老年人EBV阳性的弥漫性大B细胞性淋巴瘤临床病理观察

EBV-positive diffuse large B-cell lymphoma of elderly:a clinicopathological study

目的探讨EB病毒阳性的老年人弥漫性大B细胞性淋巴瘤(DLBCL)的组织形态特征、免疫组化、诊断与鉴别诊断,观察治疗及预后情况。方法对2例老年人EBV阳性的DLBCL行HE和免疫组化染色观察,收集临床资料并随访。结果患者年龄分别为58岁和72岁,无免疫缺陷及淋巴瘤病史。病理改变主要为大小差别较大的异型淋巴细胞弥漫浸润,散在少数R-S样细胞,可见广泛的地图样肿瘤性坏死及血管中心性浸润。免疫组化显示异型肿瘤细胞CD20弥漫强(+),80%～90%肿瘤细胞胞核EBV原位杂交呈中～强(+)。随访3～6个月,1例死亡。结论老年人EBV阳性的DLBCL罕见,是最近正在被逐渐认识的新淋巴瘤类型,其临床和病理特征独特,诊断需与淋巴瘤样肉芽肿和EBV阳性的霍奇金淋巴瘤鉴别。

Objective To analyze the clinicopathologic features of the EBV positive diffuse large B-cell lymphoma （DLBCL） of the elderly. Methods Immunohistoehemistry （IHC） and H-E staining were analyzed in 2 cases of DLBCL of elderly. Follow-up data were available. Results The cases occurred in elderly （58 years and 72 years old） without any known immunodeficieney or prior lymphoma. The main pathologic manifestations were atypical lymphoid cells varying from small nuclear to large, diffuse invasion into the fibrous tissue. Angiocentrie patterns of the lymphoid infiltration and Reed-Sternberg （HRS）-like giant cells scattered in the polymorphous composition were present. Extensive necrosis was seen in both cases. The atypical tumor cells were CD20 ＋ , and most of the tumor cells were EBV positive in nuclei by in situ hybridization. Conclusion EBV-positive DLBCL of the elderly is rare, and it is a newly recognized lymphoma. The clinicopathologic features are unique. It is important to exclude lymphomatoid granulomatosis and EBV-positive Hodgkin lymphoma before its diagnosis.