弥漫性大B细胞淋巴瘤的临床病理和免疫组织化学特征

A clinicopathologic and immunohistochemical study of diffuse large B-cell lymphoma

目的 探讨弥漫性大B细胞淋巴瘤临床和病理组织特征以及免疫组织化学特异性抗体在其诊断和鉴别诊断中的价值。方法 收集 6 0例弥漫性大B细胞淋巴瘤 ,总结其临床资料和病理学特点 ,用免疫组织化学EnVisionTM两步法标记白细胞共同抗原 (LCA)、L2 6、BLA36、CD30和bcl 6抗体。结果 76 7% (4 6 / 6 0 )弥漫性大B细胞淋巴瘤的发病年龄集中在 40～ 70岁 ,淋巴结内外均可累及 ,90 0 % (5 4/ 6 0 )患者临床分期为Ⅱ (2 4/ 5 4)、Ⅲ (2 1/ 5 4)、Ⅳ (9/ 5 4)期。组织病理形态 :中心母细胞淋巴瘤占 88 3% (5 3/ 6 0 ) ,免疫母细胞淋巴瘤占 3 3% (2 / 6 0 ) ,间变性大细胞淋巴瘤占 3 3% (2 / 6 0 ) ,富于T细胞的B细胞淋巴瘤占 5 0 % (3/ 6 0 )。免疫标记LCA、L2 6、BLA36表达率为 10 0 0 % (6 0 / 6 0 ) ,CD30表达率为 3 3% (2 / 6 0 ) ,bcl 6表达率为 95 0 % (5 7/ 6 0 )。结论 弥漫性大B细胞淋巴瘤是一组异质性肿瘤 ,侵袭性大 ,必需结合其组织病理形态和特异抗体的免疫组织化学检测进行诊断和鉴别诊断。

Objective To study the clinicopathologic and immunohistochemical features of diffuse large B-cell lymphoma (DLBCL) and the significance of immunohistochemistry in diagnosis and differential diagnosis of DLBCL. Methods 60 cases of DLBCL were studied and immunohistochemical staining for LCA, L26, BLA-36, CD30, bcl-6 were carried out with the EnVision 2 step method. Results The age range of 76.7%(46/60) patients was 40-70 years. The location of the lesion includes nodal and extranodal sites. 90.0% (54/60) were in clinical stages of Ⅱ(24/54)?Ⅲ(21/54)?Ⅳ(9/54). Histopathologic morphology presented as centroblastic (88.3%, 53/60), immunoblastic (3.3%, 2/60), anaplastic large B cell type (3.3%, 2/60) and T cell rich B cell type (5.0%, 3/60). Immunostaining showed 100% (60/60) DLBCL were positive for LCA, L26, BLA36, 3.3%(2/60) DLBCL positive for CD30, 95% (57/60) expressed bcl-6 protein. Conclusions DLBCL is an aggressive lymphoma which shows cytologic variability from case to case. The evaluation of pathologic features and immunohistochemistry in DLBCL are useful and practical for diagnostic purposes, but cannot delineate distinctive morphologic subtypes.