根据WHO淋巴造血系统肿瘤新分类对山西省淋巴瘤分布特点的分析

Prevalence of lymphoma subtypes in Shanxi according to latest WHO classification

目的根据WHO淋巴造血系统肿瘤新分类标准、分析山西省恶性淋巴瘤的分布特点。方法重新阅读HE切片,选用免疫组织化学ABC法标记间变性淋巴瘤激酶(ALK)1、bcl-6、CD(1α、3、4、5、7、8、10,15、20、23、30、43、56、68、79α和99)、细胞周期蛋白(cyclin)D1、上皮膜抗原(EMA)、IgD,κ,λ、潜伏膜抗原(LMP)1、PAX5、末端脱氧核苷酸转移酶(TdT)和Vs38C;原位杂交方法标记EBER RNA。按照WHO淋巴造血系统肿瘤新分类标准,对山西省肿瘤医院存档的447例淋巴瘤组织标本重新分类。结果447例淋巴瘤中,385例(86·1%)为非霍奇金淋巴瘤(NHL),62例(13·9%)为霍奇金淋巴瘤(HL)。68·3%NHL为B细胞来源,30·6%为T和NK细胞来源,组织细胞来源的肿瘤仅占3例(0·8%)。弥漫大B细胞淋巴瘤(DLBCL)为最常见的类型(35·1%),其他依次为外周T细胞淋巴瘤、非特殊型(PTun,12·0%)、黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤,11·7%),滤泡性淋巴瘤(FL,8·6%),前体淋巴母细胞性淋巴瘤(T-LBL,7·0%),间变性大细胞淋巴瘤(ALCL,4·2%),小淋巴细胞性淋巴瘤(B-SLL,3·6%)和套细胞淋巴瘤(MCL,2·6%)。263例B细胞淋巴瘤105例(39·9%)表达免疫球蛋白轻链,包括52例κ和53例λ。263例B细胞淋巴瘤14例表达LMP-1,14例表达EBER;119例T和NK细胞淋巴瘤6例表达LMP-1,19例表达EBER,NHL中LMP-1和EBER表达具有不一致性。62例HL37例(59·7%)一致表达LMP-1和EBER RNA,包括7例富于淋巴细胞型HL、11例混合细胞型HL和19例结节硬化型HL。结论所搜集到的山西省DLBCL的比率类似于美国、澳大利亚、日本和韩国,FL的比率明显低于美国和澳大利亚。

Objective To analyze the prevalence of lymphoma subtypes in Shanxi according to the latest World Health Organization （WHO） classification, and to compare the figures with those in other parts of the world. Methods The hematoxylin and eosin-stained sections of 447 lymphoma cases from the archive files of Shanxi Tumor Hospital were reviewed. Immunohistomchemical study was performed using a panel of antibodies, including ALK1, bcl-6, CD （1a, 3, 4, 5, 7, 8, 10, 15, 20, 23, 30, 43, 56, 68, 79a and 99）, cyclin D1, EMA, IgD, kappa, lambda, LMP1, PAXS, TdT and Vs38C. In addition, in-situ hybridization for Epstein-Barr virus-encoded RNA （EBER） was carried out. All cases were then reclassified according to the latest WHO classification of lymphoma. Results Of the 447 cases studied, 385 cases （86. 1% ） were confirmed to be non-Hodgkin lymphoma （NHL）, while 62 cases （13.9%） belonged to classic Hodgkin lymphoma （HL）. Of the NHL cases, 68.3% were of B-cell lineage and 30. 6% were of T and/or NK-cell lineage. Histiocytic neoplasm accounted for only 0. 8% （3 cases）. As for the subtyping of NHL, diffuse large B-cell lymphoma was commonest （35. 1% ）, followed by peripheral T-cell lymphoma, NOS （ 12. 0% ）, extranodal marginal zone B-cell lymphoma （ MALT lymphoma） （ 11.7% ）, follicular lymphoma （8. 6% ）, T-lymphoblastic lymphoma （7. 0% ）, anaplastic large cell lymphoma （4. 2% ）, Bsmall lymphocytic lymphoma （3. 6% ） and mantle cell lymphoma （2. 6% ）. Amongst the 263 cases of B-cell lymphoma, 105 cases （39.9%） expressed immunoglobulin light chain （kappa in 52 cases and lambda in 53 cases） in paraffin sections. Regarding markers for EB virus infection, 14 cases of the B-cell lymphoma gave positive findings with both EBER in-situ hybridization and LMP-1 immunohistochemistry, while 6 of the T/ NK-cell lymphoma expressed LMP-1 and 19 showed positive signals for EBER. In NHL, there was discordance in EBER in-situ hybridization and LMP-1 immunohistochemical results. As for HL, EB virus positivity was noted in 37 of the 62 cases （59. 7% ）, including 7 cases of lymphocyte-rich HL, 11 cases of mixed cellularity HL and 19 cases of nodular sclerosis HL In classic HL, there was complete concordance of results by both EBER in-situ hybridization and LMP-1 immunohistochemistry. Conclusions The prevalence of diffuse large B-cell lympboma in Shanxi is similar to that in America, Australia, Japan and Korea. The incidence of follicular lymphoma however is much lower than America and Australia.