized by a broad range of B-cell maturation, containingcentroblasts, immunoblasts, and Hodgkin-and Reed-Stemberg (HRS)-like giant cells.Immunohistochemical studies showed that tumor cells were positive for CD20 and (or) CD79a in almost cases, most of the cases had a high proliferative index.CD10, bcl-6, Mum-1 performed histological type, 31 cases were non-germinal center.Except the age and location (P ＜ 0.05), no other significant differences were observed in Han and Uygur elderly EBV+ DLBCL (P ＞ 0.05).Conclusion The incidence of elderly EBV+ DLBCL is low, it has some unique clinical and pathological features with poor prognosis.