弥漫性大B细胞淋巴瘤中bcl-6基因5′非编码区突变分析

目的 观察中国人弥漫性大B细胞淋巴瘤(DLBCL)中bcl-6基因5’非编码区的突变情况,并探讨其作用。方法选用bcl-6基因5‘非编码区的高频突变区2对引物,对38例DLBCL、2例淋巴结反应性增生、5例滤泡性淋巴瘤及5例T细胞淋巴瘤标本,于显微镜下提取淋巴瘤细胞,做聚合酶链反应(PCR)、直接测序分析。结果在2例淋巴结反应增生的边缘区、5例T细胞淋巴瘤及5例滤泡性淋巴瘤中均未发现有该范围内的突变,1例反应性增生的生发中心细胞中有突变,38例DLBCL中7例(18．4％)有突变。突变类型主要是碱基替代和点插入。结论在中国人DLBCL中bcl-6非编码区的突变阳性率较低（与国外资料比较）,它可能在一定程度上参与DLBCL的发生和发展。     

弥漫性大B细胞淋巴瘤研究进展

弥漫性大B细胞淋巴瘤(diffuse large B—cell lymphoma,DLBCL)是一种大B淋巴细胞弥漫性恶性增生性疾病,瘤细胞核至少2倍于正常淋巴细胞核或大于巨噬细胞核。WHO分类(2001年)将DLBCL视为独立病种,认为进一步区分其形态学变型的重复性差,且不能证实与预后的关系,免疫表型和基因表型对区分这些变型的帮助不大,因此建议病理医师可以使用“弥漫性大B细胞淋巴瘤”这一术语作为最后诊断的名称。     

弥漫性大B细胞淋巴瘤t(14;18)易位及bcl-2基因扩增的检测

目的探讨弥漫性大B细胞淋巴瘤（DLBCL）t（14;18）染色体异位及bcl-2基因扩增在其分类及临床分期、疗效评估中的作用。方法先对60例DLBCL的标本进行显微切割,获取相对比较纯的肿瘤组织,再使用细胞核芯片荧光原位杂交（FISH）对标本进行t（14;18）易位及bcl-2基因扩增检测,采用免疫组织化学SP法在组织微阵列上同步观测CD20、CD10、bcl-6、MUM1的表达,进行生发中心样（GCB）和非生发中心样（non-GCB）分类;通过病例分析得出治疗效果及临床分期的信息,并统计分析以上各因素之间的关系。结果在60例DLBCL中,10例bcl-2／IgH阳性,18例bcl-2基因扩增;GCB29例（48．3％）,non-GCB31例（51．7％）。经FISH检测t（14;18）阳性10例中,GCB8例,non-GCB2例,差异有统计学意义（P=0．031）。t（14;18）阳性及bcl-2基因扩增的病例bcl-2表达均增高。在36例正规CHOP治疗的病例中,bcl-2扩增13例,无扩增23例,bcl-2扩增的13例之治疗结果显效、部分有效、无效率分别为3例（23．1％）、4例（30．8％）和6例（46．2％）;临床分期情况为Ⅰ-Ⅱ期1例（7．7％）,Ⅲ-Ⅳ期12例（92．3％）,这两项指标与bcl-2不扩增的相比差异均有统计学意义（P=0．019、0．046）。结论t（14;18）易位及bcl-2基因扩增均是引起DLBCL之bcl-2蛋白表达的原因,bd-2阳性者与预后有关的原因难以确定,可能是由于引起其阳性表达的原因不同所致;bcl-2基因扩增与治疗效果较差及临床分期较晚有关;FISH检测t（14;18）染色体易位可用于DLBCL的分类。     

弥漫性大B细胞淋巴瘤40例细胞病理学分析

目的 探讨细胞病理学诊断弥漫性大B细胞淋巴瘤的可行性和准确性.方法 选择40例由组织活检证实的弥漫性大B细胞淋巴瘤的细胞学病例,包括浅表淋巴结细针穿刺24例、结外包块细针穿刺6例、胸腔积液5例、腹腔积液1例、脑脊液2例、纤支镜刷片2例.对这些病例的临床特点、细胞形态和免疫细胞化学进行分析.结果 所有病例均查见较多中等偏大的淋巴样肿瘤细胞,其免疫表型为40例肿瘤细胞表达CD45(100%),39例肿瘤细胞表达CD20(97.5%),38例表达CD79α (95%),均表现为弥漫阳性,所有病例均不表达CD45RO和PCK,Ki-67增殖指数(proliferative index,PI)均值为52.1%.其中6例用细胞病理材料所作的免疫细胞化学检测中有6例表达CD45,5例表达CD20,6例表达CD79α,均不表达CD45RO和PCK,Ki-67 PI 50%～70%.40例病例中有7例(17.5%)细胞病理诊断为符合弥漫性大B细胞淋巴瘤,16例(40%)诊断为大细胞淋巴瘤,6例(15%)诊断为可疑淋巴瘤,6例(15%)误诊为低分化癌,5例(12.5%)误诊为炎性病变.结论 细胞病理虽然不是诊断弥漫性大B细胞淋巴瘤的的首选方法,但不失为一种新的尝试,仅观察细胞涂片中细胞的形态难以做出准确诊断,需要结合免疫细胞化学,流式细胞术等辅助方法来提高诊断的准确性和可靠性.     

脾脏滤泡树突状细胞肿瘤伴弥漫性大B细胞淋巴瘤

滤泡树突状细胞（follicular dendritic cell，FDC）是淋巴组织系统中一类非淋巴样辅助细胞，它的主要功能是捕获和提呈抗原和免疫复合物。FDC肿瘤是一种少见的肿瘤，迄今为止，已报道的FDC肿瘤不足70例，脾脏是FDC肿瘤好发部位。作者报道1例女性，50岁，脾脏下极孤立性巨大包块，脾切除后诊断为滤泡树突状细胞肿瘤伴弥漫性大细胞淋巴瘤（DLBCL）。     

肾脏原发性弥漫性大B细胞淋巴瘤1例

患者女,61岁,左腰痛4个月余来院就诊.CT及增强造影显示:左肾见占位性病变.临床拟"肾癌"收入院.术中见左肾体积增大,与周围粘连,腹主动脉旁有肿大淋巴结,行"左肾切除术",腹主动脉旁淋巴结清扫.标本经10%福尔马林液固定,石蜡包埋,3 μm厚连续切片,作常规HE及免疫组化标记.免疫组化试剂由福州迈新公司提供.     

bcl-6与弥漫性B细胞淋巴瘤

Ｂ细胞弥漫性大细胞淋巴瘤（Ｂｃｅｌｄｉｆｕｓｅｌａｒｇｅｃｅｌｌｙｍｐｈｏｍａ，ＢＤＬＣＬ）是淋巴瘤的常见类型，占Ｂ细胞淋巴瘤的４０％。近来，人们发现ＢＤＬＣＬ中，３、１４号染色体存在较高频率的易位，涉及原癌基因ｂｃｌ６的过度表达。１ｂｃｌ...     

弥漫性大B细胞淋巴瘤梭形细胞变异二例

例1男,57岁。左上腹疼痛1月余,加重2天。以往无任何自觉症状和体征。2003年9月19日因意外撞击伤在外院急诊,CT检查提示脾脏血肿。留院观察,但症状未见缓解,且近2天疼痛加剧,转来我院就诊。外周血检查未见异常。脾脏切除术中,见脾脏肿大呈结节状,最大结节约8cm,脾门见一直径1cm肿大淋巴结。腹主动脉旁及其他处未见淋巴结肿大。术中冷冻病理诊断为恶性梭形细胞肿瘤。     

弥漫性大B细胞淋巴瘤中hENT1的表达及意义

目的 探讨hENT1在生发中心B细胞(germinal center B cell-like,GCB)型与非GCB(non-GCB)型弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)中的表达及意义.方法 采用免疫组化PV 6000两步法检测CD10、BCL-6、MUM1蛋白在DLBCL的表达并对DLBCL进行亚型分类,同时检测hENT1蛋白的表达,探讨免疫组化染色结果和临床病理参数及预后的关系.结果 (1)hENT1蛋白在DLBCL的GCB及non-GCB亚型中表达差异有显著性(P=0.031,P<0.05).(2)hENT1的表达与患者性别、年龄、部位、LDH高低、Ann Arbor分期、有无B症状的差异均无统计学意义.(3)对76例DLBCL患者进行生存分析,中位随访时间21个月.Log-rank检验GCB/non-GCB组累计生存率差异有统计学意义(P=0.010).结论 DLBCL中non-GCB型患者比例较大,预后差.在治疗过程中,检测hENT1的表达为能否使用核苷类药物提供依据.     

弥漫性大B细胞淋巴瘤的临床病理和免疫组织化学特征

目的 探讨弥漫性大B细胞淋巴瘤临床和病理组织特征以及免疫组织化学特异性抗体在其诊断和鉴别诊断中的价值。方法 收集60例弥漫性大B细胞淋巴瘤,总结其临床资料和病理学特点,用免疫组织化学EnVision^TM两步法标记白细胞共同抗原（LCA）、L26、BLA36、CD30和bcl-6抗体。结果 76．7％（46／60）弥漫性大B细胞淋巴瘤的发病年龄集中在40－70岁,淋巴结内外均可累及,90．0％（54／60）患者临床分期为Ⅱ（24／54）、Ⅲ（21／54）、Ⅳ（9／54）期。组织病理形态：中心母细胞淋巴瘤占88．3％（53／60）,免疫母细胞淋巴瘤占3．3％（2／60）,间变性大细胞淋巴瘤占3．3％（2／60）,富于T细胞的B细胞淋巴瘤占5．0％（3／60）。免疫标记LCA、L26、BLA36表达率为100．0％（60／60）,CD30表达率为3．3％（2／60）,bcl-6表达率为95．0％（57／60）。结论 弥漫性大B细胞淋巴瘤是一组异质性肿瘤,侵袭性大,必需结合其组织病理形态和特异抗体的免疫组织化学检测进行诊断和鉴别诊断。     

ALK阳性的弥漫性大B细胞淋巴瘤

目的 探讨间变性淋巴瘤激酶(ALK)阳性的弥漫性大B细胞淋巴瘤的组织病理形态和免疫组化表达的意义。方法 参照WHO2001年恶性淋巴瘤分类,对222例弥漫性大B细胞淋巴瘤进行形态学观察和免疫组化Polymer两步法标记。结果 6例弥漫性大B细胞淋巴瘤免疫组化ALK阳性表达,阳性反应物质定位于细胞质内,成粗大的颗粒状,1例合并CD30阳性表达,全部表达B系列抗原CD20、CD79α和CD138,4例不表达CD45。组织病理形态：3例为浆母细胞性,2例为免疫母细胞性伴浆细胞样分化,1例为间变性。结论 ALK阳性的弥漫性大B细胞淋巴瘤是组织形态和免疫表型独特的变异类型,与CLTC—ALK基因易位和NPM—ALK融合基因易位有关,其分子遗传学的异质性不同于以往的认识。     

Bcl-6 and Bcl-2 protein expression in diffuse large B-cell lymphoma and follicular lymphoma: correlation with 3q27 and 18q21 chromosomal abnormalities.

The bcl-2 gene on chromosome 18 at q21 and the bcl-6 gene on chromosome 3 at q27 are both highly regulated during B-cell differentiation and show an inverse relationship of expression in the normal secondary lymphoid follicle. The objective of this study was to investigate the relationship between bcl-2 and bcl-6 protein expression and the relationship between protein expression and the corresponding chromosomal alterations in malignant lymphomas, including those associated with the germinal center. Expression of bcl-2 and bcl-6 proteins was studied in 55 cases of diffuse large B-cell lymphoma (DLBCL) and 21 cases of follicular lymphoma (FL), and the results correlated with the presence of t(14;18) and 3q27 abnormalities in a subset of 52 cases with cytogenetic analysis. These cases were selected to represent a spectrum of nodal and extranodal lymphomas, including those with and without a t(14;18). It was shown that the neoplastic cells in 71% of DLBCLs and 100% of FLs expressed bcl-6 protein. Expression of bcl-6 was seen more frequently in diffuse large B-cell lymphomas with large noncleaved morphology compared with immunoblastic morphology (82% v 27%, P = .0015), but failed to correlate with 3q27 abnormalities. Thirty-eight percent of cases with 3q27 abnormalities were bcl-6 protein negative, whereas 85% of cases without a 3q27 abnormalities were bcl-6 protein positive. Expression of bcl-2 protein was shown in 51% DLBCLs (nodal v extranodal, 71% v 30%, P = .012). bcl-2 protein was expressed in 89% of FLs with t(14;18), in contrast to 25% of FLs without t(14;18) (P = .016). In DLBCL and FL with t(14;18), the most common pattern of expression was bcl-2+/bcl-6+. In lymphomas without t(14;18), there was not an inverse relationship between bcl-2 and bcl-6 protein expression. In conclusion, these data suggest that mechanisms other than gene rearrangements can deregulate bcl-2 and bcl-6 expression in lymphomas, and there does not appear to be an inverse relationship between these two proteins as seen in the normal germinal center.     

CD13+ anaplastic large cell lymphoma with leukemic presentation and additional chromosomal abnormality

Anaplastic large cell lymphoma (ALCL) is a highly malignant neoplasm characterized by pleomorphic appearance, different immunophenotypes and variable sites of involvement. Expression of myeloid‐associated markers in anaplastic large cell lymphomas may mislead the medical team and result in delay of diagnosis due to unusual phenotype. It is important to diagnose this type of tumors and distinguish it from myeloid neoplasms (extramedullary myeloid cell tumors and histiocytic tumors) since therapy and prognosis are significantly different. A 16‐year‐old female patient presented with fever, lymphadenopathy, and high white blood cell count. Diagnosing a CD13+ ALCL with leukemic presentation with additional cytogenetic abnormality (duplication 5q35) was a significant diagnostic challenge. This combination of features, unusual for lymphoma, should be considered in differential diagnosis of myeloid neoplasms and fatal infections. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Primary central nervous system B cell lymphoma with features intermediate between diffuse large B cell lymphoma and Burkitt lymphoma

B cell lymphoma with features intermediate between diffuse large B cell lymphoma and Burkitt lymphoma (DLBCL/BL) is a new lymphoma entity which is recognized in the current World Health Organization (WHO) classification (2008). We report a case of a primary central nervous system lymphoma (PCNSL) with findings consistent with DLBCL/BL. It is characterized by a very aggressive clinical course, and a widespread multifocal involvement of the CNS. Our case shows that a DLBCL/BL can manifest in the CNS alone without any systemic involvement.     

Molecular pathology diagnosis of diffuse large B cell lymphoma using BIOMED-2 clonal gene rearrangements

BackgroundClonality testing for immunoglobulin gene rearrangement analysis could be implemented effectively as a useful technique for conventional diagnosis of lymphoma. The European Biomedicine and Health Concerted Action Project BMH4-CT98-3936 (BIOMED-2) have been suggested a gold standard method to clonality detection.ObjectivesWe tested empirically clonality rearrangements of IGH and incomplete IGH D-J, on formalin-fixed, paraffin embedded (FFPE) tissue of patients with diffuse large B cell lymphoma (DLBCL).Material and methodsThis appraisal was conveyed on 50 sequential FFPE specimens of patients with DLBCL. We carried out a standard multiplex PCR and heteroduplex techniques to analysis of IGH and incomplete IGH D-J clonal gene rearrangements.ResultsIn our investigation, we were identified a total positive monoclonality of 96% (48/50) for IGH and 58% (29/50) for incomplete IGH D-J. The percentage of positive clonality was detected in three frameworks (FRI, II, III) of IGH revealed 50% (25/50), 28% (14/50) and 18% (9/50) to FRIII, FRII and FRI, respectively. Analysis of incomplete IGH D-J showed 34% (17/50) and 24% (12/50) rates of positive clonality for DH_1–6-JH and DH₇-JH, respectively. In the 4% (2/50) of cases was no detected any gene rearrangements in both of IGH and incomplete IGH D-J genes.ConclusionsAnalysis of molecular clonality gene rearrangements on FFPE tissues disclosed that using BIOMED-2 protocols, could be improvement significant clinicopathological diagnosis of DLBCL. Clonality testing is believable that to suggest as a helpful and credible technique for clonality detection in the routine diagnosis of DLBCL and other lymphoproliferative disorders.     

Primary appendiceal precursor B lymphoblastic lymphoma with peculiar morphology mimicking diffuse large B cell lymphoma

Precursor B lymphoblastic neoplasm usually presented as childhood leukemia. Most precursor lymphoblastic lymphoma are T‐cell lineage and precursor B lymphoblastic lymphoma constitutes only about 10% of cases according to the WHO Classification of Tumours of Haematologic and Lymphoid Tissues. The most frequent sites of involvement in precursor B lymphoblastic lymphoma are the skin, soft tissue, bone and lymph nodes. Primary appendiceal involvement is an uncommon condition. We present an unusual case of primary appendiceal precursor B lymphoblastic lymphoma in an 11‐year‐old boy with peculiar histological morphology mimicking diffuse large B cell lymphoma. Histologically, the tumor was composed of diffusely infiltrated large cells from mucosa and extended to the subserosal area. The tumor cells were positive to CD79a, CD20, PAX5, BCL2, CD10, TdT, p53 but not to CD3, BCL6 and CD34 by immunohistochemical studies. The response to conventional treatment regimen for lymphoblastic lymphoma was not good, with early relapse within three months. Partial remission was achieved by adding rituximab. Unfortunately, the patient died in ten months due to uncontrolled relapsed disease with generalized lymphadenopathy and massive pleural effusion. The special morphologic changes and poor response to chemotherapy may be related to the overexpression of p53.     

CD30阳性的大B细胞淋巴瘤临床病理分析

目的探讨CD30阳性的弥漫性LBCL的组织病理形态、免疫表型及临床预后的意义。方法参照WHO2001年恶性淋巴瘤分类,对8例同时表达B细胞抗原及CD30抗原的弥漫性LBCL进行形态学观察、免疫组化标记及临床随访。结果8例弥漫性LBCL免疫组化CD30阳性,阳性反应定位于胞膜,其中2例伴有核旁高尔基区点状阳性,1例合并ALK呈粗大颗粒状胞质阳性,全部表达B系列抗原CD20、CD79α及CD138,2例EBV阴性,2例TIA-1阴性。组织学特征：3例呈窦性生长,2例呈明显的T／null间变性大细胞淋巴瘤的核型改变,3例以普通的中心母细胞性为主。临床以老年患者多见,4例随访4—28个月,1例仍在化疗,3例情况良好,4例失访。结论CD30阳性的弥漫性LBCL具有嗜窦性,间变性或为普通性非间变性的组织细胞形态特征,可合并ALK阳性。     

microRNA-224在弥漫大B细胞淋巴瘤的表达及作用

目的研究miR-224在弥漫大B细胞淋巴瘤(DLBCL)患者中的表达与临床病理特征的关系,观察miR-224对弥漫大B淋巴瘤细胞系OCI-LY10增殖、侵袭能力的影响。方法收集86例DLBCL组织,并以22份无肿瘤细胞侵犯的正常淋巴结组织标本为对照,采用real-time PCR方法检测miR-224的相对表达水平,分析miR-224表达水平与患者临床病理特征的关系。对弥漫大B淋巴瘤细胞系OCI-LYl0进行miR-224反义寡核苷酸(ASO)转染并培养,MTT法检测细胞增殖能力,Transwell小室检测细胞侵袭能力,real-time PCR方法与Western blot方法检测细胞中bcl-2的表达水平。结果DLBCL患者淋巴瘤中miR-224表达水平显著低于正常淋巴结组织(P0.05),miR-224在DLBCL患者中的表达与患者年龄、性别、疾病分期均无相关性(P0.05)。miR-224ASO明显升高OCI-LYl0细胞的增殖侵袭能力,显著升高bcl-2蛋白与m RNA表达水平(P0.05)。结论miR-224抑制OCI-LY10细胞增殖侵袭可能与下调bcl-2蛋白表达相关。