弥漫大B细胞淋巴瘤骨髓侵犯的异质性与病理特征

Heterogeneity and pathological features of bone marrow invasion in diffuse large B-cell lymphoma

目的探讨弥漫大B细胞淋巴瘤(DLBCL)骨髓侵犯的异质性与病理特征。方法选取2015年1月至2018年1月间安康市中医医院收治的49例DLBCL骨髓侵犯患者的临床资料进行回顾性分析,分析其病理结果、骨髓活检及异质性。结果49例DLBCL骨髓侵犯患者中,骨髓侵犯方式分别为弥漫型59.2%(29/49),间质型16.3%(8/49),混合型14.3%(7/49),结节型6.1%(3/49),窦内型4.1%(2/49);侵犯程度中,重度占57.1%(28/49),中度占22.4%(11/49),轻度占20.4%(10/49);按照细胞形态学区分,中心母细胞型占81.6%(40/49),免疫母细胞型占10.2%(5/49),间质型占8.2%(4/49)。所有患者表达CD10、CD45RA或Pax5等B细胞阳性种类均超过一种,而CD3、CD5和CD38等不表达,但DLBCL骨髓侵犯Ⅰ~Ⅱ期和Ⅲ~Ⅳ期患者CD10、CD45RA及Pax5细胞异质性表达阳性率比较,差异无统计学意义(P>0.05)。49例DLBCL骨髓侵犯患者中,17例有髓外部位组织样本,对其髓外与髓内瘤细胞形态学比较发现,髓内、髓外瘤细胞形态一致。结论DLBCL骨髓侵犯方式多为弥漫型,侵犯程度重度占比较高,细胞形态学多为中心母细胞型,异质性分析中CD10、CD45RA或Pax5 B细胞阳性有助于DLBCL的诊断,但其不能用于DLBCL分期的诊断,髓外瘤细胞形态也可用于DLBCL的诊断。

Objective To investigate the immunophenotypic heterogeneity and pathological features of bone marrow invasion in diffuse large B-cell lymphoma(DLBCL).Methods Retrospective analysis of clinical data of 49 patients with DLBCL complicated with bone marrow invasion admitted to Ankang Hospital of Traditional Chinese Medicine from January 2015 to January 2018.The pathological results,bone marrow biopsy and heterogeneity were analyzed.Results The major types of bone marrow invasion included diffuse type 59.2%(29/49),interstitial type 16.3%(8/49),mixed type 14.3%(7/49),nodular type 6.1%(3/49),and intrassinus type 4.1%(2/49).Moderate to severe invasion occurred in 57.1%(28/49)patients.Moderate invasion occurred in 22.4%(11/49)patients and mild invasion occurred in 20.4%(10/49)patients.According to the differentiation of cell morphology,the central mother cell accounted for 81.6%(40/49),the immune mother cell accounted for 10.2%(5/49)and intrassinus type accounted for 8.2%(4/49).More than one type of positive B cells was expressed such as CD10,CD45 RAor Pax5,while CD3,CD5 and CD38 were not expressed in all the patients.However,there was no significant difference in the positive expression rate in CD10,CD45 RAand heterogeneity of Pax5 cells between patients with DLBCL complicated with stageⅠ-Ⅱbone marrow involvement and patients with DLBCL complicated with stageⅢ-Ⅳbone marrow involvement(P>0.05).Among the 49 patients with DLBCL complicated with bone marrow invasion,tissue samples for extramedullary location were available in 17 patients,and the morphological comparison between extramedullary and intramedullary tumor cells showed that the morphology of intramedullary tumors was consistent that of extramedullary tumors.Conclusion The major type of DLBCL-bone marrow invasion diffuse was diffuse and the degree of invasion was relatively high.The cell morphology mostly was central mother cell type.In the heterogeneity analysis,the positive expression of precursor B cells for CD10,CD45 RAor Pax5 was helpful for the diagnosis of DLBCL,but it could not be used for the diagnosis of stages for DLBCL.The cell morphology of extramedullary tumors could also be used for the diagnosis of DLBCL.