96例淋巴母细胞淋巴瘤临床病理分析

A clinicopathological study of 96 cases of lymphoblastic lymphoma

目的探讨淋巴母细胞淋巴瘤(LBL)病理组织学特点及免疫组织化学特征.方法对96例LBL作免疫组化检测,结合临床资料进行临床病理分析.患者中位年龄16(4～72)岁.男69例,女27例.结果原发于淋巴结者73例,其中伴纵隔肿物31例;骨髓侵犯15例.临床Ⅲ～Ⅳ期73例,中位生存期5.5(2～120)个月.TdT阳性率为75.0%(72例),CD99阳性率为92.7%(89例).肿瘤为T细胞标志者78例,B细胞标志18例.小于30岁年龄组T细胞标志占82.1%(64例),伴纵隔肿块者T细胞标志占93.6%(29例).T-LBL、临床Ⅲ～Ⅳ期、Ki-67增殖指数＜80%以及非化疗组预后较差(P＜0.01).结论青少年男性,临床上出现纵隔占位伴浅表或多处淋巴结肿大应考虑LBL可能;TdT阴性不能排除LBL诊断;T-LBL多见;临床分期、免疫表型、Ki-67表达水平与预后相关;及时有效的化疗是延长生存期的关键.

Objective To investigate the clinicopathological and immunohistochemical features of lymphoblastic lymphoma (LBL). Methods A retrospective clinicopathological study of 96 cases LBL was carried out. Immunohistochemical staining was used for the characterization and immunophenotyping. Results The patients age ranged from 4 to 72 years, with a median of 16 years, 69 patients were male and 27 female. Seventy-three cases had superficial or multi-lymphoadenopathy and 31 of them had mediastinal masses. Bone marrow was involoved in 15 cases. Seventy-three cases were in clinical stages Ⅲ and Ⅳ. The median survival of the followed-up patients was 5.5 (2~120)months. TdT and CD99 positive reactions were 75.0% and 92.7%, respectively. Of the 96 cases, 78 displayed T-cell marker positivity and 18 B-cell markers. 82.1% of the patients younger than 30 years of age had significantly higher incidences of T-LBL (64 patients), and 93.6% of the patients with mediastinal masses expressed T-cell markers. The poor prognostic factors were T-cell tumors, clinical stages Ⅲ and Ⅳ, Ki-67 PI<80% and no chemotherapy (P<0.01). Conclusion In children and young males, mediastinal masses with superficial or multi-lymphoadenopathy favors the diagnosis of LBL,but negative TdT reaction can not exclude this diagnosis. T-LBL is more common than B-LBL. Clinical stages, immunophenotypes and the level of Ki-67 expression were closely related with prognosis of LBL.