艾滋病相关伯基特淋巴瘤临床病理分析

Clinicopathological characteristics of acquired immunodeficiency syndrome related Burkitt lymphoma

目的探讨艾滋病(AIDS)相关伯基特淋巴瘤(BL)患者的临床病理特征。方法回顾性分析2017年1月至2021年12月首都医科大学附属北京佑安医院诊断的AIDS相关BL患者29例,收集其临床资料,采用苏木精-伊红染色、免疫组织化学染色和荧光原位杂交观察肿瘤组织的病理学特征。结果所有患者中男28例,女1例;年龄<40岁16例,≥40岁13例;人类免疫缺陷病毒感染≤1年18例,人类免疫缺陷病毒感染>1年11例;发生淋巴结肿大29例;累及消化系统19例,累及骨髓8例,累及中枢6例;Ann Arbor分期Ⅲ/Ⅳ期26例,Ⅰ/Ⅱ期3例;乳酸脱氢酶升高者16例,其余未检测;β2微球蛋白升高者10例,正常者1例,其余未检测;EB病毒拷贝数>500者13例,≤500者16例。苏木精-伊红染色可见组织固有结构消失、背景蓝染,中等大肿瘤细胞呈铺路石状弥漫浸润,伴星空现象,其中10例局部呈浆细胞样分化,核分裂像、核碎裂常见,细胞核圆形、核染色质呈细颗粒状。29例患者均CD20、CD10、Bcl-6阳性。29例患者>90%的肿瘤细胞Ki-67阳性,>50%的肿瘤细胞C-MYC阳性,荧光原位杂交检测显示均有MYC易位。29例患者中CD38阳性27例;MUM1阳性14例;EBER阳性13例。结论AIDS相关BL患者多为中年男性,肿瘤细胞相关指标多为阳性,治疗应兼顾抗病毒和BL化疗。

Objective To investigate the clinicopathological characteristics of acquired immunodeficiency syndrome(AIDS)related Burkitt lymphoma(BL).Methods A total of 29 AIDS related BL patients diagnosed in Beijing Youan Hospital,Capital Medical University from January 2017 to December 2021 were analyzed retrospectively.Clinical data were collected,and pathological features of tumor tissues were observed by hematoxylin-eosin staining,immunohistochemical staining,and fluorescence in situ hybridization.Results There were 28 males and one female in all patients.There were 16 patients aged<40 years and 13 patients aged≥40 years.18 patients were infected with human immunodeficiency virus≤one year,and 11 patients were infected with human immunodeficiency virus>one year.Lymph node enlargement occurred in 29 patients.Digestive system was involved in 19 patients,bone marrow in eight patients,and central system in six patients.There were 26 patients with Ann Arbor stage Ⅲ/Ⅳ and three patients with Ann Arbor stage Ⅰ/Ⅱ;16 patients with elevated lactate dehydrogenase;β2 microglobulin was elevated in ten patients and normal in one patient.The copy number of epstein-barr virus was more than 500 in 13 patients and less than 500 in 16 patients.Hematoxylin-eosin staining showed loss of tissue inherent structure,background blue staining,diffuse infiltration of medium and large tumor cells in the shape of paving stones,accompanied by starry sky phenomenon,ten cases of local plasmacytoid differentiation,common nuclear mitosis,nuclear fragmentation,round nucleus,fine granular nuclear chromatin.All 29 patients were positive for CD20,CD10,and Bcl-6.>90% of tumor cells were Ki-67 positive and>50% of tumor cells were C-MYC positive in 29 patients,and fluorescence in situ hybridization showed MYC translocation in 29 patients.Twenty-seven patients were CD38 positive;14 patients were MUM1 positive.EBER positive was found in 13 patients.Conclusion AIDS related BL patients are mostly middle-aged males,and tumor cell related indicators are mostly positive.Antiviral therapy and BL chemotherapy should be combined for treatment.