5种Ig蛋白重链在黏膜相关淋巴组织淋巴瘤中的表达及其临床病理意义

Expression and clinical pathological significance of the five types heavy chain of Ig protein in mucosa-associated lymphoid tissue lymphoma

目的探讨黏膜相关淋巴组织淋巴瘤(mucosa-associated lymphoid tissue lymphoma,MALToma)中Ig蛋白重链表达及其鉴别诊断价值和临床病理意义。方法收集50例非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)作为实验组,包括30例MALToma、10例滤泡性淋巴瘤(follicular lymphoma,FL)、10例浆细胞瘤(plasmacytoma,PC),并以10例反应性淋巴组织增生(reactive lymphoid hyperplasia,RLH)作为对照组,应用免疫组化En Vision法检测两组中IgM、IgA、IgD、IgG、IgE的表达,分析两组间及实验组3种肿瘤中Ig蛋白重链的表达,并分析MALToma中5种Ig蛋白重链表达与各临床病理特征的关系。结果IgM、IgA在实验组、MALToma及PC中的阳性率均低于对照组(P<0.05);IgG、IgA在FL中的阳性率低于对照组(P<0.05)。IgM在FL、MALToma、PC中的阳性率及表达强度呈升高趋势(P<0.05);IgG的阳性率呈下降趋势(P>0.05)。Ig蛋白重链在两组表达模式有3种:单种Ig重链、全阴性Ig重链缺失及多种Ig重链表达。MALToma、FL、PC中单种Ig重链/全阴性Ig重链缺失阳性率分别为86.7%、60%、80%,对照组中均为多种Ig重链表达,3种肿瘤与RLH中单种Ig重链/全阴性Ig重链缺失阳性率比较差异均有统计学意义(P<0.05)。MALToma中IgG阳性率与肿瘤细胞类型相关(P<0.05)。结论 IgM和IgG在FL、MALToma、PC表达呈此消彼长趋势,支持生发中心后来源的MALToma和PC大多经历了抗体类别转换,且高频表达单种IgG。MALToma中单种Ig重链/全阴性Ig重链缺失表达是一种常见高频事件,有助于MALToma与RLH的鉴别诊断。

Purpose To investigate the expression of the heavy chain of lg protein, and observed it＇ s value on differential diagnosis and significance on clinical pathological. Methods 50 eases of non-Hodgkin＇ s lymphoma （NHL） were collected as experimental group,including 30 cases of MALToma, 10 cases of follicular lymphoma （FL）, and lO cases of plasmacytoma （ PC）, 10 cases of reactive lymphoid hyperplasia （RLH） were collected as control group. The expression of IgM, IgA, IgD, IgG and IgE were detected by immunohistochemistry in the two groups. Results The lower positive rates of IgM, IgA were observed in the experimental group, MALToma, PC, and the lower positive rates of IgG, IgA were observed in FL （P 〈 0. 05）. The positive rate and expression intensity of IgM showed a rising trend （ P 〈 0. 05 ） , and the positive rate of IgG show a downward trend （ P 〉 0. 05） in FL, MALToma, PC. There were three patterns of the heavy chain expression in the two groups： a singletype expression, all negative expression, and a various type expression. The positive rates of a single type/all negative heavy chain expression were 86.7% , 60% , 80% , 0 respectively in MALToma, FL, PC and RLH, the differences were statistically significant （P 〈 0. 05）. The positive rate of lgG was related to the type of tumor ceils in MALToma（ P 〈 0. 05 ）. Conclusion The expressions of IgM and IgG show a contrast /rend in FI,, MALToma, PC, and support that the tnosl of MALToma and PC which come from post-germinal center experience class switch recombination, and frequently express a single lgG. A single type/all negative heavy chain expression is a frequent event in the MALToma, and it＇ s helpful to the differential diagnosis of MALToma and RLH.