艾滋病相关性弥漫大B细胞淋巴瘤4例临床病理分析

Human Immunodeficiency Virus-Diffuse Large B-cell Lymphoma:A Clinicopathological Analysis of Four Cases

目的 探讨艾滋病相关性弥漫大B细胞淋巴瘤(AIDS-DLBCL)的临床和病理组织学特点,提高临床及病理医师对AIDS-DLBCL的认识。方法 对4例AIDS-DLBCL进行回顾性分析,详细复习临床资料,复阅全部病理切片,统计相关的免疫组化结果,分析其临床病理学特征,随诊其预后,并复习相关文献。结果 在4例AIDS-DLBCL中,患者发病年龄34~54岁,平均46岁,首发的临床症状主要为体表淋巴结肿大。组织学上,弥漫大B细胞淋巴瘤以中等—大淋巴细胞弥漫性浸润,细胞异型性明显;免疫组化主要表达B细胞淋巴瘤的标记,如CD20、CD10、干扰素调节因子4(MUM-1)、重组人B细胞淋巴瘤蛋白(Bcl-6)。随访截至2020年12月,随诊时间6~14个月,4例患者入院后根据病情需要接受了R-CHOP方案及抗AIDS治疗,主要不良反应为骨髓抑制,现情况良好、无复发。结论 AIDS-DLBCL总体预后不良,临床确诊晚,早期诊断和规范化治疗是改善AIDS-DLBCL总体生存的关键措施。

Objective In order to investigate the clinical and pathological features of human immunodeficiency virus-diffuse large B cell lymphoma(HIV-DLBCL),and to improve the understanding of HIV-DLBCL by clinicians and pathologists.Methods Four cases of HIV-DLBCL were analyzed,and clinical data and the pathological sections were reviewed. The relevant immunohistochemical results were statistically analyzed. The clinicopathological features were analyzed with followup. Results Among the four cases of HIV-DLBCL,the onset age of the patients ranged from 34 to 54 years,with an average age of 46 years. Histologically,diffuse large B-cell lymphoma was characterized by diffuse infiltration of medium-large lymphocytes with distinct cellular atypia,and pathological mitosis,nuclear debris and necrosis were common.Immunohistochemically,B-cell lymphoma markers such as CD20,CD10,MUM-1,Bcl-6 were positive. Follow-up was completed in December 2020,and the follow-up date was from six to fourteen months. All patients accepted anti-HIV therapy plus various anti-lymphoma chemotherapy individually,including R-CHOP. The main adverse effects were bone marrow toxicity. Four cases of HIV-DLBCL were in good condition without recurrence. Conclusion Although the prognosis of HIVDLBCL is generally poor,the final diagnosis is delayed,early diagnosis and individualized therapy is one of the key points to improve the overall survival of HIV-DLBCL patients.