淋巴结内及胃肠道弥漫性大B细胞淋巴瘤的分型及其临床意义

2001年WHO对恶性淋巴瘤提出了最新分类方法,总共分30个独立疾病:属非霍奇金淋巴瘤(NHL)有28个,其中B细胞来源NHL 13个,T/NK细胞来源NHL 15个;属霍奇金淋巴瘤有2个疾病(见表1).     

睾丸原发性弥漫性大B细胞淋巴瘤临床病理学分析

目的:探讨睾丸原发性弥漫性大B细胞淋巴瘤(DLBCL)的临床病理特征、免疫表型及治疗方法。方法:回顾性分析23例睾丸DLBCL的病理形态学及免疫组化标记,结合文献对其临床病理学特点进行分析。23例患者年龄48～76岁,平均61.4岁,82.6%患者超过50岁。病变部位左侧睾丸9例,右侧14例,均为单侧发病。临床主要表现为睾丸无痛性进行性肿大。结果:组织学主要表现为肿瘤细胞弥漫浸润于睾丸实质,细胞体积较大,异型性明显,核分裂易见。免疫表型均表达B细胞标志物。5例获得随访资料,4例截止随访时均存活,随访时间2～32个月,1例随访9个月后死亡。结论:睾丸DLBCL少见,多发于老年男性患者,具有侵袭性生物学行为。诊断时极易误诊或漏诊,其确诊依赖组织病理学,免疫组化标记对明确诊断及鉴别诊断有一定价值。     

胃肠道弥漫性大B细胞淋巴瘤中之t（14;18）染色体易位及Bcl-2基因扩增的研究

目的：探讨胃肠道弥漫性大B细胞淋巴瘤（diffuse large B-cell lymphoma,DLBCL）中之染色体t（14;18）（q32;q21）易位及Bcl-2基因扩增与DLBCL亚型分类及病人预后间的关系;探讨其在胃肠道DLBCL发病中的作用机制。方法：应用荧光原位杂交（fluorescence in situ hybridization,FISH）技术检测45例胃肠道DLBCL组织中之t（14;18）（q32;q21）染色体易位及Bcl-2基因扩增情况;应用免疫组化染色法检测该45例胃肠道DLBCL中之Bcl-2蛋白的表达。结果：在45例胃肠道DLBCL病人中,10例（22%）存在t（14;18）（q32;q21）易位,10例（22%）存在Bcl-2基因扩增。t（14;18）（q32;q21）易位阳性者与阴性者间的亚型分类比例差异有统计学意义（P〈0.01）。Bcl-2基因扩增阳性者与阴性者间之生存时间差异有统计学意义（P〈0.05）。而t（14;18）（q32;q21）染色体易位及Bcl-2基因扩增与Bcl-2蛋白表达间均属无关（P〉0.05）。结论：t（14;18）（q32;q21）染色体易位与胃肠道DLBCL的免疫表型分类相关,生发中心B细胞（germinal center B cell-like,GCB）型与非GCB型间存在分子遗传学差异。而检测Bcl-2基因扩增对判断胃肠道DLBCL病人的预后具有重要意义。     

原发性脾脏弥漫性大B细胞淋巴瘤1例

原发性脾脏淋巴瘤(primary splenic lymphoma,PSL)是一种罕见的恶性淋巴瘤,通常定义为病变首发于脾脏,一般无脾外脏器及淋巴组织受累。PSL发生率很低,仅占恶性淋巴瘤的1%左右[1]。笔者报道1     

前列腺原发性弥漫性大B细胞淋巴瘤1例

1病例报告 患者,男,56岁,因"排尿困难1个月"入院.全身浅表淋巴结未触及肿大,肝脾肋下未触及.肛检前列腺Ⅱ度大,质地中等,边界清,表面光滑,无结节,无触痛,中间沟变浅.MRI示前列腺增大,大小约5.4 cm×4.5 cm×4.3 cm,以中央叶增大明显,T2WI信号增高,边缘叶T2WI上较高信号,T1WI上略低信号.B超提示"中度前列腺肥大并多发钙化灶".血常规正常.血肌酐Cr 78 μmol/L,乳酸脱氢酶LDH 197 U/L,总前列腺特异抗原TPSA 2.6990 ng/mL,游离前列腺特异抗原FPSA 0.1260 ng/mL.行"经尿道超脉冲前列腺等离子电切术",术中见前列腺切面红棕色,质软,血管丰富.     

原发性胃弥漫性大B细胞淋巴瘤40例诊治分析

原发性胃弥漫性大B细胞淋巴瘤（ DLBCL）是胃恶性淋巴瘤（ PGML）中最常见的一种,近年来发病率呈逐渐升高的趋势［1］,它的临床表现缺乏特异性,临床医师对其认识不足,误诊率高。回顾性分析2008年1月至2013年6月我院收治的40例胃DLBCL患者的临床资料,以加强对该病的认识,探讨其诊治方法。     

肾脏弥漫性大B细胞淋巴瘤并转移及脾肿大1例

<正>患者,女,35岁,因左侧腰痛伴乏力2个月于2018年3月入院。既往发现脾脏肿大伴乏力5年余,在当地医院就诊,B超提示:脾脏肿大,血常规提示三系下降,患者当时未继续行骨髓穿刺术,给予输血治疗后症状好转出院,期间症状偶有出现,     

原发性腹膜后弥漫大B细胞淋巴瘤的临床分析

目的:总结原发性腹膜后弥漫大B细胞淋巴瘤(diffused large B-cell lymphoma, DLBCL)的诊治经验。方法:回顾性分析2012年9月—2019年10月我院收治的6例原发性腹膜后DLBCL的临床特征、治疗和预后。其中男4例,女2例;年龄42～73岁,平均62.17岁;左侧3例,右侧1例,双侧2例。5例首诊表现为腰腹痛,1例无症状体检发现。CT或MRI影像学检查提示腹膜后肿瘤。其中CT检查5例,MRI检查1例;单发肿块4例,多发结节样2例;肿瘤最大径5.5～17.8 cm,平均10.98 cm。本组均否认既往淋巴瘤病史,3例术前诊断为腹膜后恶性肿瘤,因穿刺活检出血或肠道损伤风险大,行剖腹探查无法完整切除肿瘤,行腹膜后肿瘤切取活检术,1例术前诊断为左肾上腺皮质癌并左肾侵犯,行左腹膜后肿瘤及左肾切除术,1例诊断为腹膜后恶性肿瘤,行CT引导下腹膜后肿物穿刺活检,1例诊断为腹膜后恶性肿瘤并结肠侵犯,行无痛肠镜活检。5例行静脉化疗,1例行腹膜后病变区域局部放疗。结果:术后或活检病理诊断均为腹膜后DLBCL,Ann Abor分期Ⅱ期4例(2例累及肠道,1例累及肾脏,1例累及输尿管),Ⅳ期2例。IPI评分1分1例,2分3例,4分2例。3例行利妥昔单抗联合环磷酰胺+表柔比星+长春新碱+泼尼松(R-CHOP)方案化疗;2例因经济困难未使用利妥昔单抗,行CHOP方案化疗;1例确诊1个月后因病情进展死亡,未行化疗。术后或活检后随访1～22个月,平均9.83个月。本组4例死于病情进展;2例存活,其中1例放化疗后完全缓解,另1例术后辅助化疗中。结论:原发性腹膜后DLBCL临床罕见,临床表现不典型,确诊需依靠病理检查,手术或穿刺活检是获取病理组织的重要方式。治疗首选R-CHOP方案静脉化疗,本病预后不良。     

早期原发性胃弥漫大B细胞淋巴瘤的治疗与预后分析

目的探讨早期原发性胃弥漫大B细胞淋巴瘤（DLBCL）的预后影响因素及治疗方式的选择。方法回顾性分析天津医科大学附属肿瘤医院1993年1月至2008年8月间经胃镜活检或手术病理证实的75例早期DLBCL患者的临床病理资料。结果75例患者中接受单纯化疗20例．手术联合化疗55例：两组患者完全缓解率分别为65．0％（13／20）和83．6％（46／55）,治疗有效率分别为75．0％（15／20）和92．7％（51／55）,5年生存率分别为86．9％和78．7％,差异均无统计学意义（均P〉0．05）。单因素和多因素预后分析显示,国际预后指数（IPI）评分是DLBCL患者的独立预后因素（P〈O．05．HR=11．350,95％CI：1．011-127．371）。结论IPI评分是早期胃DLBCL中的独立预后因素：单纯化疗与手术联合化疗的疗效无显著差异。     

原发性肝脏弥漫性大B细胞淋巴瘤1例MDT讨论

目的 总结1例原发性肝脏弥漫性大B细胞淋巴瘤(primary diffuse large B cell lymphoma of liver,PDLBCLL)的临床表现和影像学表现,并探讨其病因、组织来源、病理特点、诊断和鉴别诊断、治疗方法的选择及预后,以提高对该病的认识及合理诊治水平.方法 回顾性分析四川大学华西医院于...     

SIRT1 expression is associated with poor prognosis of diffuse large B-cell lymphoma

Sirtuin1 (SIRT1) is a nicotinamide adenine dinucleotide-dependent deacetylase. Recently, it is suggested that SIRT1 may be involved in the development of malignant tumors including mouse lymphoma. Therefore, we investigated the prevalence and the prognostic impact of SIRT1 expression in diffuse large B-cell lymphoma (DLBCL). Immunohistochemical expression of SIRT1, p53, bcl2, CD10, bcl6, and multiple myeloma-1 (MUM1) were evaluated by using a 2 mm core from 104 DLBCL patients for tissue microarray. Positive expression of SIRT1 was seen in 74% (77/104) of patients. In total DLBCL patients, SIRT1 and p53 expression were significantly associated with shorter overall survival (OS) by univariate analysis (P=0.001 and P=0.011, respectively). SIRT1 was also an independent prognostic factor by multivariate analysis (P=0.01). According to the expression patterns of CD10, bcl6, and MUM1, germinal center B cell (GCB) types were represented in 38 cases (37%) and non-GCB types were represented in 66 cases (63%). In the GCB type, only p53 expression was associated with a significantly shorter OS (P=0.032). In the non-GCB type, expression of SIRT1 correlated with shorter OS by univariate analyses (P=0.005) and multivariate analyses (P=0.049). In conclusion, we showed that SIRT1 expression is a clinically significant prognostic indicator for DLBCL patients.     

Immunohistochemical expression patterns of germinal center and activation B-cell markers correlate with prognosis in diffuse large B-cell lymphoma

Recent studies with cDNA microarrays showed that diffuse large B-cell lymphoma (DLBCL) cases with gene expression profiles similar to germinal center (GC) B cells had much better prognosis than DLBCL cases with gene expression profiles resembling activated B cells. The goal of the current study is to evaluate if using a panel of GC B-cell (CD10 and Bcl-6) and activation (MUM1/IRF4 and CD138) markers by immunohistochemistry defines prognosis in patients with de novo DLBCL. Immunohistochemical stains for the above markers were performed on paraffin-embedded tissues from 42 de novo DLBCL patients. Median follow-up in all patients was 41 months (range, 1-103 months) and in surviving patients was 65 months (range, 14-103 months). These cases could be classified into three expression patterns: GC B-cell pattern (pattern A) expressing CD10 and/or Bcl-6 but not activation markers; activated GC B-cell pattern (pattern B) expressing at least one of GC B-cell markers and one of activation markers; and activated non-GC B-cell pattern (pattern C) expressing MUM1/IRF4 and/or CD138 but not GC B-cell markers. Patients with pattern A had much better overall survival than those with the other two patterns (Kaplan-Meier survival analysis, P < 0.008, log rank test). Using multivariate Cox proportional hazards regression analysis, the international prognostic index scores and the expression pattern of these markers were independent prognostic indicators. Our results suggest that expression patterns of this panel of GC B-cell and activation markers by immunohistochemistry correlate with the prognosis of patients with DLBCL. Immunohistochemical analysis on paraffin-embedded tissues is more readily available than gene expression profiling by cDNA microarray and may provide similar prognostic information.     

Primary diffuse large B-cell lymphoma of the sigmoid colon

IntroductionExtranodal lymphomas are commonly encountered in the gastrointestinal tract but lymphomas of colon and rectum are rare. Non-Hodgkin lymphoma is the most common type of colonic lymphoma and represents less than 0.5% of colorectal neoplasms. Chemotherapeutical agents are gateway to disease remission and sometimes cure in most patients but surgery may be necessary in emergent situations.Case presentationA 77-year-old male patient presented with abdominal discomfort, constipation, and obstructive defecation symptoms. Radiological imaging revealed a mass in the sigmoid colon extending towards the rectum. Colonoscopy was performed and biopsy of a nearly 10 cm ulcerovegetative lesion was obtained. Histological examination following biopsy revealed it to be a diffuse large B-cell lymphoma of the sigmoid colon. There was no indication for surgery and the patient was referred to medical oncology clinic for chemotherapy treatment.DiscussionNon-Hodgkin lymphoma is a lymphoproliferative disorder with the diffuse large B cell lymphoma (DLBCL) being the most common subtype. The DLBCL subtype is rarely observed in the colon and rectum. Chromosomal abnormalities are involved in the pathophysiology and gene rearrangements lead to adjustments in lymphocyte function and differentiation.ConclusionIn this case report, we present a rare presentation of a Non-Hodgkin lymphoma presenting in the sigmoid colon. The disease can present with nonspecific symptoms and various imaging modalities along with histopathological evaluation is necessary for the correct subtyping of lymphoma. Chemoradiotherapy is key for treatment, and surgery is usually reserved for cases of obstruction, perforation, or bleeding.     

The positive relationship between the expression of CD44 variant 6 and prognosis in colorectal cancer

CD44 variant 6 (CD44 v6) is well known as a useful marker of tumor progression; however, its relationship to prognosis has not yet been elucidated. In this study, we investigated the expression of CD44 v6 in colorectal cancer to analyze its relationship to hepatic metastasis as well as to prognosis. Tumor tissues were obtained from 42 patients with colorectal cancer who underwent curative resection with follow-up periods ranging from 5.9 to 71.3 months. There were 21 patients (50%) whose tumors were positive for CD44 v6, with no significant difference between colon and rectal cancer. CD44 v6 staining was significantly related to Dukes' classification as well as to hepatic metastasis. The 5-year survival rate was significantly higher in patients with CD44 v6 negative cancer (84%) than in those with CD44 v6 positive cancer (31%). Thus, we concluded that CD44 v6 could be a reliable prognostic indicator, as well as a predictor of metastatic potential after curative surgery for colorectal cancer.     

A case of diffuse large B-cell lymphoma of the lung demonstrating diffuse ground-glass shadows

We report a case of 77-year-old woman suffering from breathlessness on exertion and dry cough. Chest computed tomography (CT) showed diffuse ground-glass shadows. A video-assisted thoracoscopic lung biopsy resulted in the diagnosis of diffuse large B-cell lymphoma (DLBCL). Gene rearrangement analysis using polymerase chain reaction (PCR) technique was performed on the cells in bronchoalveolar lavage (BAL) fluid, and showed the clonality of the immunoglobulin heavy chain (IgH) gene, supporting the diagnosis. DLBCL should be considered in the differential diagnosis of diffuse ground-glass shadows in the chest CT, and gene rearrangement analysis may have an impact on the diagnosis of pulmonary DLBCL.     

Primary esophageal diffuse large B-cell lymphoma: Report of a case

Primary esophageal lymphoma is very rare, with fewer than 25 cases documented in the English-language literature. We report a case of primary diffuse large B-cell lymphoma of the esophagus in a 42-year-old woman. Barium esophagogram revealed almost complete esophageal obstruction at the level of the cervical esophagus, and flexible endoscopy showed a circumferential submucosal tumor covered with intact mucosa. Neck magnetic resonance imaging (MRI) showed a wide cervical mass circumferentially encompassing the lumen of the cervical esophagus. Biopsies taken with multiple forceps during flexible and rigid esophagoscopy were nondiagnostic. Finally, external esophageal wall biopsies taken during neck exploration provided information that helped us establish the diagnosis. Pathohistological findings confirmed non-Hodgkin's lymphoma of the diffuse large B-cell type. The patient was treated with combined immunochemotherapy, consisting of rituximab plus cyclophosphamide, vincristine, adriablastin, and prednisone (CHOP), followed by irradiation. A complete response was achieved, and 3 years after diagnosis and treatment the patient was disease-free.