中国人黏膜相关淋巴组织结外边缘区淋巴瘤染色体易位的临床研究

目的 探讨中国人不同部位黏膜相关淋巴组织结外边缘区淋巴瘤(MALTL)中分子遗传学异常的发生情况.方法 应用间期荧光原位杂交(FISH)方法,检测217例不同部位MALTL的t(11;18)(q21;q21)/API2-MALT1、t(1;14)(p22;q32)/IGH-BCL10、t(14;18)(q32;q21)/IGH-MALT1和涉及BCL6基因的染色体易位.结果 染色体易位的总发生率为21%(46/217).全部病例共检测出4种主要染色体异常,其中第1种13%(29/217)为t(11;18)(q21;q21)/API2-MALT1,最常见的发生部位是肺47%(8/17)和小肠29%(4/14),其次为唾液腺1/6例、胃14%(12/84)和眼附属器6%(4/68).第2种1%(3/217)为t(1;14)(p22;q32)/IGH-BCL10,仪见于肺12%(2/17)和胃1%(1/84).第3种1%(2/217)为t(14;18)(q32;q21)/IGH-MALTI,仅见于肺6%(1/17)和眼附属器2%(1/68).第4种2%(4/217)为BCL6基因涉及的染色体易位,见于唾液腺1/6例和胃4%(3/84).4%(8/217)为涉及IGH基因但未知与其易位的伙伴基因的染色体易位.结论 以上4种染色体易位在中国人不同解剖部位的MALTL中的发生率有明显不同,与欧美国家所报道的染色体易位的发生率相比较,分布稍有差异.     

胃黏膜相关淋巴样组织淋巴瘤染色体易位t(11;18)与BCL10的表达

目的　检测胃黏膜相关淋巴样组织 (MALT)淋巴瘤的染色体易位t(11;18) (q2 1;q2 1)和BCL10蛋白表达的情况。方法　采用RT PCR检测胃MALT淋巴瘤和滤泡性胃炎 (FG)中API2 MLT融合及免疫组化检测BCL10蛋白、Ki 6 7表达情况 ,并结合临床病理进行分析。结果　 14例胃MALT淋巴瘤中有 3例 (2例低恶性 ,1例低～高恶性 )检测到API2 MLT融合 ,8例FG无此融合。BCL10在FG淋巴滤泡生发中心细胞胞质中弱表达 ,在胃MALT淋巴瘤中表达明显增强 ,且 4 2 .5 %的病例细胞核阳性。胃低～高恶性及弥漫大细胞淋巴瘤 (DLBCL)的Ki 6 7标记率显著强于低恶性MALT淋巴瘤 (P<0 .0 5 )。BCL10核表达与Ki 6 7阳性表达之间差异无显著性 (P >0 .0 5 ) ,但随Ki 6 7表达增强 ,BCL10核表达的概率增加。结论　API2 MLT融合和BCL10核表达可能与胃MALT淋巴瘤从低恶性向高恶性转化有关。RT PCR检测API2 MLT融合是检测t(11;18) (q2 1;q2 1)的一项重要工具     

胃黏膜相关淋巴组织淋巴瘤BCL10核表达与其对幽门螺杆菌根除治疗无反应相关

背景：经幽门螺杆菌（H．pylori）根除治疗，约75％的早期胃黏膜相关淋巴组织（MALT）淋巴瘤患者可获得完全缓解。肿瘤细胞有BCL10核表达和t（11；18）（q21；q21）可能提示胃MALT淋巴瘤对根除治疗无反应。目的：探讨单纯H．pylori根除治疗对国人早期胃MALT淋巴瘤的疗效，以及肿瘤细胞BCL10核表达和t（11；18）（q21；q21）对治疗方案选择的提示作用。方法：收集19例早期胃MALT淋巴瘤患者，以免疫组化方法检测BCL10核表达，以间期荧光原位杂交方法检测t（11：18）（q21；q21）。所有患者均首选H．pylori根除治疗，并行内镜活检病理随访。结果：本组19例早期胃MALT淋巴瘤患者中10例（52．6％）经单纯H．pylori根除治疗获得完全缓解。10例完全缓解者中2例（20，0％）肿瘤细胞BCL10核表达阳性，9例对根除治疗无反应者中7例（77．8％）阳性，阳性率显著高于完全缓解者（P〈0．05）。14例患者行t（11；18）（q21；q21）检测，8例完全缓解者均未检出该易位，6例对根除治疗无反应者中3例（50．0％）检出该易位．两组检出率差异无统计学意义（P〉0．05）。结论：单纯H．pylori根除治疗可使本组52．6％的早期胃MALT淋巴瘤患者获得完全缓解。胃MALT淋巴瘤肿瘤细胞BCL10核表达与其对根除治疗无反应相关。     

非霍奇金淋巴瘤中肺耐药相关蛋白的表达及意义

目的 研究非霍奇金淋巴瘸（NHL）中肺耐药相关蛋白（LRP）的表达及其临床意义。方法 应用免疫组化S-P法检测43例NHL患者（其中初治病例32例,复发病例11例）和10例坏死增生性淋巴结炎患者组织中的LRP水平。结果 LRP在NHL患者中表达明显高于坏死增生性淋巴结炎患者（P〈0．05）,而且NHL复发组高于初治组（P〈0．05）。12例随访患者中LRP阴性者治疗效果优于LRP阳性者。结论 LRP过度表达与NHL临床耐药及疗效相关。     

肺黏膜相关淋巴组织淋巴瘤临床特征分析

目的：提高肺黏膜相关淋巴组织淋巴瘤诊治水平。方法回顾性分析江西省人民医院及南昌大学第二附属医院自2005年1月至2015年1月确诊的8例肺黏膜相关淋巴组织淋巴瘤的临床表现、影像学特点、诊断手段、误诊情况、治疗及预后。结果8例肺黏膜相关淋巴组织淋巴瘤中男6例,女2例,年龄38~75岁,中位年龄65岁。主要症状：咳嗽(5例)、咳痰(4例)、发热(2例)、胸闷(4例)、乏力(3例)、消瘦(3例),无症状2例。胸部 CT 表现：双肺分布5例,单肺分布3例,实变影5例,肿块及结节影4例,斑片状浸润影3例,支气管充气征5例,钙化1例,空洞2例。确诊方法：经气管镜活检1例,CT 引导下经皮肺穿刺5例,外科手术2例。误诊分析：5例误诊为细菌性肺炎,1例误诊为肺真菌病,1例误诊为肺癌,1例误诊为肺转移癌。治疗及预后：2例外科手术患者术后未行放化疗,4例转入血液内科行化疗(CHOP 方案),2例放弃治疗。8例患者随访时间2~105个月,2例死亡,6例存活。结论肺黏膜相关淋巴组织淋巴瘤临床表现不典型,容易误诊,诊断需要组织病理活检。     

肺黏膜相关淋巴组织淋巴瘤的免疫表型和诊断标准

肺黏膜相关淋巴组织 (MALT)淋巴瘤是非常少见的一种肺的原发性低度恶性淋巴瘤 ,其病因不清 ,瘤细胞表达B细胞抗原 ,在病理学上符合其他部位MALT型淋巴瘤的一般特点 ,诊断需结合组织病理学、免疫学检测和临床特点。施行局部切除、化疗、低剂量的放疗或综合治疗 ,预后良好。     

肺黏膜相关淋巴组织淋巴瘤的免疫表型和诊断标准

肺黏膜相关淋巴组织(MALT)淋巴瘤是非常少见的一种肺的原发性低度恶性淋巴瘤，其病因不清，瘤细胞表达B细胞抗原，在病理学上符合其他部位MALT型淋巴瘤的一般特点，诊断需结合组织病理学、免疫学检测和临床特点。施行局部切除、化疗、低剂量的放疗或综合治疗，预后良好。     

免疫组化染色及荧光原位杂交法检测肺鳞状细胞癌中间变性淋巴瘤激酶基因蛋白的表达

目的采用免疫组化染色及荧光原位杂交法检测肺鳞状细胞癌中间变性淋巴瘤激酶基因(ALK)蛋白的表达情况。方法收集诊断为肺鳞状细胞癌未经任何筛选的石蜡固体标本194例,采用高特异性和敏感性的抗ALK抗体(D5F3)进行免疫组化染色检测,并对检测中呈阳性的标本进一步进行荧光原位杂交检测。结果免疫组化法共检出ALK呈强阳性的标本3例(1.55%);中等强度的标本3例(1.55%);弱阳性标本5例(2.58%);进一步行荧光原位杂交检测显示,仅ALK呈强阳性的标本中存在有棘皮类微管蛋白4(EML-4)-ALK基因融合,而免疫组化染色检测中呈中等强度和弱阳性标本为假阳性。结论 EML4-ALK基因融合在肺鳞状细胞癌中少量存在,对于克唑替尼靶向治疗是否有敏感性仍需要进一步临床研究;免疫组化染色检测ALK蛋白显示为强阳性才可确诊为存在EML4-ALK基因融合。     

Nuclear expression of BCL10 or nuclear factor kappa B helps predict Helicobacter pylori-independent status of low-grade gastric mucosa-associated lymphoid tissue lymphomas with or without t(11;18)(q21;q21)

The t(11;18)(q21;q21) translocation is a specific marker for Helicobacter pylori-independent status of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, there are no reliable markers to predict tumor response to H pylori eradication in patients without t(11;18)(q21;q21). Nuclear expression of BCL10 and nuclear factor kappa B (NF-kappaB) was recently found to be closely associated with H pylori-independent status of the high-grade counterpart of gastric MALT lymphoma, which usually lacks t(11;18)(q21;q21). This study examined whether these 2 markers can also predict H pylori-independent status of low-grade gastric MALT lymphomas without t(11; 18)(q21;q21). Sixty patients who underwent successful H pylori eradication for low-grade gastric MALT lymphomas were included. Forty-seven (78.3%) patients were negative for t(11;18)(q21;q21); among them, 36 (76.6%) were H pylori dependent and 11 (23.4%) were H pylori independent. Nuclear expression of BCL10 was significantly higher in H pylori-independent than in H pylori-dependent tumors (8 of 11 [72.7%] vs 3 of 36 [8.3%]; P < .001). Nuclear expression of NF-kappaB was also significantly higher in H pylori-independent than in H pylori-dependent tumors (7 of 11 [63.6%] vs 3 of 36 [8.3%]; P < .001). Further, nuclear translocation of BCL10 and NF-kappaB was observed in 12 of the 13 patients with t(11;18)(q21;q21), and all these 12 patients were H pylori independent. In summary, nuclear expression of BCL10 or NF-kappaB is predictive of H pylori-independent status of low-grade gastric MALT lymphoma with or without t(11;18)(q21; q21).     

High frequency of t(11;18) in gastric mucosa-associated lymphoid tissue lymphomas in Taiwan,including one patient with high-grade transformation

t(11;18)(q21;q21), the most frequent chromosomal aberration of mucosa-associated lymphoid tissue (MALT) lymphoma, occurs in 30% of gastric patients.Although the translocation is often associated with an 'aggressive' course, it has not been described in transformed MALT lymphomas. We screened 15 gastric MALT lymphomas [three with concurrent or subsequent high-grade transformation and 11 diffuse large B-cell lymphomas (DLBCLs)] in Chinese patients for t(11;18). t(11;18) was found in 9/15 (60%) MALT lymphomas, but not in any DLBCLs. One patient, with subsequent high-grade transformation, showed the translocation in low- and high-grade lesions. t(11;18) was frequent in Chinese gastric MALT lymphomas and unusually one transformed lymphoma carried the translocation.     

Case of acute lymphoblastic leukemia presenting with t(14;18)/BCL2, t(8;14)/cMYC, and t(1;2)/FCGR2B

The majority of follicular lymphoma and Burkitt's lymphoma are associated with reciprocal translocations involving BCL2 and cMYC, respectively. Unusual reports of aggressive lymphoma presenting with both translocations have been described as well as rare cases with a third structural alteration usually involving BCL6. The patient described here presented with aggressive high-grade lymphocytic leukemia, FAB subtype L2 (ALL-L2), and three reciprocal translocations, t(14;18)(q32;q21), t(8;14)(q24.1;q32), and t(1;2) (q22-23;p13). Despite immature morphology the leukemic blasts had a mature B-cell phenotype; they were positive for surface immunoglobulin heavy chains and negative for CD34, TdT, and CD10. Most reported dual t(14;18)/t(8;14) cases have not shown sIg and were positive for CD10. Molecular genetic analyses showed the typical rearrangements of BCL2 and cMYC as well as the FCGR2B gene on chromosome 1q23. The occurrence of a third oncogene rearrangement in association with the dual BCL2, cMYC translocations in ALL patients is very rare. To our knowledge, this is the first case where the third hit involves the FCGR2B locus. This report reiterates the poor prognosis associated with activation of cMYC together with elevated Bcl-2 expression. These data also support recent evidence that dysregulation of FCGR2B may play a role in tumor progression.     

A case of H. pylori and API2-MALT1 gene-negative gastric mucosa-associated lymphoid tissue lymphoma with a carcinoma-like signet-ring cell lymphoepithelial lesion]

A 60-year-old woman presented in February 2003 with an ulcer on the lesser curvature of the anglus. The endoscopic biopsy specimens showed epithelial signet-ring cell associated with lymphoid infiltration, suggesting a diagnosis of gastric cancer. Histopathological examination confirmed the diagnosis of low-grade B-cell lymphoma of MALT with epithelial signet-ring cell lymphoepithelial lesion, which was negative for H. pylori and t (11;18) (q21;q21) translocation (API2-MALT1 gene). This case was treated with H. pylori eradication and additional radiation therapy, and the tumor was disappeared.