CD20阴性弥漫性大B细胞淋巴瘤一例

Diffuse large B-cell lymphoma with negative CD20: a case report

CD20阴性弥漫性大B细胞淋巴瘤(DLBCL)是一类罕见的侵袭性较强且较难诊断的淋巴增生性疾病,多发于免疫抑制合并病毒感染者。该文报道了1例原发于淋巴结的70岁CD20阴性DLBCL女性患者,其反复发热约半年,左侧颈部淋巴结进行性肿大,质韧,无触痛。首诊考虑为转移性肿瘤,最终由专业的病理医师对颈部淋巴结活组织切片进行复检,行免疫组织化学检查示P63(+++),CD30(+++),LCA(+++),PAX8(+++),P53(90%+),PAX5(+++),MUM1(+),BCL2(+++),BCL6(+++),C-MYC(80%+),Ki-67 (index 30%);分子病理示EBER(散在+),CD20(-),TIA1(-),CD43 (-),EMA (-),CD7 (-),ALK (-),Ber-EP4 (-),CD3 (-),CDX2(-),CK20(-),CK7(-),Napsin A(-),TTF-1(-),WT-1(-),CD10(-),考虑为CD20阴性DLBCL(间变亚型,非生发中心型)。结合影像学、血液学等辅助检查确诊为DLBCL。确诊后予患者CTOD方案(环磷酰胺+地塞米松+吡柔比星)化学治疗,其病情稳定后出院,随后失访。

CD20-negative diffuse large B-cell lymphoma （DLBCL） is a rare and invasive type of lymphoproliferative disease, which is difficult to be diagnosed and primarily occurs in patients with immunosuppression complicated with viral infection. In this study, one female 70-year-old patient diagnosed with CD20- negative DLBCL originating from the lymph nodes was reported. She experienced recurrent fever for approximately half a year, and progressive enlargement in the left cervical lymph nodes with toughening and no tenderness. The patient was suspected with a metastatic tumor during the first diagnosis, and finally diagnosed with lymphoma via biopsy of the cervival lymph nodes by professional pathologists, hnmunohistochemical examination demonstrated P63 （＋＋＋）, CD30 （＋＋＋）, LCA （＋＋＋）, PAX8 （＋＋＋）, P53 （90% ＋）, PAX5 （＋＋＋）, MUM1 （＋）, BCL2 （＋＋＋）, BCL6 （＋＋＋）, C-MYC （80% ＋） and Ki-67 （index 30%）. The molecular pathological examination revealed EBER （diffuse ＋ ）, CD20 （-）, TIA1 （-）, CD43 （-）, EMA （-）, CD7 （-）, ALK （-）, Ber-EP4 （-）, CD3 （-）, CDX2 （-）, CK20 （-）, CK7 （-）, NapsinA （-）, TTF-1 （-）, WT-1 （-） and CD10 （-）. The possibility of negative CD20 DLBCL was considered （anaplastic, non-germinal center B-cell-like）. The diagnosis of DLBCL was confirmed combined with auxiliary examinations, such as imaging and hematological tests. She received chemotherapy using the CTOD regimen （ cyclophosphamide ＋ dexamethasone ＋ pirobisin） and was discharged after her physcial condition became stable. She was lost to subsequent follow-up.