原发性乳腺弥漫性大B细胞淋巴瘤4例临床病理分析

Clinicopathological analysis of 4 cases of primary breast diffuse large B-cell lymphoma

目的:探究原发性乳腺弥漫性大B细胞淋巴瘤(Primary breast diffuse large B-cell lymphoma,PB-DLBCL)的临床病理特征、鉴别诊断及治疗预后。方法:收集右江民族医学院附属医院病理科2017年1月至2020年12月就诊的4例PB-DLBCL患者的相关临床资料、病理组织切片及免疫组化表型并结合相关文献进行分析。结果:4例均为中青年女性,年龄38~56岁,均因乳腺无痛性增大包块就诊,左乳2例,右乳2例。3例为非生发中心型,1例为生发中心型。根据Ann Arbor分期标准:Ⅰ期3例,Ⅱ期1例。镜检:乳腺正常结构被破坏,中等大小的圆形或卵圆形肿瘤细胞弥漫分布,胞质少至丰富,嗜碱性,核仁可见,核分裂像易见。免疫组化:CD19、CD20、CD79a、PAX5(+),部分病例CD10、BCL-6及BCL-2(+),Ki-67增殖指数85%~90%。随访至2021年7月,1例失访,1例死亡,2例健在。结论:PB-DLBCL发病率低,临床症状及影像学表现无特殊,预后差,确诊需结合病理组织形态学及免疫表型。

Objective:To investigate the clinicopathological features,differential diagnosis,treatment and prognosis of primary breast diffuse large B-cell lymphoma(PB-DLBCL).Methods:Four cases of PB-DLBCL were collected(from January,2017 to December 2020,in the department of pathology,The Affiliated Hospital of Youjiang Medical University for Nationalities),the relevant clinical data,pathological sections and immunohistochemical phenotypes of the patients were analysed combined with relevant literature.Results:All of the 4 patients were middle-aged women with an onset age of 38-56 years old.They were all treated for painless enlargement of breast mass,including 2 cases of left breast and 2 cases of right breast,3 cases were non-GCB,1 case GCB.According to Ann Arbor staging criteria,3 cases were stageⅠ,1 case was stageⅡ.Under the microscope,the normal structure of mammary gland was destroyed,the mediumsized,round or oval tumor cells were diffusely distributed,with less to rich cytoplasm,basophilic,with visible nucleolus and mitotic figures.According to the immunohistochemical phenotype,CD19、CD20、CD79a、PAX5 were positive,in some cases,CD10、BCL6 and BCL-2 were positive.Ki-67 proliferation indexes were from 85%to 90%.The followup time of the cases was up to July 2021,and 1 patient was lost to follow-up,1 patient died and 2 patients were still alive.Conclusion:The incidence of PB-DLBCL is low.The clinical symptoms and imaging features are not special,and the prognosis is poor.The diagnosis should be combined with histopathology and immunophenotype.