扁桃体原发性恶性淋巴瘤的免疫病理学特征

Immunopathological characteristics of tonsillar malignant lymphoma

目的:探讨扁桃体原发性恶性淋巴瘤的类型特征和Ki-67、bcl-6及CD10的表达,阐明其生物学意义。方法:应用组织形态学和免疫组织化学方法,按照WHO造血和淋巴组织肿瘤第四版分类,复查50例扁桃体原发性恶性淋巴瘤的诊断并标记分类观察。结果:本组滤泡性淋巴瘤(FL)37例,弥漫大B细胞淋巴瘤(DLBCL)9例,伯基特淋巴瘤(BL)和外周T细胞淋巴瘤(PTCL)各2例。FL 1、2级为惰性淋巴瘤16例;Ki-67阳性在惰性淋巴瘤占25%(4/16),侵袭性占58.06%(18/31),Ki-67表达在不同恶性程度组间比较差异有统计学意义(P<0.05);bcl-6在88%(44/50)的扁桃体恶性淋巴瘤中不同程度表达。bcl-6+/bcl-2+在低级别FL中占40.00%(8/20),高级别中占61.89%(13/21),DLBCL中占77.78%(7/9);CD10表达在性别组间比较差异有统计学意义(P<0.05)。结论:本组病例均为非霍奇金恶性淋巴瘤;以FL为主,其次是DLBCL,而BL和PTCL少见;从低级别FL转变为高侵袭性DLBCL,Ki-67表达率有增高趋势;bcl-6在不同类型中表达不同,侵袭性淋巴瘤中的表达明显高于惰性淋巴瘤;bcl-6+/bcl-2+表达从FL低级别到高级别并向DLBCL转变过程中依次增高。

Objective To study the subtypes of 50 cases of tonsillar malignant lymphoma and the expressions of Ki-67,bcl-6 and CD10 and explore their bilolgical significance.Methods By means of histomorphology and immunohistochemistry,50 cases of primary tonsillar biopsy were reviewed according to the new classification of WHO(2008).Results There were 37 cases of follicular lymphoma(FL),9 cases of diffuse large B-cell lymphoma(DLBCL),2 cases of Burkitt' s lymphoma(BL) and 2 cases of peripheral T-cell lymphoma(PTCL),16 cases of FL grade 1 and 2.The expression of Ki-67 was in 25%(4/16) of the indolent lymphoma,and 58.06%(18/31) of the aggressive lymphoma.The Ki-67 expression showed significant difference between different grades of malignancy(P<0.05).The variable expression of bcl-6 was in 88%(44/50) of NHL of tonsil.Coexpression of bcl-2+ and bcl-6+ in 40%(8/20)of the low grade FL,61.89%(13/21) of the high grade FL and 77.78%(7/9)of DLBCL.The CD10 expression showed statistical significance between genders(P<0.05).Conclusion All the cases of tonsillar malignant lymphoma are non-Hodgkin' s lymphoma.The most histological subtypes is FL,in turn DLBCL,BL and PTCL.There is a rising tendency of Ki-67 expression from low grade FL to aggressive DLBCL.The expressions of bcl-6 vary in different subtypes such as FL,DLBCL,BL and PTCL.There is an increase trend of bcl-2+ and bcl-6+ coexprssions in low grade FL,high grade FL and DLBCL in sequence.