血管内大B细胞淋巴瘤临床病理学特征分析

目的探讨血管内大B细胞淋巴瘤的临床病理学特征。 方法回顾性分析2008年1月至2017年12月经泰安市中心医院病理科确诊的12例血管内大B细胞淋巴瘤患者的临床资料,观察血管内大B细胞淋巴瘤的病理形态学特征及免疫表型。 结果12例血管内大B细胞淋巴瘤患者中男性7例,女性5例,年龄58~76岁;临床症状主要有皮肤红斑及皮下结节（发生于皮肤者）、头痛头晕及行走不稳（发生于中枢神经系统者）咳嗽咳痰（发生于肺者）;光镜下表现血管腔内充满肿瘤细胞,肿瘤细胞大多相似于中心母细胞或免疫母细胞;免疫组织化学检测显示肿瘤细胞CD20阳性。 结论血管内大B细胞淋巴瘤是一种相对少见的淋巴瘤,以淋巴瘤细胞选择性的在血管腔内生长为特征;临床表现与其发生部位有关,掌握其共同的特征并结合免疫组织化学检测结果方能正确诊断。     

弥漫大B细胞淋巴瘤治疗进展

非霍奇金淋巴瘤(non-Hodgkin lymphoma NHL)是恶性淋巴瘤的一大类型,在中国所占比例明显高于霍奇金淋巴瘤.弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)是非霍奇金淋巴瘤中最为常见的一种类型,在临床、免疫表型及分子遗传学等方面具有高度异质性,其治疗方案也呈多样化.近10年来,DLBCL的诊断及治疗取得了重要进展,现就其规范化治疗方案及最新治疗研究进行阐述.     

Primary colonic lymphoma: report of two cases and a literature review

Primary colonic lymphoma is a very rare malignant tumor with no standard treatment. We report two cases of primary colonic lymphoma successfully treated with surgery and chemotherapy, and chemotherapy alone, respectively. The first case was a 61-year-old woman who presented with abdominal pain of more than 1 month. The patient was diagnosed with a colonic tumor, and immunohistochemical examinations confirmed the initial diagnosis of colonic lymphoma. The patient underwent laparoscopic-assisted right hemicolectomy followed by postoperative adjuvant chemotherapy with the cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen, combined with targeted therapy with rituximab (R-CHOP). The second case was a 78-year-old man who presented with a complaint of abdominal distention for more than 1 year. Diffuse large B-cell lymphoma was definitively diagnosed by immunohistochemical examinations, and the patient underwent systemic chemotherapy with the R-CHOP regimen. Primary colonic lymphoma is a rare type of non-Hodgkin''s lymphoma (NHL), and the clinical treatment is not standardized, unlike for many other types of lymphoma. Therefore, treatment is mainly based on the patient’s symptoms to determine whether surgery or systemic chemotherapy is appropriate. Rituximab is effective in some patients and may play an important role in the treatment of unresectable or asymptomatic colonic lymphoma.     

以皮肌炎为首发表现的皮肤型弥漫性大B细胞淋巴瘤合并噬血细胞综合征患者的临床特点

目的:报道1例以皮肌炎(DM)为首发表现的皮肤弥漫性大B细胞淋巴瘤(DLBCL)合并噬血细胞综合征(HPS)的患者,提高对该疾病的认识.方法:回顾性分析该患者的临床特征、诊疗方法并对相关文献进行复习.结果:患者,女,52岁,因肌无力、肌酶谱升高、肌电图肌源性改变及皮肤特征性皮疹,诊断为皮肌炎.经糖皮质激素治疗,肌力、皮...     

p63阳性的弥漫大B细胞淋巴瘤1例并文献复习

弥漫大B细胞淋巴瘤是最常见的非霍奇金淋巴瘤,p63在弥漫大B细胞淋巴瘤中可表达,因此在临床上易被误诊为p63阳性的上皮源性恶性肿瘤,尤其在淋巴结发生转移时。本研究报道1例以呼吸道症状为首发症状的弥漫大B细胞淋巴瘤患者,临床高度怀疑肺恶性肿瘤并淋巴结转移。行右腋窝淋巴结穿刺活检病理诊断,结果显示p63阳性,提示为鳞状细胞癌,而完善免疫组织化学检查后,最终诊断为弥漫大B细胞淋巴瘤。因此,认识p63阳性的弥漫大B细胞淋巴瘤很有必要,可减小临床误诊的可能性。     

肝血管内大B细胞性淋巴瘤2例临床病理观察

目的探讨肝血管内大B细胞性淋巴瘤的临床病理特征、诊断与鉴别诊断、治疗及预后。方法回顾性分析2例肝血管内大B细胞性淋巴瘤患者的临床资料、组织病理学形态和免疫组化结果。结果光镜下肝窦内和小血管内可见较多具有明显异型性的淋巴样细胞浸润,汇管区可见慢性炎细胞浸润,亦可见少许异型淋巴细胞样细胞,未见明确纤维化。免疫组化示CD20、PAX5弥漫(+),CD3散在少许(+),Ki-67阳性率为70%,AE1/AE3、CD117和CD56均(-);其中例1 CD5弥漫(+)。结论血管内大B细胞性淋巴瘤是一种具有高度侵袭性的结外弥漫性大B细胞性淋巴瘤的亚型,由于该病临床表现多样及不典型性,造成了部分患者的诊断困难,因此,掌握临床病理及免疫组化特征对该病的诊断和鉴别诊断具有重要意义。     

血管内大B细胞淋巴瘤1例报告及文献复习

目的：了解血管内大B细胞淋巴瘤的临床，病理特征及治疗、预后情况。方法：对1例血管内大B细胞淋巴瘤（IVL）的临床特点及病理特征结合国内外文献进行分析。结果：该病例通过对肌肉活检得到诊断并给予积极的治疗。结论：IVL预后一般较差，但通过提高该病的诊断水平，可于肌肉活检做出诊断，做到早期诊断，及时治疗，可改善预后争取较好的转归。     

弥漫性大B细胞淋巴瘤的治疗最新进展

弥漫性大B细胞淋巴瘤(DLBCL)是一组具有生物学异质性的B细胞恶性肿瘤.CD20单克隆抗体(如利妥昔单抗)的应用使得DLBCL患者的预后得到明显改善,但是仍有部分患者应用联合利妥昔单抗的化疗方案后疗效不佳.因此,根据DLBCL的不同亚型及细胞起源,选择不同的治疗方案,成为目前DLBCL治疗关注的重点.本文就DLBCL的亚型及细胞起源等方面,总结DLBCL治疗方法及其预后研究的最新进展.     

T-cell/histiocyte-rich large B-cell lymphoma in a child: A case report and review of literature

T-cell/histiocyte-rich large B-cell lymphoma is uncommon in children population. There were few cases reported in the literature with wide range clinical presentations including advanced stage, and more involvement of liver, spleen and bone marrow. Head and neck lymphadenopathy tends to present in younger children. We report a case of 10-year-old boy who initially presented intermittent fever, headaches and neck lymphadenopathy. Subsequently, he developed diffuse lymphadenopathy and hepatosplenomegaly. T-cell/histiocyte-rich large B-cell lymphoma was diagnosed on a cervical lymph node biopsy. Cervical lymphadenopathy in this age group is most commonly reactive or non-malignant processes. Lymphoma is much less frequent; mainly are non-Hodgkin lymphomas. However, a subset of large B-cell lymphoma called T-cell/histiocyte- rich B-cell lymphoma is rare in children.     

Pidilizumab in the treatment of diffuse large B-cell lymphoma

Introduction: The programmed death-1 (PD-1) immune checkpoint pathway is an emerging target in the treatment of hematologic malignancies. Pidilizumab is an mAb that binds to PD-1 and is a safe and well-tolerated therapy. Recent data have shown clinical activity utilizing this strategy in diffuse large B-cell lymphoma (DLBCL).

Areas covered: The role of PD-1 expression in hematologic malignancies is explored. Recent clinical trials including the results of a Phase I trial in hematologic malignancies and a Phase II trial of pidilizumab following autologous hematopoietic stem-cell transplant (AHSCT) are reviewed.

Expert opinion: We review data that suggest that PD-1 is a promising target in the treatment and management of DLBCL. Changes in immune subsets following administration of pidilizumab are felt to represent on-target responses. The improvement in progression-free survival (PFS) following AHSCT supports a response to therapy. Importantly, the improvement in PFS for patients with positive FDG-PET/CT following AHSCT indicating residual disease further supports direct activity of pidilizumab in DLBCL.     

P53异常在弥漫大B细胞淋巴瘤中的预后价值

本研究旨在分析P53异常在弥漫大B细胞淋巴瘤(DLBCL)中的预后价值。采用荧光原位杂交法(FISH)对50例DLBCL患者的扁桃体组织进行P53基因检测,同时采集患者外周血用酶联免疫吸附(ELISA)法进行血清P53蛋白含量的检测,了解DLBCL患者P53基因及P53蛋白表达与淋巴瘤预后的关系。结果表明,50例患者中P53缺失者21例,阳性率42.0%,患者血清P53蛋白含量为(176.25±61.25)pg/ml,高于正常对照。经Cox模型似然比检验结果筛选,DLBCL患者的P53异常可作为独立的预后因素。P53基因检测阳性患者的死亡风险高于P53检测阴性者。经FISH检测,组织学P53基因缺失的患者同时有相对较高的血清突变型P53蛋白水平。结论:P53异常可作为DLBCL患者独立的预后因素,在疾病诊断初期即对DLBCL患者的P53表达进行检测有利于准确判断预后。     

The role of lipid peroxidation in neurological disorders

There has been much evidence demonstrating the involvement of oxidative stress in the pathology of neurological disorders. Moreover, the vulnerability of the central nervous system to reactive oxygen species mediated injury is well established since neurons consume large amounts of oxygen, the brain has many areas containing high iron content, and neuronal mitochondria generate large amounts of hydrogen peroxide. Furthermore, neuronal membranes are rich in polyunsaturated fatty acids, which are particularly susceptible to oxidative stress. Recently, the biological roles of products produced by lipid peroxidation have received much attention, not only for their pathological mechanisms associated with neurological disorders, but also for their practical clinical applications as biomarkers. Here, we discuss the production mechanisms of reactive oxygen species in some neurological disorders, including Alzheimer’s disease, Down syndrome, Parkinson’s disease, and stroke. We also describe lipid peroxidation biomarkers for evaluating oxidative stress.     

原发性皮肤弥漫性大B细胞性淋巴瘤(腿型)17例临床病理分析

目的探讨原发性皮肤弥漫性大B细胞性淋巴瘤(腿型)(PCDLBCLLT)的临床病理特点。方法回顾性分析17例PCDLBCLLT的临床资料、组织学形态和免疫组化标记。结果 17例PCDLBCLLT的发病年龄为31～86岁,平均64.4岁;其中男性9例,女性8例,男女之比为1.1∶1;主要发生于腿部和躯干部。组织学表现为弥漫分布的肿瘤细胞,以中心母细胞和免疫母细胞为主,核分裂象易见,肿瘤组织不累及表皮。免疫组化:肿瘤细胞表达B细胞相关抗原,bcl-2、MUM1、FOX-P1和bcl-6(+),Ki-67增殖指数为60%～90%。结论 PCDLBCLLT是一种独特类型的大B细胞性淋巴瘤,预后较差。     

Diagnosis and treatment of pediatric anaplastic lymphoma kinase-positive large B-cell lymphoma: A case report

BACKGROUNDAnaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare type of lymphoma with high invasiveness and rapid progression. It occurs in all age groups, but is extremely rare in children. The lesions mainly involve the lymph nodes and may present with extra-nodal involvement. Response to conventional chemotherapies and local radiotherapy is poor, with a 5-year overall survival of less than 40%. Recently, the use of ALK inhibitors for the treatment of this disease has been reported.CASE SUMMARYWe present a case of a 12-year-old boy diagnosed with ALK+LBCL. The patient had a 2-mo medical history of a calvarial mass, extensive systemic involvement, and positive bone marrow clathrin heavy chain (CLTC)-ALK fusion gene. Complete remission 1 (CR1) was achieved using the modified LMB89 Group C regimen followed by autologous stem cell transplantation. The patient relapsed 3 mo later. He then achieved CR2 with three short courses of chemotherapy (COP, reduced-dose ICE, low-dose Ara-c+VP16) and continuous alectinib targeted therapy. Afterward, allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed. At 16 mo after the allo-HSCT, the patient was still in CR2.CONCLUSIONThe modified LMB89 Group C regimen and ALK inhibitors are effective. Allo-HSCT should be performed after remission.     

免疫化疗对弥漫性大B细胞淋巴瘤患者预后评价因子的影响

目前联合利妥昔单克隆抗体的免疫化疗已成为弥漫性大B细胞淋巴瘤(DLBCL)的一线治疗方案。本研究借助当前免疫化疗状况对过去国际预后指数(IPI)及目前报道的几种不同免疫学亚型的预后指导价值进行评估分析。采用回顾性分析方法,分别收集接受免疫化疗的病例(R-CHOP组,51例)和常规化疗的病例(CHOP组,75例)的临床资料,并通过免疫组织化学方法,按目前报道的常用分型方法将两组患者分成不同的免疫学亚型,并探讨两组间不同临床因素、IPI分组及不同免疫学亚型分型对治疗反应率和预后的提示作用。结果表明,CHOP组75例。R-CHOP组的治疗完全反应率(68.6%)明显高于CHOP组(58.7%),年龄因素和IPI风险评分在两组中都有提示预后的作用。Han模型及Muris模型区分不同的免疫学亚型,结果在CHOP组有一定的治疗反应率和预后提示作用,而在R-CHOP组,不同的免疫学亚型间没有明显的治疗反应率和预后差异。结论:IPI评分在免疫化疗中仍具有重要的预后评价作用,但利妥昔单克隆抗体的应用可能会使基因学差异导致的预后影响减弱甚至消失。免疫化疗的应用提高了DLBCL的治疗反应率及生存率。     

弥漫性大B细胞淋巴瘤中miR-34a、FOXP1表达的相关性及临床意义

目的 研究弥漫性大B细胞淋巴瘤(DLBCL)中微小RNA(miR)-34a、叉头框蛋白P1(FOXP1)表达的相关性及临床意义.方法 选择2018年2月至2019年7月期间经达州市中心医院病理确诊的DLBCL组织79例和反应性增生淋巴结组织60例,采用荧光定量PCR检测miR-34a的表达水平、western blot...     

弥漫大B细胞淋巴瘤MRI表现与血管生成拟态、网状纤维的相关性

目的分析颅内弥漫大B细胞淋巴瘤（DLBCL）MRI征象与血管生成拟态（VM）、网状纤维的相关性。方法收集2017年3月~2020年4月经我院确诊并做MRI检查的颅内DLBCL患者93例。分别记录所有患者MRI征象,并对肿瘤标本进行染色、分析,不同性质VM及网状纤维的强化指数,VM、网状纤维与强化指数的关系,MRI表现与血管生成拟态、网状纤维的关系。结果肿瘤内微血管密度42.42±18.78 mm²,病灶成熟血管数目9.65±4.02 mm²。所有颅内患者中单发62例,多发31例,共149个病灶;93例MRI结果中53个T1WI呈等信号、40个稍低信号;44个T2WI呈等信号、49个稍高信号;所有病灶DWI呈高信号;62个分叶征病灶,47个脐凹征病灶,31个尖角征病灶,26个握拳征病灶;18个脑膜浸润病灶;所有病灶均有PAS染色阳性索状或网状结构,其中53个强阳性,40个弱阳性;网状纤维染色：49个病灶（强阳性）内分布较多网状纤维;44个病灶（弱阳性）中散布网状纤维;所有患者均有强化,强化指数为0.996±0.368。患者微血管密度与强化指数呈正相关（P < 0.05）,强化指数与成熟血管数量正相关(P < 0.05)。VM弱阳性组强化指数低于强阳性组（P < 0.05）;网状纤维弱阳性组强化指数低于强阳性组（P < 0.05）。VM、网状纤维与强化指数呈明确的正相关(P < 0.05)。坏死MRI表现与VM呈负相关（P < 0.05）。结论DLBCL MRI表现坏死与VM呈负相关,DLBCL在MRI表现中有一定特点,可按其表现进行诊断。