弥漫性大B细胞淋巴瘤的病理、免疫组化特征及IgH基因重排的检测

A Clinicopathologic and Immunohistochemical Study and Detection Rearrangement of Immunoglobulin Heavy Chain(IgH)Gene Study of Diffuse Large B-Cell Lymphoma

目的 探讨弥漫性大B细胞淋巴瘤 (DLBCL)临床和病理组织学特征以及免疫组化特异性抗体及IgH基因重排检测在其诊断和鉴别诊断中的价值。方法 收集 30例弥漫性大B细胞淋巴瘤及其临床资料 ,用免疫组化S P法标记LCA ,CD2 0 ,CD79a ,CD30及bcl 2抗体和用PCR方法检测 15例IgH基因重排。 结果 70 %(2 1/ 30 )弥漫性大B细胞淋巴瘤发病年龄在 40～ 70岁 ,淋巴结内外都可累及。组织病理学 :中心母细胞淋巴瘤占 83.3%(2 5 / 30 ) ,免疫母细胞淋巴瘤占 3.3%(1/ 30 ) ,间变性大细胞淋巴瘤占 6 .7%(2 / 30 ) ,及富于T细胞B细胞淋巴瘤占 6 .7%(2 /30 )。免疫标记LCA均表现阳性 ,CD2 0、CD79a、CD30、bcl 2表达率分别为 86 .7%(2 6 / 30 ) ,93.3%(2 8/ 30 ) ,6 .7%(2 / 30 ) ,2 0 %(6 / 30 )。 15例DLBCL中IgH基因重排阳性为 6 6 .7%(10 / 15 )。 结论 弥漫性大B细胞淋巴瘤是一组异质性肿瘤 ,必须结合其组织病理学形态和特异抗体的免疫组化检测 ,对一些疑难病例需做IgH基因重排检测以进行诊断和鉴别诊断。

Objective To study the clinicopathologic and immunohistochemical features of diffuse large B-cell lymphoma(DLBCL)and the significance of immuneohistochemistry and the detection rearrangement of IgH gene in diagnosis and differential diagnosis of DLBCL.Methods Thirty cases of DLBCL were studied and immunohistochemical staining for LCA、CD20、CD79a、CD30、bcl-2 were carried out with S-P method,15 cases were investigated for IgH gene rearrangements by polymerase chain reaction(PCR)technique.Results A age range of 40～70 years included 21(70%)patients.The location of the lesion included nodal and extranodal sites.Histopathologic morphology presented as centroblastic(83.3%,25/30),immuneoblastic(3.3%1/30),anaplastic large B cell type(6.7%,2/30)and T cell rich B cell type(6.7%,2/3).Immunostaining showed 100%(30/30),86.7%(26/30),93.3%(28/30),6.7%(2/30),20%(6/30)were positive for LCA、CD20、CD79a、CD30、bcl-2 .The positive amplification of clonal IgH gene in 10 out of 15 samples(66.7%)from DLBCL.Conclusion DLBCL shows cytologic variability from case to case.The evaluation of pathologic feathers and immuneohistochemistry in DLBCL are useful diagnostic method.Sometimes the detection of rearrangement of IgH gene is useful for difficult cases in the diagnosis of DLBCL.