恶性淋巴瘤1126例临床特点分析

 目的　分析恶性淋巴瘤患者住院的临床特点。方法　从该院病案数据库提取2005年1月至2009年12月住院恶性淋巴瘤患者的资料,剔除未能明确病理分型及重复入院的病例,从年龄、性别、病理类型、肿瘤起病部位及分期等方面进行分析、总结。结果　住院的恶性淋巴瘤患者1126例,男女比例为1.94∶1。霍奇金淋巴瘤（HL）患者年龄集中在20～40岁,以混合细胞型（64.16 %）、结节硬化型（29.48 %）为主。非霍奇金淋巴瘤（NHL）患者年龄以50~70岁为多,发病率位于前10位的为弥漫大B细胞淋巴瘤（53.31 %）、结外NK／T细胞淋巴瘤（7.35 %）、套细胞淋巴瘤（6.40 %）、B细胞慢性淋巴细胞白血病／小淋巴细胞淋巴瘤（4.30 %）、间变性大细胞淋巴瘤（4.09 %）、前T细胞淋巴母细胞白血病／淋巴瘤（3.88 %）、外周T细胞淋巴瘤（非特指）（3.46 %）、血管免疫母细胞型淋巴瘤（3.04 %）、滤泡性淋巴瘤（2.94 %）、伯基特淋巴瘤（2.52 %）。两者起病部位均以颈部淋巴结常见。结论　HL和NHL发病存在性别、年龄、病理类型、起病部位等差异。     

肺原发性淋巴瘤1 例报告

 恶性淋巴瘤是一组起源于淋巴结或淋巴结外部位淋巴组织的免疫细胞肿瘤，一般分霍奇金淋巴瘤（HL）和非霍奇金淋巴瘤（NHL）。其中NHL的发病率约占全部恶性淋巴瘤的90％。近年来，国内外原发性结外淋巴瘤（Primary extranodal lymphoma，PENL）屡有报道，国外资料报道：结外淋巴瘤发病部位最常见的前5位依次是胃肠道、Waldeyer环、皮肤、中枢神经系统、软组织。     

非霍奇金淋巴瘤1012例临床病理分析

目的:了解我院近10年来非霍奇金淋巴瘤(NHL)的发病特点,分析影响NHL预后的相关因素.方法:回顾性分析了近10年来我院收治的1012例NHL患者的临床病理特点,对影响新疆地区NHL生存率及预后的临床病理因素进行分析.结果:1012例NHL中以40～60岁汉族男性发病多见,最主要病理类型依次为弥漫性大B细胞淋巴瘤(DLBCL)346例(34.1%),外周T细胞淋巴瘤(PTCL)185例(18.3%),滤泡淋巴瘤(FL)97例(9.6%),黏膜相关淋巴组织淋巴瘤(MALT)94例(9.3%),NK/T细胞淋巴瘤62例(6.1%),T-淋巴母细胞淋巴瘤(T-LBL)47例(4.6%).结性起病的淋巴瘤619例(61.2%),结外起病的淋巴瘤393例(38.8%).本组维吾尔族女性FL淋巴瘤患者人数比例较汉族女性患者高(P=0.002),汉族男性PTCL患者人数比例高于维吾尔族男性患者(P=0.015).5年总生存率为45.8%.单因素分析显示临床分期,行为状态评分(PS),B症状,年龄,肿块大小,血清乳酸脱氢酶(LDH),结外器官受侵数目及IPI是NHL的预后因素(P＜0.05).多因素分析提示T细胞来源,Ⅲ～Ⅳ临床分期,IPI评分3～5分及LDH增高是NHL独立的预后不良因素(P＜0.05).结论:新疆地区NHL发病以中年多见,结性起病者多于结外起病,B细胞淋巴瘤多于T细胞淋巴瘤.免疫分型、临床分期、IPI、血清LDH水平与NHL预后相关.     

弥漫大B细胞淋巴瘤异质性研究进展

弥漫大B细胞淋巴瘤（DLBCL）是非霍奇金淋巴瘤（NHL）最常见的一种类型,占成人NHL的30%-40%。化学治疗通常能改善DLBCL患者的生存预后,但是由于异质性而导致DLBCL患者的临床特征及对治疗反应的不同,约有50%的患者不能通过标准的治疗方案治愈。我们结合国内外文献,对DLBCL异质性的研究作一简要综述,以期对其发病机制有更进一步的认识。     

1326例非霍奇金淋巴瘤临床病理特点分析

目的 非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)是严重威胁人类健康和生命的恶性肿瘤之一,各年龄段均可发病,具有高度异质性,不同病理亚型的临床特征有很大差异.本研究调查云南地区NHL患者的临床病理特征,为本地区开展NHL临床诊疗及防治工作提供参考.方法 回顾性分析云南省肿瘤医院2003-01-01-2012-12-31收治的NHL患者的临床病理资料.结果 共计1 326例NHL纳入统计,男女比例为1.6∶1;年龄4～85岁,中位年龄50岁.全组患者中B细胞淋巴瘤为933例(70.4％),T细胞淋巴瘤为361例(27.2％),两者比例为2.6∶1;以弥漫大B细胞淋巴瘤(34.7％,460/1 326)、结外NK/T细胞淋巴瘤鼻型(9.1％,121/1 326)、外周T细胞淋巴瘤(6.4％,85/1 326)、滤泡性淋巴瘤(5.8％,77/1 326)及结外粘膜相关淋巴组织边缘区淋巴瘤(4.8％,63/1 326)最常见.淋巴结起病者占45.8％(607/1 326),最常见为颈部及锁骨上淋巴结(27.3％,362/1 326);结外起病者占50.3％(667/1 326),常见部位依次为胃肠道(10.9％,144/1 326)、韦氏环(10.6％,141/1 326)及鼻腔(10.5％,139/1 326).全组患者Ⅰ、Ⅱ期占54.8％(726/1 326),Ⅲ、Ⅳ期占45.2％(600/1 326).单因素分析显示,病理类型、侵袭性分级、起病部位、节外淋巴瘤、B症状、ECOG评分、血清LDH水平和大肿块为NHL临床分期的影响因素.多因素分析结果显示,病理类型、侵袭性分级、起病部位、B症状、ECOG评分、血清LDH水平和大肿块为NHL临床分期的影响因素.结论 云南地区NHL发病以中年人为主,男性多于女性,B细胞淋巴瘤显著多于T细胞淋巴瘤,结外起病者略高于结内起病者,病理恶性程度、起病部位、全身症状、体能状态评分、血清乳酸脱氢酶水平和大肿块对临床分期有明显影响.     

B细胞性非霍奇金淋巴瘤中BCL-6、CD10和BCL-2的蛋白表达及其临床病理意义

背景与目的：BCL-6、CD10均为淋巴结生发中心B淋巴细胞（GC—B细胞）的标志，它们在结内外弥漫性大B细胞淋巴瘤（DLBCL）及其它类型淋巴瘤中的表达特征及意义值得研究。本研究分析了B细胞性非霍奇金淋巴瘤（B—NHL）中BCL-6、CD10和BCL-2的蛋白表达及其临床病理意义。方法：免疫组化EnVision两步法分析135例B—NHL常见类型[包括DLBCL 22例，滤泡性淋巴瘤（FL）18例，B小淋巴细胞性淋巴瘤（B—SLL）18例，套细胞淋巴瘤（MCL）15例，淋巴浆细胞性淋巴瘤（LPL）7例，Burkitt’s淋巴瘤（BL）5例，B淋巴母细胞性淋巴瘤（LBL）3例；结外DLBCL 29例，胃粘膜相关淋巴样组织结外边缘区B细胞淋巴瘤（MALT-L）18例]和对照组5例T—NHL、5例结节型淋巴细胞为主型霍奇金淋巴瘤（NLPHL）以及10例淋巴结反应性增生（RLH）石蜡包埋组织中BCL-6、CD10以及BCL-2蛋白的表达。结果：①BCL-6和CD10阳性表达均只见于RLH（100％和100％）、结内DLBCL（72．7％和40．9％）、结外DLBCL（75．9％和41.4％）、FL（88．9％和72．2％）以及BL（100％和100％），其余B—NHL如B-SLL、MCL、MALT—L、LPL、LBL以及T-NHL和NLPHL中均未见BCL-6和CD10蛋白的表达。BCL-2蛋白表达可见于结内、结外DLBCL、FL、B—SLL、MCL、MALT—L以及LBL，阳性率分别为：36．4％、27．6％、83．3％、88．9％、86．7％、72．7％和33．3％；而LPL、BL、T—NHL以及NLPHL未见BCL-2蛋白表达；②DLBCL中BCL-6的表达形式可以分为四种类型：GC／FL型、中间型、散在型和阴性型；③40．9％的结内DLBCL、41．4％的结外DLBCL、72．2％的FL以及100％的BL为BCL-6＋／CD10＋表达，其中BCL-6蛋白表达均为GC／FL型；④在临床特征上，BCL-6＋／CD10＋的结内DLBCL与非BCL-6＋／CD10＋的结内DLBCL相比，前者的临床分期低于后者（P〈0．05）。结论：BCL-6、CD10和BCL-2蛋白的联合检测，可以用于部分B—NHL的诊断和鉴别诊断；BCL-6＋／CD10＋的结内淋巴瘤可能具有更好的临床预后。     

弥漫大B细胞淋巴瘤基于分子遗传学特性的分层治疗策略

弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）是成年人非霍奇金淋巴瘤（NHL）中最常见的类型,占全部NHL的30％～40％。它是一组在临床表现、组织形态和预后等多方面具有很大异质性的恶性肿瘤。     

不同部位和类型恶性淋巴瘤与EBV感染相关性研究

目的：对不同部位和类型的恶性淋巴瘤中EB病毒（Epstein-Barr virus，EBV）的感染情况进行检测和分析，探讨EBV感染可能与恶性淋巴瘤的病因关系。方法：收集恶性淋巴瘤组织标本127例，其中鼻腔及鼻咽淋巴瘤60例，胃淋巴瘤30例，表浅淋巴结淋巴瘤37例。组织病理学诊断为非霍奇金淋巴瘤（NHL）108例，霍奇金淋巴瘤（HD）19例。采用原位分子杂交方法检测淋巴瘤组织中EBV编码的小RNA（EBER），确定EBV在恶性淋巴瘤细胞中的存在。结果：108例NHL（包括鼻腔及鼻咽、胃、表浅淋巴结部位），EBER检测46例阳性，阳性率为42.6%。鼻腔/鼻咽NHL的EBER阳性率为58.3%（35/60），其中NK/T细胞淋巴瘤29例，EBER阳性19例，阳性率为65.5%（19/29）；B细胞淋巴瘤31例，EBER阳性16例，阳性率为51.6%（16/31）。胃部NHL的EBER阳性率为30.0%（9/30），其中B细胞淋巴瘤28例，EBER阳性9例，阳性率为32.1%（9/28）；T细胞淋巴瘤2例，均为EBER阴性。表浅淋巴结NHL18例，EBER阳性2例，阳性率为11.1%（2/18）；表浅淋巴结HD19例，EBER阳性5例，阳性率为26.3%（5/19）。结论：本组资料非霍奇金淋巴瘤EBV感染阳性率（42.6%）略高于霍奇金淋巴瘤EBV感染阳性率（26.3%），差异无显著性意义（P〉0.05）。鼻腔及鼻咽NHL的EBV感染阳性率（58.3%）高于胃NHL（30.0%）和表浅淋巴结NHL（11.1%）（P〈0.05）。研究提示各类型淋巴瘤与EBV感染均有密切关系，且存在部位依赖性。     

输尿管弥漫性大B细胞淋巴瘤伴颈部淋巴结肿大1例

淋巴瘤是临床常见的一种恶性肿瘤,其起源于人类免疫系统细胞及前体细胞.在临床上分为霍奇金淋巴瘤( HL)和非霍奇金淋巴瘤( NHL)两种类型.NHL的发病率和死亡率都非常高,位居全球常见癌症的前十位[1] ,而弥漫性大B细胞淋巴瘤( DLBCL)是非霍奇金淋巴瘤的一个亚型,患者5年生存率远低于非霍奇金淋巴瘤患者[2].提...     

青海地区淋巴瘤253例临床特点与预后因素分析

目的 分析淋巴瘤的临床特点及预后相关因素.方法 对青海地区253例淋巴瘤患者临床资料进行回顾性研究并随访.采用Kaplan-Meier法分析患者不同临床特点及实验室检查的生存期差异.采用Cox比例风险回归模型分析影响预后的因素.结果 253例淋巴瘤患者中,男、女比例为1.56∶1,中位年龄为48岁,发病年龄高峰为40岁和60岁左右.结内起病（56.13％）较多,结外起病常见部位为鼻咽部和胃肠道.病理类型为霍奇金淋巴瘤40例（15.81％）,非霍奇金淋巴瘤213例（84.19％）.前者以结节硬化型（72.50％）最多见;后者中B细胞淋巴瘤148例（69.48％）,最常见的病理类型为弥漫大B细胞淋巴瘤（39.91％）、滤泡细胞淋巴瘤（12.21％）及周围T细胞非特殊型淋巴瘤（9.39％）.单因素预后分析显示,临床分期、有无B症状、血红蛋白（Hb）、乳酸脱氢酶（LDH）、国际预后指数（IPI）及治疗方案与非霍奇金淋巴瘤预后密切相关（均P＜0.05）.Cox回归模型多因素分析显示,临床分期、IPI及治疗方案与非霍奇金淋巴瘤的预后关系密切,差异有统计学意义（均P＜0.05）.结论 青海地区淋巴瘤发病年龄有两个高峰,结内发病高于结外,B细胞淋巴瘤多见,IPI分组适用于该地区非霍奇金淋巴瘤的预后评估,并可作为其独立的预后因素.     

Biological characteristics and prognosis of childhood malignant lymphoma

The biological characteristics and prognosis of childhood malignant lymphoma were reviewed. A national survey of 568 cases of childhood malignant lymphoma in Japan revealed that 505 cases (88.9%) were non-Hodgkin's lymphoma (NHL), and 63 cases (11.1%) were Hodgkin's lymphoma (HL). The biological characteristics of NHL in Japan were a male predominance, an average age of 7.8 years, and frequent occurrence in the head and neck (38.2%). Histopathologically, only 3.2% of NHL was nodular type and 96.8% was diffuse type (lymphoblastic 28.4%, histiocytic 19.5%, medium-size cell 18.6%, Burkitt's 14.6%, and miscellaneous 15.8%.) The characteristics of the 63 cases of HL were a male predominance, an average age of 9.3 years, 73% of primary lesions in the cervical nodes, and 46.6% of mixed cellularity type. The survival rate at 7 years estimated by the Kaplan -Meier method was 41.1% for patients with NHL, and 84.9% for patients with HL. Leukemic conversion and CNS involvement occurred in 27.9% and 22.9% of patients with NHL, respectively. The current multi-institutional treatment study for NHL conducted by the Children's Cancer and Leukemia Study Group (CCLSG) has improved the prognosis of childhood NHL to an 84.6% induction rate with initial therapy and a relapse-free survival rate of 55.6% at four years. The most important principle for the management of childhood malignant lymphoma is the recognition of the systemic nature of the disease.     

Type Distribution of Lymphomas in Lebanon: Five-Year Single Institution Experience

Background: Lymphomas represent the fifth most frequent cancer in Lebanon. However, little is knownconcerning epidemiologic characteristics and distribution of lymphoid neoplasms according to the 2008 WHOclassification. Materials and Methods: We conducted a retrospective study of lymphoma cases diagnosed from2008 till 2012 at Hôtel-Dieu de France University Hospital. Results: A total of 502 new cases of lymphoma werediagnosed at our institution during a five year period: 119 cases (24%) were Hodgkin lymphomas (HL) and 383cases (76%) were non-Hodgkin lymphomas (NHL). HLs were equally distributed in both sexes with a meanage at diagnosis of 30 years. Among NHL, 87% (332 cases) were B cell lymphomas, 9% (34 cases) were T celllymphomas and 4%(17 cases) were classified as precursor lymphoid neoplasms. Among B cell lymphomas,44% (147 cases) were diffuse large B cell lymphomas (DLBCL), 20% (65 cases) follicular lymphomas and 8%(27 cases) mantle cell lymphomas. DLBCL were equally distributed in both sexes with a mean age of 58 years.Follicular lymphomas were characterized by a male predominance (57%) and a mean age of 60 years. Mantlecell lymphomas showed a pronounced male predominance (85%) with a mean age of 60 years in men and 70years in women. Some 72% of patients having T cell lymphomas were men, with a mean age of 57 years in menand 45 years in women, while 65% of patients having precursor lymphoid neoplasms were women with a meanage of 22 years in women and 30 years in men. Conclusions: The lymphoma subtype distribution in Lebanon isunique when compared to other countries from around the world. In fact, Hodgkin and follicular lymphomasare more frequent than in most Far Eastern, European and American countries, while T-cell lymphomas andDLBCL are less frequent.     

Insights into the multistep transformation process of lymphomas: IgH-associated translocations and tumor suppressor gene mutations in clonally related composite Hodgkin's and non-Hodgkin's lymphomas.

Clonally related composite lymphomas of Hodgkin's lymphoma (HL) and Non-Hodgkin's lymphoma (NHL) represent models to study the multistep transformation process in tumorigenesis and the development of two distinct tumors from a shared precursor. We analyzed six such lymphomas for transforming events. The HLs were combined in two cases with follicular lymphoma (FL), and in one case each with B-cell chronic lymphocytic leukemia, splenic marginal zone lymphoma, mantle cell lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL). In the HL/FL and HL/MCL combinations, BCL2/IGH and CCND1/IGH translocations, respectively, were detected in both the HL and NHL. No mutations were found in the tumor suppressor genes FAS, NFKBIA and ATM. The HL/DLBCL case harbored clonal replacement mutations of the TP53 gene on both alleles exclusively in the DLBCL. In conclusion, we present the first examples of molecularly verified IgH-associated translocations in HL, which also show that BCL2/IGH or CCND1/IGH translocations can represent early steps in the pathogenesis of composite HL/FL or HL/MCL. The restriction of the TP53 mutations to the DLBCL in the HL/DLBCL case exemplifies a late transforming event that presumably happened in the germinal center and affected the fate of a common lymphoma precursor cell towards development of a DLBCL.     

Hodgkin’s and Non-Hodgkin’s Lymphomas in an Indian Rural Medical Institution: Comparative Clinicopathologic Analysis

In this prospective, hospital-based two year study, we comparatively evaluated clinicopathologic featuresof Hodgkin’s lymphoma (HL, n = 48) and Non-Hodgkin’s lymphoma (NHL, n = 76) in an Indian rural medicalinstitution. A lower median age of onset (28.1 versus 39.9 years) and and higher male to female ratio (3.8:1versus 3.2:1) were noted for HL compared to NHL. The commonest symptom was neck swelling (58.3% versus65.8%) while peripheral lymphadenopathy was the commonest sign (83.3% versus 94.7%). The commonestlymph-node group involved was cervical (79.2% versus 79.0%). Bone marrow involvement was lower in HL(8.33% versus 18.4%). The commonest histological subtype was mixed cellularity (45.8%) in HL and diffusemixed variant (31.6%) in NHL. Most cases presented at advanced stage (54.2% in HL, 71.1 % in NHL). Hencea distinct clinicopathologic profile was noted in HL and NHL that are comparable to other Indian studies butdifferent from Western studies. Recognition of such characteristic features should assist in providing appropriatediagnosis and suitable management in rural communities having limited access to sophisticated medical services.     

恶性淋巴瘤骨髓受累的免疫表型特征

目的:探讨淋巴瘤骨髓受累的免疫表型特征。方法:采用流式细胞仪CD45/SSC设门方法对34例恶性淋巴瘤患者的骨髓标本进行检测,以骨髓涂片细胞学检查作阳性对照。收集骨髓受累患者的CD分子表达数据。结果:①对34例恶性淋巴瘤患者的骨髓应用流式细胞仪进行检测,发现23例阳性,阳性率67.65%(23/34),95%可信区间(51.92%,83.37%)。②该23例阳性患者中,非霍奇金淋巴瘤(NHL)19例,霍奇金淋巴瘤(HL)4例。NHL患者中B细胞来源免疫荧光单克隆抗体标记抗原出现频率最高的为CD19,CD20;T细胞来源标记抗原出现频率最高的为CD7。而在HL患者中出现频率最高的为CD9。结论:采用流式细胞仪CD45/SSC设门方法,发现非霍奇金淋巴瘤骨髓受累患者免疫表型特征为:B细胞来源:CD19、CD20;T细胞来源:CD7。霍奇金淋巴瘤为:CD9。     

呼吸系统原发性淋巴瘤11例临床分析(英文)

目的了解呼吸系统原发性淋巴瘤(PLRS)的临床病理特点及治疗结果。方法分析11例患者的临床表现、影像学改变、病理类型、治疗及生存情况。结果原发于气管2例,原发于肺9例。临床表现主要为咳嗽胸闷、发热、胸片和胸部 CT 扫描表现为肿块或阴影。病理类型为霍奇金(HD)2例;非霍奇金淋巴瘤(NHL)9例,包括低度恶性7例,其中黏膜相关淋巴瘤5例(55.6%),中度恶性2例。10例行手术治疗,8例术后加化疗,2例术后加放疗。治疗后2例 HD 患者的无病生存期超过5年,黏膜相关淋巴瘤和其它类型的 NHL 中位生存期分别为39个月和34个月。结论 PLRS 的临床和影像学表现为非特异性,病理类型以低度恶性黏膜相关淋巴瘤多见,外科手术为治疗首选,预后良好。     

细针针吸细胞学在淋巴瘤诊断中的应用

 目的 探讨霍奇金氏淋巴瘤（HL）和非霍奇金氏淋巴瘤（NHL）针吸穿刺的敏感性，及淋巴瘤在针吸细胞学中容易产生的错误诊断。方法 对细针针吸细胞学诊断的318例HL和NHL与组织病理学结果对比。结果 淋巴瘤的敏感性为95．6％，HL的敏感性为93．7％，NHL的敏感性为96．1％。69例HL中误诊为NHL3例，反应性增生1例。NHL容易与HL及小细胞肿瘤混淆，包括小细胞癌，不典型类癌，胚胎性横纹肌肉瘤等。249例NHL中，6例误诊为HL，其中2例弥漫大B，2例富于T的B细胞淋巴瘤，1例滤泡中心型，1例为大细胞间变。免疫细胞化学结果与病理结果均一致。结论 针吸细胞学可以对淋巴瘤作出准确诊断，但应该做到多点针吸使标本满意，并要结合临床资料，免疫细胞化学可以作为淋巴瘤细胞学诊断的辅助手段。