胃弥漫性大B细胞淋巴瘤一例

<正>1病例介绍患者,男,72岁,主因"便秘2月余,伴腹胀、食欲不振1月"入院。入院前2月无明显诱因出现排便不畅,4~5 d一行,大便干稀不调。无脓血便。入院前1月出现腹胀、食欲不振,遂就诊于我院。入院时患者大便6 d未结,伴腹胀、食欲不振,无腹痛、恶心、呕吐。寐安,小便可。查体:体温38.3℃,脉搏84次/min,呼吸18次/min,血压140/70 mm Hg。     

乳腺黏膜相关淋巴瘤转变为弥漫性大B细胞淋巴瘤一例

原发于乳腺的黏膜相关淋巴瘤(MALT-ML)发病率极低,绝大多数是低度恶性,很少扩散,预后较好,但少数可转化为高度恶性淋巴瘤。笔者在临床发现1例乳腺MALT-ML转变为高度恶性弥漫性大B细胞淋巴瘤。现报告如下。患者,女,42岁。于2005年4月份无意中发现左乳内上象限肿块,约3×2 cm大小     

原发胃肠道弥漫性大B细胞淋巴瘤的预后分析

目的 对原发胃肠道弥漫性大B细胞淋巴瘤(PGI-DLBCL)的特征、治疗和预后进行探讨.方法 回顾性分析2003年至2007年收治的20例PGI-DLBCL患者的临床特征、肿瘤分子分型和治疗方式,并对生存率和预后等相关因素进行统计学分析.结果 所有患者平均总生存期为42～52个月,无进展生存期为37～47个月.国际评分指数(IPI)为0～2分和＞2分时对患者的预后具有提示作用.在原发胃或原发肠道淋巴瘤患者中,分子病理类型[发生中心(GCB型)和非GCB型]对患者的预后无显著的提示意义.利妥昔单抗联合化学治疗(R-CHOP)与单用化学治疗(CHOP)对患者预后的影响差异无统计学意义(P＞0.05),而手术切除病灶可能对长期生存有利.结论 PGI-DLBCL的最佳治疗方式可能不同于其他部位的DLBCL,还需要大样本的病例进行对照分析.     

老年弥漫性大B细胞淋巴瘤预后因素及治疗分析

目的探讨老年弥漫性大B细胞淋巴瘤（DLBCL）预后因素,不同治疗方案对其生存的影响。方法回顾性分析72例初发老年DLBCL的性别、年龄、临床分期、B症状、ECOG-PS评分、结外病灶、血清LDH水平、血红蛋白水平、IPI评分与预后的相关性,其中可评价的为64例。比较接受3周CHOP方案34例和接受3周R-CHOP方案30例的生存情况。结果老年DLBCL患者中位生存期40．3个月,2年OS率67．43％,3年OS率49．89％。多因素分析显示年龄、ECOG-PS、临床分期、IPI评分是影响老年DLBCL患者预后的独立危险因素（P〈0．05）。CHOP组和R-CHOP组2年及3年OS率差异均有统计学意义,2年OS率（53．3％VS72．1％,P〈0．05）,3年OS率（39．2％VS60．8％,P〈0．05）。结论年龄、ECOG-PS、临床分期、IPI评分是老年DLBCL患者的预后相关因素,R-CHOP方案疗效优于CHOP方案。     

BRCA1在弥漫性大B细胞淋巴瘤中的表达及意义

目的 探讨BRCA1在弥漫性大B细胞淋巴瘤的表达及与疾病预后的关系.方法 收集50例弥漫性大B细胞淋巴瘤标本和20例瘤周正常组织标本,采用免疫组化方法检测BRCA1在弥漫性大B细胞淋巴瘤和瘤周正常组织的表达,分析BRCA1表达与患者临床特点以及疾病预后的关系.结果 不同性别、年龄、发病部位、临床分期弥漫性大B细胞淋巴瘤患者BRCA1表达差异均无统计学意义（P均＞0.05）;弥漫性大B细胞淋巴瘤组织BRCA1表达的阳性率明显低于瘤周正常组织（x2=4.047,P＜0.05）;BRCA1表达阴性组的2年生存率高于阳性组（P＜0.05）.病变部位、临床分期、BRCA1表达、国际预后指数是影响弥漫性大B细胞淋巴瘤患者预后的独立变量.结论 BRCA1表达降低与弥漫性大B细胞淋巴瘤的发生有关,BRCA1可作为判断弥漫性大B细胞淋巴瘤预后的分子标志物.     

新疆维吾尔族弥漫性大B细胞淋巴瘤患者免疫学亚型及预后分析

目的探讨Choi免疫学分型在新疆维吾尔族弥漫大B细胞淋巴瘤(DLBCL)中的作用及预后意义。方法采用EnVision二步法检测78例新疆维吾尔族DLBCL肿瘤组织中的GCET1、FOXP1、CD10、bcl-6、MUM1的表达,并对其进行Choi免疫学分型,采用Kaplan-Meier法进行生存分析,Cox比例风险模型分析影响预后的因素。结果 CD10、bcl-6、MUM1、GCET1、FOXP1的阳性率分别为19.2%(15/78)、24.4%(19/78)、62.8%(49/78)、30.8%(24/78)、53.8%(42/78)。生发中心样B细胞(GCB)型DLBCL与非生发中心样B细胞(non-GCB)型DLBCL所占比例分别为29.5%(23/78)、70.5%(55/78)。全组患者中位生存时间为28个月(95%CI:16.1³9.9个月),3年总生存率(OS)为46%。GCB组与non-GCB组的3年OS分别为58%与39%,差异有统计学意义(P<0.01),多因素分析显示,国际预后指数(IPI)及免疫学分型是新疆吾尔族DLBCL患者的独立预后因素。结论新疆维吾尔族DLBCL以non-GCB型为主,Choi免疫学分型法有助于判断新疆维吾尔族DLBCL预后。     

2例AIDS相关弥漫性大B细胞淋巴瘤患者

[摘要]?分析在甘肃省武威肿瘤医院治疗的2例自体造血干细胞移植（auto-hematopoietic stem cell transplantation, ASCT）AIDS相关弥漫性大B细胞淋巴瘤（AIDS-related diffuse large B-cell lymphoma, AIDS-DLBCL）患者的临床特征、治疗及预后,并复习相关文献,探讨ASCT在治疗AIDS-DLBCL中的作用。     

弥漫性大B细胞淋巴瘤患者化疗后乙型肝炎病毒激活情况分析

目的：比较弥漫性大 B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）患者接受CHOP方案的基础上联合与不联合利妥昔单抗治疗后,HBsAg 阳性患者和 HBsAg 阴性患者的临床特点,HBV 激活的发生情况、转归及预防性抗病毒治疗的价值。方法回顾性调查在我院接受CHOP或R-CHOP方案化疗的DLBCL患者的临床资料,对比分析患者的临床特征及HBV激活情况。结果121名患者符合入选标准,其中24例为HBsAg阳性,97例为HBsAg阴性。7例患者化疗前病毒拷贝数＞103拷贝/mL,给予抗病毒治疗,无一例发生 HBV 激活;17例未接受预防性抗病毒治疗的 HBsAg阳性患者中,CHOP方案组1例（10％）发生 HBV 激活,R- CHOP 方案组4例（28．6％）发生 HBV激活,其中2例（14．3％）死于肝功能衰竭。RCHOP组 HBV激活的发生率明显高于CHOP方案组（P＝0．015）,两组均高于接受抗病毒治疗者（P＝0．018）。97例 HBsAg阴性患者中,只有1例同时伴有乙型肝炎核心抗体 HBcAb 阳性的患者发生 HBV激活,其发生率明显低于 HBsAg阳性患者（P＝0．000）。结论 HBsAg阳性患者接受CHOP,尤其是含有利妥昔单抗的方案化疗后,HBV激活风险不仅明显增高,而且对患者有严重危害,对于这部分患者给予预防性抗病毒治疗可以降低HBV激活风险,改善患者预后。既往感染过HBV的 HBsAg阴性患者在接受含利妥昔单抗的方案化疗后,亦可发生 HBV激活,但激活的风险较低,尚需进一步研究预防性抗病毒治疗在这部分患者中的价值。     

18F-FDG PET/CT与骨髓活检评估弥漫性大B细胞淋巴瘤骨髓浸润的比较研究

目的:评估¹⁸F-FDG PET/CT与骨髓活检(BMB)对弥漫性大B细胞淋巴瘤(DLBCL)患者骨髓浸润(BMI)的诊断效能,明确PET/CT能否替代BMB成为BMI的诊断手段。方法:回顾性分析2014年1月—2022年4月初诊的224例DLBCL患者,所有患者化疗前均接受PET/CT和BMB检查。比较PET/CT与BMB诊断BMI的敏感度、特异度、阳性预测值、阴性预测值、漏诊率、2种方法的一致性、对分期的影响,比较PET阳性患者中BMB阳性组与BMB阴性组、局灶组与弥漫组血常规、乳酸脱氢酶(LDH)、总生存期(OS)的差别。结果:224例患者中共检出BMI阳性患者33例(14.7%),其中PET/CT检出31例(13.8%),BMB检出17例(7.6%)。PET/CT与BMB检出BMI的敏感度分别为93.9%、51.5%,特异度分别为100.0%、100.0%,阳性预测值分别为100.0%、100.0%,阴性预测值分别为99.0%、92.3%,漏诊率分别为6.1%、48.5%。PET/CT与BMB诊断一致的206例(92.0%),包括191例均阴性,15例均阳...     

回肠末端弥漫性大B细胞淋巴瘤并肠梗阻1例报道

原发性肠道淋巴瘤临床很少见,易误诊。     

Aggressive large B-cell lymphoma with plasma cell differentiation: immunohistochemical characterization of plasmablastic lymphoma and diffuse large B-cell lymphoma with partial plasmablastic phenotype

Background

Plasmablastic lymphoma has recently come to be considered a distinct entity among mature B cell neoplasms, although the limits with diffuse large B-cell lymphoma (DLBCL) need to be more accurately defined.

Design and Methods

Here we show the results of an immunohistochemical study of 35 cases of plasmablastic lymphoma compared with a set of 111 conventional DLBCLs.

Results

Our results demonstrate that the use of a limited combination of immunohistochemical markers (PAX5&CD20, PRDM1/BLIMP1 and XBP1s) enables the identification of a plasmablastic immunophenotype highly characteristic of plasmablastic lymphoma cases and associated with an aggressive clinical behavior. Additionally, the study shows that the acquisition of a partial plasmablastic phenotype (PRDM1/BLIMP1 expression) in DLBCL is associated with shorter survival in R-CHOP-treated patients.

Conclusions

The use of a restricted combination of immunohistochemical markers (PAX5&CD20, PRDM1/BLIMP1 and XBP1s) enables a more accurate definition of terminal differentiation for large B-cell lymphoma.     

Transformation of follicular lymphoma to diffuse large B-cell lymphoma proceeds by distinct oncogenic mechanisms

This study was undertaken to further elucidate the biological mechanisms underlying the frequent event of transformation of follicular lymphoma (FL) to diffuse large B-cell lymphoma (t-FL). The gene expression profiles of 20 paired lymph node biopsies, derived from the same patient pre- and post-transformation, were analysed using the Lymphochip cDNA microarray. TP53 mutation analysis was performed and copy number alterations at the c-REL and CDNK2A examined. Immunohistochemistry was performed on an independent panel of paired transformation paraffin-embedded samples. Transformed follicular lymphoma was predominantly of the germinal centre B-like phenotype both at the mRNA and protein level. Despite this homogeneity, transformation proceeded by at least two pathways. One mechanism was characterised by high proliferation, as assessed by the co-ordinately expressed genes of the proliferation signature. This group was associated with the presence of recurrent oncogenic abnormalities. In the remaining cases, proliferation was not increased and transformation proceeded by alternative routes as yet undetermined. Genes involved in cellular proliferation prevailed amongst those that were significantly increased upon transformation and T cell and follicular dendritic-associated genes predominated amongst those that decreased. t-FL is a germinal centre B (GCB)-like malignancy that evolves by two pathways, one that is similar in proliferation rate to the antecedent FL and the other that has a higher proliferation rate and is characterised by the presence of recognised oncogenic abnormalities.     

弥漫大B细胞淋巴瘤患者治疗前FDG-PET/CT检查与预后的相关性分析

目的:评估治疗前18氟-氟代脱氧葡萄糖-正电子发射计算机断层显像(18F-FDG-PET)/CT的最大标化摄取值(SUVmax)对弥漫大B细胞淋巴瘤(DLBCL)预后预测价值。方法:回顾分析76例新发DLBCL患者初次PET/CT检查中最大SUVmax与疾病分期、乳酸脱氢酶(LDH)、校正国际预后指数(R-IPI)等预后因素之间的相关性以及预后分析。结果:初发DLBL患者PET/CT的SUVmax与疾病分期、B症状、LDH、β2微球蛋白(β2-MG)、美国东部肿瘤协作组(ECOG)评分呈正相关。R-IPI3个预后组中的SUVmax有显著区别,R-IPI预后差的一组SUVmax均值明显高于前2组,有统计学意义(P<10与SUVmax≥10组总有效率分别为87.9%和55.8%(P     

双侧卵巢非霍奇金淋巴瘤弥漫大B细胞型2例

1病历资料例1.女,57岁,以"下腹胀痛、尿频、食欲不振1个月余为主诉"于2008-04-14就诊我院妇产科,拟诊为多发子宫肌瘤。行"经腹全子宫及双附件切除术+病灶切除术"后病理检查诊断双侧卵巢非霍奇金淋巴瘤。住我院血液科,予以CHOP(氟美松10 mg,每日1次静脉滴注,连用     

Primary diffuse large B-cell lymphoma of the uterus: A SEER database analysis

Uterine diffuse large B-cell lymphoma (DLBCL) is a rare clinical condition. Most studies for uterine DLBCL are derived from case reports and series. Our main objective was to present a new case while also investigating the demographic, clinical characteristics, and survival of women with primary uterine DLBCL as compared to non-uterine DLBCL using the Surveillance, Epidemiology, and End Results incidence database. We queried the Surveillance, Epidemiology, and End Results database for women aged 18 years or older with a diagnosis of primary DLBCL from 1975 to 2017. The most common site of primary uterine DLBCL is the cervix uteri not otherwise specified, followed by endometrium, uterus not otherwise specified, corpus uteri, myometrium and isthmus uteri. Non-uterine DLBCL cases tend to be older than uterine DLBCL cases. Uterine DLBCL is most common among women aged 40 to 64 years. Patients with uterine DLBCL showed greater survival than non-uterine DLBCL patients, and patients treated in the rituximab era also exhibited a survival benefit. Both the elderly and African American cohorts experienced worse overall survival.