非霍奇金淋巴瘤365例WHO新分类的临床病理分析

Clinicopathologic analysis and classification of 365 cases of non-Hodgkin's lymphomas according to the new WHO criteria

目的 探讨广东地区非霍奇金淋巴瘤的临床病理特征。方法 按照WHO恶性淋巴瘤新分类诊断标准对广东地区 3家医院 36 5例NHL进行重新分类。从患者的年龄、性别、部位、免疫标记、基因重排检测、病理诊断 6个方面进行统计学分析。结果 36 5例NHL中 ,结内 14 1例 ,结外 2 2 4例 ;在 2 2 4例结外淋巴瘤中 ,最常见的部位依次是消化道、鼻腔、颅内 ;B细胞淋巴瘤 2 71例 ,T细胞淋巴瘤 92例 ,非T非B淋巴瘤 2例 ;113例B细胞淋巴瘤IgH基因重排检测 ,阳性率为 82 3% ;4 5例T细胞淋巴瘤TCRγ基因重排检测 ,阳性率为 91 1%。在B细胞淋巴瘤中 ,最常见的依次是弥漫性大B细胞淋巴瘤、黏膜相关淋巴组织型边缘区B细胞淋巴瘤、滤泡性淋巴瘤。在 92例T细胞淋巴瘤中 ,最常见的是周围T细胞淋巴瘤。结论 广东地区结外淋巴瘤的比率超过结内 ,T细胞淋巴瘤的发病率较西方国家高 。

Objective To analyze the clinicopathologic characteristics of non- Hodgkin's lymphoma diagnosed in Guangdong according to the newly proposed WHO classification of non-Hodgkin's lymphoma. Methods A total of 365 cases of non- Hodgkin's lymphoma diagnosed in three hospitals in Guangdong area were enrolled in this study. Hematoxylin and eosin stained slides and immunohistochemical stains were reviewed. All cases were classified according to new WHO classification of non-Hodgkin's lymphoma (2001). Clinical data, including age, gender, and site of disease involvement, were reviewed. Results Among the 365 NHL cases, 271 were of B-cell lymphomas,92 were of T-cell lymphomas and 2 were of non-B and non-T lymphomas. Diffuse large B-cell lymphoma, extranodal marginal zone lymphoma, and follicular lymphoma were the most common B-cell subtypes and represented 43.3%,11.5%,and 5.5%, respectively, of all NHL cases. Among the 92 cases of T-cell lymphomas, unspecified peripheral T-cell lymphoma were the most common subtypes (17.8%). Monoclonal IgH gene rearrangements were found in 92 out of 113 samples (82.3%) from malignant B cell lymphomas and TCRγ gene rearrangements were found in 41 out of 45 samples (91.1%) from malignant T cell lymphomas. The rate of extranodal lymphoma exceeded that of lymph node lymphoma, the three most common extranodal sites were the gastrointestinal tract, nasal and central nervous system. Conclusion The incidences for various subtypes of non-Hodgkin's lymphomas in Guangdong are distinct from those in Western countries and similar in many ways to those in other countries in the Far East. Compared with other western countries, Guangdong has a higher rate of extranodal lymphoma, lower rate of follicular lymphoma, and the younger median age of patients.