Non Hodgkin’s Lymphoma with Right Atrial Intra Cardiac Metastases

Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most variant of Non-Hodgkin’s Lymphoma (NHL) and also the most common variant with secondary intracardiac masses. Case summary: 7 years old child presented to emergency with acute decompensated cardiac failure, ascites and tender hepatomegaly. 2D echo evaluation was suggestive of large intracardiac mass in the right atrium almost completely obstructing Tricuspid valve orifice, gross pericardial effusion and dilated Inferior Vena Cava (IVC). Emergency tumor excision surgery was performed which revealed 4 × 4 cm pinkish firm mass arising from anterior Tricuspid annulus which was completely excised. Child was extubated on postoperative day (POD) 0 and was on minimal inotropic support. Ascites reduced significantly on POD1 allowing abdominal palpation which revealed a mass in the epigastric region. This prompted evaluation by pediatrician and oncology workup suggestive of increased 18-Flouro Deoxy Glucose (18-FDG) uptake in the mediastinum, abdomen, bilateral proximal thighs, all mediastinal lymph nodal stations, bilateral lung hilar stations 10R, 10L involving all encasing the heart and great vessels with pleural deposits, Celiac trunk, superior Mesenteric Artery (SMA), Portal vein, IVC and abdominal aorta. Histo pathology Examination (HPE) and Immuno Histo Chemistry (IHC) of intracardiac mass revealed DLBCL which is metastatic in nature. Chemotherapy was started as per (French American British Lymphomes Malins B) FAB LMB-96 protocol with the child currently in the Induction phase having poor prognosis and less survival interval. Conclusion: Surgery can be considered a treatment option for metastatic intracardiac masses during emergency scenarios like cardiogenic shock to relieve obstruction along the pathway of blood flow in the heart even though we may not be able to completely excise the tumor surgically.

Hepatitis B surface antigen seroconversion after HBV reactivation in non-Hodgkin's lymphoma

Reactivation of hepatitis B virus(HBV)can occur in lymphoma patients infected with HBV when they receive chemotherapy or immunotherapy.Prophylactic administration of lamivudine(LAM)reduces the morbidity and mortality associated with HBV reactivation.However,what defines HBV reactivation and the optimal duration of treatment with LAM have not yet been clearly established.HBV reactivation may occur due to the cessation of prophylactic LAM,although re-treatment with nucleoside analogs may sometimes result in hepatitis B surface antigen(HBsAg)seroconversion,which is a satisfactory endpoint for the management of HBV infection.We report a case of HBV reactivation in a 68-year-old HBsAg-positive patient who received rituximab-based immunochemotherapy for follicular lymphoma.HBV reactivation developed following cessation of prophylactic LAM therapy.The patient subsequently received treatment with entecavir(ETV),which led to a rapid and sustained suppression of HBV replication and HBsAg seroconversion.We also appraised the literature concerning HBV reactivation and the role of ETV in the management of HBV reactivation in lymphoma patients.A total of 28 cases of HBV reactivation have been reported as having been treated with ETV during or after immunosuppressive chemotherapy in lymphoma patients.We conclude that ETV is an efficacious and safe treatment for HBV reactivation following LAM cessation in lymphoma patients treated with rituximab-based immunochemotherapy.

The prognostic value of programmed cell death ligand 1expression in non-Hodgkin lymphoma:a meta-analysis

Objective: Although the prognostic value of programmed cell death-ligand 1(PD-L1) expression in non-Hodgkin lymphoma(NHL) has been evaluated in many studies, the results remain controversial. To investigate the prognostic role of PD-L1 expression and the association between PD-L1 expression and clinicopathological features of NHL, we performed a meta-analysis.Methods: The Pub Med, EMBASE, and Cochrane Library databases were searched up to November 30, 2017. The hazard ratio(HR), 95% confidence interval(CI), and odds ratios(OR) with 95% CIs were combined to evaluate the association of PD-L1 expression with overall survival(OS) and clinicopathological features. Review manager 5.3 and STATA 12.0 were used in this meta-analysis.Results: A total of 2,005 patients across nine studies were enrolled in our meta-analysis, and the pooled results showed that high PD-L1 expression was associated with a poor prognosis(HR=2.04, 95% CI: 1.18–3.54, P=0.01). In the subgroup analysis according to histology types, pooled results demonstrated that an increased PD-L1 expression was an unfavorable prognostic factor for diffuse large B-cell lymphoma(HR=1.92, 95% CI: 1.06–3.48, P=0.03) but not for natural killer/T-cell lymphoma(HR=2.41, 95%CI: 0.47–12.22, P=0.29). Pooled ORs indicated that PD-L1 expression was higher in NHL with international prognostic indices of≥3. However, PD-L1 expression had no correlation with gender, age, disease stage, lactate dehydrogenase level, B symptoms, and germinal center B-cell-like lymphoma.Conclusions: High PD-L1 expression was a poor prognostic biomarker in patients with NHL. Because of our limited sample size,high-quality studies with larger sample sizes are needed to validate our results.

Hepatitis C virus-associated B cell non-Hodgkin's lymphoma

The hepatitis C virus(HCV) infected patients are prone to develop bone marrow or various tissue infiltrates with monoclonal B cells, monoclonal B lymphocytosis or different types of B cell non-Hodgkin's lymphoma(BCNHL), of which the most common are splenic marginal zone BCNHL, diffuse large BCNHL and follicular lymphoma. The association between chronic HCV infection and non Hodgkin's lymphoma has been observed especially in areas with high prevalence of this viral infection. Outside the limitations of some studies that have been conducted, there are also geographic, environmental, and genetic factors that contribute to the epidemiological differences. Various microenvironmental signals, such as cytokines, viral antigenic external stimulation of lymphocyte receptors by HCV antigens, and intercellular interactions contribute to B cell proliferation. HCV lymphotropism and chronic antigenic stimulation are involved in B-lymphocyte expansion, as mixted cryoglobulinemia or monoclonal gammopathy of undetermined significance, which can progress to BCNHL. HCV replication in B lymphocytes has oncogenic effect mediated by intracellular HCV proteins. It is also involved in an important induction of reactive oxygen species that can lead to permanent B lymphocyte damage, as DNA mutations, after binding to surface B-cell receptors. Posttransplant lymphoproliferative disorder could appear and it has a multiclonal potentiality that may develop into different types of lymphomas. The hematopoietic stem cell transplant made for lymphoma in HCV-infected patients can increase the risk of earlier progression to liver fibrosis and cirrhosis. HCV infected patients with indolent BCNHL who receive antiviral therapy can be potentially cured. Viral clearance was related to lymphoma response, fact that highlights the probable involvement of HCV in lymphomagenesis. Direct acting antiviral drugs could be a solution for the patients who did not tolerate or respond to interferon, as they seem to be safe and highly effective. The use of chemotherapy in combination with rituximab for the treatment of BCNHL in patients infected with HCV can produce liver dysfunction. The addition of immunotherapy with rituximab can increase the viral replication, and severe complications can occure especially in patients co-infected with hepatitis B virus or immune immunodeficiency virus, in those with hepatocarcinoma,cirrhosis, or liver cytolysis. But the final result of standard immunochemotherapy applied to diffuse large BCNHL patients with HCV infection is not notably worse than in those without this viral infection. The treatment of patients chronically infected with HCV and having BCNHL is complex and requires a multidisciplinary approach and the risk / benefit ratio of rituximab treatment must be evaluated especially in those with liver cytolysis.

Treatment of Nodal Non Hodgkin Lymphoma in West Africa: Experience of Institut Curie in Dakar

In Senegal, few studies have been devoted to non-Hodgkin’s lymphoma. We conducted a retrospective descriptive study of 73 cases treated at the Institut J. Curie Hospital Aristide Le Dantec for non-Hodgkin’s lymphomas from 2001 to 2007. The main objective was to determine the clinical and therapeutic aspects. Our population consisted of 39 men and 34 women (sex ratio: 1.14). The average age was 36 years with extremes of 5 and 76 years. The most common locations were cervical (30.6%) and oropharynx (8.21%). Multiple locations were found in 30.6% of cases. Only 54.4% have histological exam. Patients were managed on cytology basis 42.6% of cases. Histology was performed in 39 patients (54.4%). Among these patients, 69% had aggressive lymphoma, of which 12.82% had a large B-cell lymphoma among indolent lymphomas (59%). The small cleaved cell lymphoma was most often found with 78.26% of cases. The patients were staged with insufficient tools. The protocol most often used was CHOP (64.3%). The most common complications reported were gastrointestinal (11%) followed by skin complications (8.2%). Radiotherapy was performed for 6 patients or 8.2% of cases. Therapeutic strategy was most often used as chemotherapy alone (69.9%). The median duration of follow-up is 18 months.

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.

Role of Immunostaining in Detecting Extra-Pattern and Subtle Lymphomatous Infiltration in Bone Marrow Biopsies of NHL Patients

Introduction: Immunohistochemistry (IHC) enables the examination of a greater number of trephine biopsy levels and is helpful in determining additional scattered malignant cells. The aim of this study is to detect extra-pattern and subtle lymphomatous infiltration in bone marrow biopsies using CD20 and CD3 immunostaining. Patients and Methods: This study was conducted on 100 newly diagnosed Non Hodgkin Lymphoma (NHL) patients. Their bone marrow trephine biopsies were assessed on routine histology [Hematoxylin and Eosin (H & E)], and were further subjected to IHC using CD20 and CD3. Results: Pattern of involvement by H & E was highlighted by IHC. It showed additional interstitial pattern in 9 cases, parasinusoidal streaks in one case and highlighted a patchy pattern in another case with interstitial involvement on H & E. IHC also detected subtle infiltrations on additional 5.5% cases compared with histology alone. It helped in differentiating reactive (12 cases) and malignant lymphoid infiltration (33 cases). Conclusion: CD20 and CD3 immunostaining performed routinely on bone marrow trephine biopsies has the ability to reveal extra-pattern of infiltration and improve detection of subtle lymphoid involvement. A combined procedure identifying several distinctive features, in particular histotopography and IHC, provides a promising way of discriminating reactive from neoplastic lymphoid infiltrates in bone marrow trephine biopsies.

Infiltrative cardiac lymphoma with tricuspid valve involvement in a young man

Cardiac metastases are among the topics with limited systematic reviews.Theoretically,the heart can be infiltrated by any malignancy with the ability to spread to distant structures.Thus far,no specific tumors are known to have a predilection for the heart,but some do metastasize more often than others,for example,melanoma and primary mediastinal tumors.We report a case of cardiac metastasis from a diffuse large B cell lymphoma in a young man.The peculiarity of this case is that besides the involvement of right ventricle and atrium,the tricuspid valve was also infiltrated.Valvular metastasis is rarely reported in the medical literature.

Biodistribution and Anti-tumor Activities of the ^(131)I-labeled Rituximab in Nude Mice Bearing Human Burkitt's lymphoma

OBJECTIVE To explore the biodistribution and anti-tumoractivity of ^(131)I labeled rituximab injected intratumorally orintraperitoneally in vivo in nude mice bearing Raji human Burkitt's lymphoma xenografts.METHODS The rituximab and the mouse IgG were labeled withNa^(131)I using the IODO-GEN method.BALB/C nude mice werexenografted with ^(131)I-Rituximab or ^(131)I-IgG and killed on the 1st,3rd,7th,and 15th day after injection.The tumor/non-tumor ratio(T/NT)and the dose injected in each gram of the tissue(%ID/g)from12 organs or tissues of interest,e.g.tumor,blood,were calculated.The long and short axes of each tumor were measured by calipersat 2-3-day intervals after treatment,and the growth inhibition ofthe tumor was calculated using the MIRD formula.RESULTS When comparing intraperitoneal injection(IP)andintratumoral injection(IT)of ^(131)I-IgG,intratumoral injection of^(131)I-rituximab produced a significantly higher tumor/non-tumorratio in all tissues and organs of interest on the 1st,3rd,and 7thday,respectively(P<0.05).The %ID/g of tumor was 1.4-1.7-foldand 1.5-3.7-fold in the IP and IgG IT groups,respectively,but the%ID/g of non-tumors was significantly lower in the IP group andIgG IT group.Similarly,the tumor growth was greatly inhibitedby intratumoral injection of the ^(131)I-rituximab,whereas it wasless inhibited by other forms of the treatment(P<0.05).However^(131)I-rituximab injected intratumorally inhibited tumor growth ina dose-dependent manner.The inhibition rate was less with alow dose(75μCi)and greater with a high dose(150μCi),yet thedifference was not significant(P>0.05).CONCLUSION Tumors can absorb the highest amount of theradiolabelled antibodies,and the tumor/non-tumor ratios in thegroup with intratumoral injection of the ^(131)I-rituximab resulted inthe optimal anti-tumor activity.

The Impact of Human Immunodeficiency Virus Infection (HIV) on Lymphoma in South Africa

Human immunodeficiency virus (HIV) infection is endemic in South Africa. Non-Hodgkin lymphoma (NHL) occurs with increased frequency in HIV seropositive individuals. The increase in NHL has been more marked in the last decade, with HIV being the major contributor to this increase. More than 70% of the adult NHL patients at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg, are HIV seropositive. In addition, HIV has impacted on the clinical presentation—being more aggressive and atypical. Histologically, HIV-NHL typically manifests as B-cell, high grade lymphomas, including diffuse large B-cell lymphoma (DLBCL);Burkitt lymphoma (BL);B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL and plasmablastic lymphoma. The latter two entities, which were previously rare or unknown, have gained prominence in the last decade, occurring primarily in HIV seropositive individuals. HIV-NHL, being associated with all these adverse prognostic factors results in a poorer overall survival.

超声参数联合外周血指标诊断儿童淋巴瘤的价值分析

目的探讨超声参数联合外周血指标对儿童淋巴瘤的诊断价值。方法对2018年6月至2020年10月该院收治的疑为淋巴瘤的浅表淋巴结肿大123例患儿进行超声检查,其中85例患儿经病理诊断为淋巴瘤(淋巴瘤组),38例患儿诊断为良性病变(良性组),同期选取30例健康儿童作为健康组。评价长短径比(L/S)、淋巴门、血流类型等超声参数对儿童非霍奇金淋巴瘤的诊断价值。通过逆转录-聚合酶链反应分析3种免疫相关基因——CC趋化因子受体5(CCR5)、程序性细胞死亡蛋白1(PD-1)、叉头盒P3(FOXP3)在淋巴瘤儿童外周血中的表达,分析超声参数联合3种外周血指标对儿童淋巴瘤的联合诊断价值。结果L/S、淋巴门、血流类型联合诊断淋巴瘤的受试者工作特征曲线下面积、灵敏度和特异度分别为0.846、89.41%、68.42%。淋巴瘤组患儿外周血CCR5、PD-1、FOXP3 mRNA相对表达量均明显高于健康组和良性组,差异均有统计学意义(P<0.05)。超声参数联合外周血CCR5、PD-1、FOXP3诊断淋巴瘤的受试者工作特征曲线下面积、灵敏度和特异度分别为0.976、97.65%、92.11%。结论超声参数(L/S、淋巴门和血流类型)联合外周血CCR5、PD-1、FOXP3对淋巴瘤具有较高的诊断价值。

PCR-SSCP检测非霍奇金淋巴瘤患者骨髓克隆性T细胞受体基因重排及其临床意义

背景与目的:进一步了解非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL)患者骨髓标本克隆T细胞受体(Tcellreceptor,TCR)基因重排情况及临床意义。方法:应用聚合酶链反应(polymerasechainreaction,PCR)联合单链构象多态性(single-strandconformationpolymorphism,SSCP)分析43例NHL患者骨髓标本TCRVγI-Jγ基因重排情况。结果:43例NHL患者有26例(60.5%)存在克隆性TCRVγI-Jγ基因重排。16例骨髓形态学检查未发现淋巴瘤细胞浸润者中有3例(18.8%)发现克隆性TCRVγI-Jγ基因重排,此3例患者分别于4～9个月后行骨髓形态检查时发现淋巴瘤细胞浸润;27例骨髓形态学检查有淋巴瘤细胞浸润者有23例(85.2%)存在克隆性TCRVγI-Jγ基因重排阳性。26例PCR扩增阳性病例经SSCP分析发现7例(26.9%)存在寡/亚克隆重排。7例存在寡/亚克隆重排患者经3～11个月有5例(71.4%)发展为白血病,存在寡/亚克隆重排NHL患者1年内转化为白血病的发生率显著高于无寡/亚克隆重排患者(10.5%)(P<0.005)。结论:应用PCR检测NHL患者骨髓标本克隆性TCRVγI-Jγ基因重排可较骨髓形态学检查更早发现NHL患者骨髓浸润微小病灶。具有寡/亚克隆NHL患者更易发展为白血病,还可发展为急性非淋巴细胞白血病。

Survivin、caspase-3在非霍奇金淋巴瘤组织中的表达及意义

背景与目的:Survivin是新近发现的凋亡抑制因子,在肿瘤的发生中起重要作用。Survivin在多种肿瘤组织广泛表达而在正常成人组织不表达,可直接抑制caspase-3和caspase-7活性。本研究旨在通过检测survivin、caspase-3蛋白在不同恶性度非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL)组织中的表达,探讨二者与NHL发病的关系及其临床意义。方法:应用免疫组织化学EnVisionsystem法检测NHL患者组织标本survivin、caspase-3蛋白的表达。结果:Survivin及caspase-3在54例NHL中的阳性率分别为51.9%(28/54)和83.3%(45/54)。Survivin在低度恶性组NHL中的表达(19.0%,4/21)低于中-高度恶性组(72.7%,24/33),两组之间有显著性差异(P<0.05);caspase-3表达也有同样规律。Survivin及caspase-3的共同表达率为46.3%(25/54)。结论:NHL中有survivin过度表达。

CHOPE方案治疗侵袭性非霍奇金淋巴瘤(NHL)40例

目的:观察CHOPE方案治疗侵袭性NHL的近期疗效。方法:80例侵袭性NHL患者,分成对照组与治疗组,每组各40例。对照组为CHOP方案:CTX 750mg/m^2静脉注射,d1;VCR 1.4mg/m^2,静脉注射,d1;ADM 40mg/m^2,静脉注射,d1;强的松100mg/d,d1～5。治疗组为CHOPE方案:CHOP(同对照组)+VP-16 100mg/d,静脉滴注,d1～3。21天为1个周期,完成2个周期以上者做疗效评价。结果:治疗组40例患者中,CR 21例,PR 12例,NC 4例,PD 3例,总有效率(CR+PR)为82.5%。结论:CHOPE方案治疗侵袭性NHL的近期疗效满意,不良反应可耐受。

EBER1/2、TNF-α与NHL组织坏死的相关性

目的 探讨EBV感染、TNF -α与非霍奇金淋巴瘤 (NHL )组织坏死的相关性。方法 将 12 4例NHL标本分为坏死组与无坏死组 ;分成NK/T、TCL、BCL 3种类型。采用原位杂交方法检测EBV编码的RNA (EBER 1/2 ) ,对EBER 1/2阳性标本采用免疫组织化学S -P法检测TNF -α水平。结果 坏死组 2 7例 ,无坏死组 97例 ;NK /T 2 3例、TCL 5 0例、BCL 5 1例。EBER1/2阳性率为 2 8.2 % ( 35 /12 4) ,其中坏死组阳性率为 85 .2 % ( 2 3/2 7) ,无坏死组为 12 .4% ( 12 /97) ,2组比较有非常显著性差异 ,P <0 .0 1。NK /T感染率为 5 2 .2 % ( 12 /2 3) ,TCL为 36.0 % ( 18/5 0 ) ,BCL为 9.8% ( 5 /5 1) ,NK/T、TCL与BCL比较有非常显著性差异 ,P <0 .0 1。TNF -α阳性率为 8.6% ( 3/35 ) ,且多呈弱阳性。结论 EBV感染 (EBER 1/2阳性 )主要见于NK /T和TCL ,与NHL组织坏死相关 ;TNF -α与NHL组织坏死无明显相关性 ;

流式细胞技术在诊断B-NHL患者骨髓受累中的应用

本研究探讨流式细胞术(FCM)在诊断B细胞非霍奇金淋巴瘤(B-NHL)患者骨髓受累中的应用意义。利用多参数FCM检测54例初治B-NHL患者的骨髓标本,并结合骨髓形态学和分子生物学检测结果进行分析。FCM诊断B-NHL患者骨髓受累的标准为出现单克隆B细胞。分子生物学方法诊断骨髓受累的标准为出现肿瘤性免疫球蛋白重链(IgH)基因重排。结果表明,在诊断B-NHL患者骨髓受累方面,FCM的检出率最高(27.5%,14/54例),其次为分子生物学方法(22.2%,12/54例),而形态学检出率最低(5.6%,3/54例)。3种方法联合运用,可将B-NHL患者淋巴瘤骨髓受累的检出率提高至38.9%(21/54例)。FCM方法诊断淋巴瘤骨髓受累的14例患者中,骨髓B淋巴细胞kappa/lam bda轻链比值远超过诊断界值。FCM在早期患者(3/26例)中亦能检测到骨髓受累。在3例形态学诊断骨髓受累的患者中,FCM均检测到单克隆B细胞。FCM与分子生物学方法检测结果符合率为70.4%(38/54例,p=0.14)。结论:对于B-NHL患者,运用FCM检测骨髓中单克隆B细胞,在诊断淋巴瘤患者骨髓受累方面敏感性高、准确性好。B-NHL早期患者也存在骨髓受累的可能,应及时在治疗前评价骨髓是否受累。采用FCM、分子生物学检测技术能提高淋巴瘤患者骨髓受累的诊断效率。

恶性淋巴瘤的肝脾侵犯──29例NHL尸体肝脾穿刺分析

本文介绍２９例ＮＨＬ尸体的肝脾穿刺研究。肝穿刺２９例，肝侵犯率７９．３％。脾穿刺２６例。脾侵犯率７６．９％。有肝脾肿大的病例肝或脾侵犯率分别为７１．４％和９０％，无肝脾肿大的病例，肝或脾侵犯率分别为８０．０％和６８．７５％。ＬＤＨ显著升高和高热多见于肝侵犯病例。脾累及的病人常同时有肝累及，肝累及病人几乎均同时有脾累及。由于肝侵犯的证实，３１％的病例分期上升。

非霍奇金淋巴瘤survivin和Ki67的表达及意义

目的 探讨survivin蛋白、增殖相关抗原Ki 67在不同恶性度非霍奇金氏淋巴瘤 (NHL)中的表达及意义。方法 应用免疫组织化学envisionsystem法检测NHL组织中survivin蛋白和Ki 67的表达。结果 在反应性增生淋巴组织 (LNRH)中未检测到survivin蛋白表达。在NHL中survivin蛋白表达率为 51.9% (2 8/ 54) ,其中低度恶性及中高度恶性组NHL中的表达率分别为 19% (4/ 2 1)、72 .7% (2 4/3 3 ) ,两组之间比较差异有显著性 (P <0 .0 0 1)。survivin、Ki67表达与恶性度均显著相关 ,而且survivin表达也与Ki67指数相关。结论 survivin蛋白在NHL患者组织中高表达 。

非霍奇金淋巴瘤Skp2和p27^(kipl)表达特点及其临床意义

目的研究S期激酶相关蛋白(Skp2)和p27kipl在非霍奇金淋巴瘤(NHL)中的表达及其与临床特征和预后之间的关系。方法应用免疫组化方法检测31例NHL患者Skp2和p27kipl的表达情况,并研究其与临床特征和生存预后的关系。结果 (1)Skp2蛋白高表达的患者多为Ⅲ~Ⅳ期和IPI高危者;p27kipl蛋白高表达患者为IPI低危者,但与分期无关。(2)Skp2和p27kipl蛋白表达均与B症状、性别和年龄无关。(3)Skp2和p27kipl两者之间无明显相关性(r=-0.126,P>0.05)。(4)Skp2蛋白低表达患者的生存情况明显好于高表达患者(P<0.05),而p27kipl蛋白高表达的生存情况也好于低表达患者,但差异无统计学意义(P>0.05)。结论 Skp2高表达提示NHL患者的临床特征及预后较差,而p27kipl高表达则提示NHL患者临床特征及预后较好。

血清肿瘤标志物NSE、CA-125在非霍奇金淋巴瘤诊断及预后判定中的临床价值

目的探讨血清肿瘤标志物NSE和CA-125在非霍奇金淋巴瘤(NHL)中的表达情况及临床意义。方法采用电化学发光免疫测定法测定56例NHL患者血清肿瘤标志物NSE和CA-125的表达水平,判定NSE和CA-125的表达与NHL患者临床特征及其预后的相关性。结果 56例NHL患者化疗前血清NSE值(34.63±8.54)μg/L,CA-125(47.59±9.53)μg/L,均明显高于对照组,差异有统计学意义(P<0.05);且NSE、CA-125表达水平的高低与NHL患者B症状、临床分期、IPI预后指数及治疗效果等临床特征相关(P<0.05)。结论血清肿瘤标志物NSE、CA-125联合定量检测可提高NHL诊断敏感性,同时对NHL临床分期、疗效判定及预后等方面具有一定临床意义。