原发性CD5阳性的弥漫性大B细胞淋巴瘤4例临床病理分析

CD5-positive diffuse large B-cell lymphomas:a clinicopathologic analysis of four cases

目的探讨CD5阳性的弥漫性大B细胞淋巴瘤的临床病理特征、诊断、治疗及预后。方法回顾性分析4例CD5阳性的弥漫性大B细胞淋巴瘤患者的临床资料、组织病理形态及免疫组化结果。结果 4例患者年龄均>60岁,乳酸脱氢酶和α-羟丁酸脱氢酶水平均显著升高。光镜下分别在纤维组织中、肝窦内、髓腔中及淋巴结内可见成片或弥漫的体积中～大的异型淋巴样细胞浸润。免疫组化示4例CD20、PAX-5和CD5均弥漫(+),Ki-67阳性率约60%～80%,CD3、CD10和cyclinD1均(-);3例bcl-2弥漫(+),1例部分(+)。随访0.5～10个月,3例患者6个月内死亡。结论 CD5阳性的弥漫性大B细胞淋巴瘤是一种具有高度侵袭性的弥漫性大B细胞淋巴瘤的亚型,主要累及老年人,预后较差,因此正确掌握临床病理及免疫组化特征对该病的诊断具有重要意义。

Objective To investigate the clinicopathological features, diagnosis, therapy and prognosis of CD5 ＋ diffuse large B cell lymphoma. Methods Retrospective analysis of the clinical data was conducted in four cases of CD5 ＋ diffuse large B cell lymphoma, and the pathological and immunohistochetnical results were analyzed. Results All patients were more than 60 years old, with higher level of serum lactate dehydrogenase and ot-hydroxybutyrate dehydrogenase. Under light microscope, there were many atypical lymphocyte-like ceils of medium-large size infiltrating in the fibrous connective tissue, hepatic sinusoids, bone marrow, and lymph node. Immunohistochemistry showed that CD20, PAX-5 and CD5 were diffusely positive, the positive rate of Ki-67 was from 60% to 70%. CD3, CDIO and cylcinD1 were all negative, and bcl-2 was diffusely positive in 3 cases but partially in 1 case. After a follow-up of 10 months, 3 of 4 patients died in 6 months. Conclusions CD5 ＋ diffuse large B cell lymphoma is a highly aggressive subtype of diffuse large B cell lymphoma, involves older people and shows a poor prognosis. Therefore, understanding the clinical pathological and immunohistochemical features of this disease, will play an important role in the diagnosis of CD5 ＋ DLBCL.