摘要
目的探讨胃肠道侵袭性B细胞淋巴瘤即弥漫性大B细胞淋巴瘤（DLBCL）、Burkitt淋巴瘤（BL）、特征介于DLBCL和BL之间不能分类型的淋巴瘤（DLBCL／BL）的组织学特点，及其临床病理参数、免疫组织分型与预后的相关性。重点讨论c-myc抗体在胃肠道侵袭性B细胞淋巴瘤中的表达特点，及预测其基因易位的价值和意义。方法对54例胃肠道侵袭性B细胞淋巴瘤的临床资料、组织学、免疫组织化学（EnVision法）进行观察分析并随访；荧光原位杂交（FISH）检测所有病例c—myc和部分病例的bcl-2的基因状态；免疫组织化学检测c．mye、Tel-1及CD383种c-myc基因预测抗体的表达；统计分析各临床病理参数问及其与预后的关系，并对基因易位预测指标c-myc进行准确性检验（ROC曲线）。结果54例胃肠道侵袭性B细胞淋巴瘤，包括49例DLBCL（免疫分型：生发中心B细胞型1I例，活化B细胞型38例）、4例DLBCL／BL、1例BL，中位年龄56岁，男女之比为1．6：1．0，中位生存时间42个月，其中11例在97个月内死亡。组织学观察可见异型的大细胞弥漫浸润胃肠道壁全层，部分伴有核碎裂及星空现象（18／54）。瘤细胞CD20、CD79a均阳性，CIN3（4／54）、CD5（7／54）、bcl-2（26／54）、Tel-1（17／54）、CD38（15／54）部分阳性，CD3、CD30均阴性，Ki-67阳性指数40％一100％。FISH检测显示部分病例出现bcl一2（1／19）和c—myc（4／54）易位，后者免疫组织化学c—myc均阳性（阳性百分数为80％～100％）。单因素分析显示B症状、行为状态、乳酸脱氢酶、国际预后指数、远处转移、临床分期、c—myc阳性百分数90％以上、c-myc易位在内的8个因素与预后相关，CD5阳性的DLBCL预后不良，其中乳酸脱氢酶、远处转移、c—myc易位是独立的预后因素。ROC曲线显示c—mye抗体阳性百分数预测c-myc基因易位的最佳阈值为75％。结论胃肠�
Objective To study the histological features, diagnosis, differential diagnoses of aggressive B-cell lymphomas of the gastrointestinal tract and to correlate clinical prognosis with pathologic parameters and immunophenotypes with an emphasis on c-myc, Tcl-1 and CD38 expression and their values in predicting the status of c-myc gene translocation. Methods Fifty-four cases of aggressive B-cell lymphomas of the gastrointestinal tract with complete clinical and pathologic data were retrospectively collected. The clinical data, histologic and immunohistochemical findings and follow-up results were analyzed. Predictive immunohistochemical stains including c-myc, Tcl-1 and CD38 were performed and ROC curve analysis was used to confirm the accuracy of these markers in predicting c-myc translocation. Results Of 54 cases, there were 33 males and 21 females with median age of 56 years. Histological types of lymphomas included 49 cases of DLBCL （ 11 cases of germinal central B cell like and 38 cases of activated B cell like by Hans classification）, 4 cases of DLBCL/BL and 1 case of BL. Eleven of 54 patients died within
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2014年第1期8-14,共7页
Chinese Journal of Pathology
