子宫内膜弥漫性大B细胞性淋巴瘤临床病理观察

目的探讨子宫内膜弥漫性大B细胞性淋巴瘤的临床病理特征及鉴别诊断要点。方法对1例子宫内膜弥漫性大B细胞性淋巴瘤进行临床病理检查,标本采用常规石蜡切片,HE和免疫组化染色,透射电镜观察,并复习相关文献。结果镜下可见病变组织中主要为中心细胞样和中心母细胞样形态的肿瘤细胞。免疫组化显示瘤细胞LCA、CD20、CD79α、lambda(),Ki-67阳性率为80%。电镜下肿瘤细胞数量多,排列紧密,体积较大,核大呈卵圆形,异染色质较多、边集,胞质内细胞器较少。结论发生于子宫内膜的恶性淋巴瘤很少见,该肿瘤的诊断和鉴别诊断主要依靠病理组织学和免疫组化。     

B-cell lymphoma, unclassifiable: a review of the literature

B-cell lymphoma, unclassifiable, (BCLU) is a subtype of lymphoma first recognized by the World Health Organization in 2008. Patients with this lymphoma have a very poor prognosis, with a rapidly progressive and refractory clinical course despite intensive therapy. Clinical data remain sparse, and no established therapeutic approach exists for the treatment of BCLU. Although BCLU may currently be under-recognized, its incidence is expected to increase with improved detection. Diagnostic accuracy is critical to prevent under- or overtreatment of patients. Treatments may need to be more intensive and include central nervous system prophylaxis. Development of clinical trials evaluating immunochemotherapy is recommended for this challenging lymphoma subtype. Nurses play a critical role in providing disease and treatment education and assessment, monitoring during therapy, and managing treatment-related side effects. Nurses need to emphasize prevention of chemotherapy complications and timely communication with the oncology healthcare team.     

睾丸原发弥漫性大B细胞淋巴瘤超声表现1例

患者男,58岁,因发现左侧睾丸增大1周且伴睾丸疼痛加重2d入院.体格检查:左侧阴囊较对侧明显增大,阴囊内扪及一直径约5 cm实性肿物,质韧,无触痛,睾丸扪诊欠清.实验室检查:血常规、血沉、肿瘤标记物均未见异常.二维超声检查:左侧睾丸较对侧体积增大,其内见一大小约4.8 cm×3.4 cm不均质低回声区,边界不清晰;CD...     

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.     

弥漫性大B细胞淋巴瘤分型研究进展

弥漫性大B细胞淋巴瘤(DLBCL)是一组B淋巴细胞来源最常见的、且具有异质性的非霍奇金淋巴瘤。本文就DLBCL的最新分型研究进行阐述。     

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.     

胃肠道原发性弥漫性大B细胞淋巴瘤的分型研究

目的探讨胃肠道原发性弥漫性大B细胞淋巴瘤（DLBCL）的分型及与临床病理的关系。方法采用EnVision免疫组化法标记28例胃肠道原发性弥漫性大B细胞淋巴瘤中MUM1、bcl-6、CD10、bcl-2、Ki-67的表达。结果28例胃肠道原发性弥漫性大B细胞淋巴瘤中,12例为生发中心细胞样型（GCB）,16例为非生发中心细胞样型（非GCB）。非GCB型的增殖活性与GCB型相似;GCB型和非GCB型中bcl-2表达的阳性率分别为33.3%（4/12）和56.2%（9/16）。结论胃肠道原发性弥漫性大B细胞淋巴瘤以非GCB型多见,预后较差。     

肾上腺弥漫性大B细胞淋巴瘤声像图特点分析

目的探讨肾上腺弥漫性大B细胞淋巴瘤(ADBCL)的超声声像图特点。方法回顾性分析经病理证实的18例ADBCL患者的超声表现及临床资料,总结其声像图特点,并与增强CT结果对照。结果本组18例ADBCL患者中,单侧4例,双侧14例,共32个病灶。肿块最大直径3.7~13.8 cm,平均7.9 cm。所有病灶均表现为低回声实质性肿块,81.3%(26/32)肿块形态不规则、呈典型的分叶状;87.5%(28/32)肿块内部回声均匀;75%(24/32)肿块边界清晰,部分有包膜;所有病灶彩色多普勒检查均未见明显血流信号。增强CT肿块显示为软组织密度影,内未见明显强化或轻度强化。结论 ADBCL具有特征性的声像图表现,超声检查对其诊断有重要价值。     

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.     

My treatment approach to patients with diffuse large B-cell lymphoma

My favored treatment approach for patients with diffuse large B-cell lymphoma continues to evolve. Diffuse large B-cell lymphoma can now be cured in more than 50% of patients. This is a result of improved definitions of the disease, improved diagnostic capabilities, better staging and restaging techniques, a useful prognostic index to guide therapeutic decisions, and the development of increasingly effective therapies. Positron emission tomographic scans have improved the accuracy of both staging and restaging. Findings on a positron emission tomographic scan at the end of therapy are the best predictors of a good treatment outcome. Numerous subtypes of diffuse large B-cell lymphoma have been identified that require specific treatment approaches. For example, plasmablastic lymphoma typically lacks CD20 and does not benefit from treatment with rituximab. Diffuse large B-cell lymphoma originating in specific extranodal sites such as the central nervous system, testes, and skin presents special problems and requires specific treatment approaches. A subgroup of diffuse large B-cell lymphoma with a very high proliferative rate seems to have a poor outcome when treated with CHOP-R and does better with regimens used for patients with Burkitt lymphoma. New insights into the biology of these disorders are likely to further change treatment approaches. Recognition that diffuse large B-cell lymphoma is not one disease, but a variety of clinicopathologic syndromes provides the opportunity to further improve our ability to benefit patients.     

影响弥漫大B细胞淋巴瘤预后的主要危险因素分析

目的 探讨弥漫大B细胞淋巴瘤(DLBCL)的临床特点、实验室检查、治疗措施以及肿瘤细胞来源与预后的关系.方法 对106例DLBCL患者进行国际标准化预后指数(IPI)评分、Ann Arbor分期、ECOG评分、肿瘤细胞来源以及采用不同治疗策略的疗效进行回顾性分析,并对影响预后的独立危险因素进行分析.结果 按IPI评分,低中危者61例(57.5％),中高危者45例(42.5％);按AnnArbor分期,Ⅰ期8例(7.6％),Ⅱ期16例(15.1％),Ⅲ期54例(50.9％),Ⅳ期28例(26.4％);25例(23.6％)患者伴骨髓受侵,其中16例诊断为淋巴肉瘤细胞白血病;38例ECOG评分≥2分、67例(63.2％)乳酸脱氢酶(LDH)值升高;伴B症状者59例(55.7％).106例DLBCL患者完全反应(CR)63例(59.4％),部分反应13例(12.3％),病情稳定3例(2.8％),死亡29例(27.4％),治疗总有效率为71.7％,4年总生存率为72.6％;单因素分析显示:IPI评分、临床分期、ECOG分级、肿瘤细胞来源、LDH水平、有无骨髓侵犯、治疗策略的选择、是否获得CR均与预后有关.COX核型回归多因素分析发现非生发中心来源(HR=4.24,P=0.001)、骨髓侵犯(HR=2.08,P=0.012)、是否获得CR(HR=2.72,P=0.006)以及治疗策略的选择(HR =2.58,P=0.009)是影响DLBCL预后的独立危险因素.结论 骨髓侵犯、不同肿瘤细胞来源是DLBCL的独立预后影响因素,用免疫组化方法检测不同肿瘤细胞的来源类型,对预后有一定的提示作用,同时利妥昔单抗联合化疗可显著提高DLBCL患者的疗效,造血干细胞移植是DLBCL的最佳治疗策略.     

老年人EBV阳性的弥漫性大B细胞性淋巴瘤临床病理观察

目的探讨EB病毒阳性的老年人弥漫性大B细胞性淋巴瘤(DLBCL)的组织形态特征、免疫组化、诊断与鉴别诊断,观察治疗及预后情况。方法对2例老年人EBV阳性的DLBCL行HE和免疫组化染色观察,收集临床资料并随访。结果患者年龄分别为58岁和72岁,无免疫缺陷及淋巴瘤病史。病理改变主要为大小差别较大的异型淋巴细胞弥漫浸润,散在少数R-S样细胞,可见广泛的地图样肿瘤性坏死及血管中心性浸润。免疫组化显示异型肿瘤细胞CD20弥漫强(+),80%～90%肿瘤细胞胞核EBV原位杂交呈中～强(+)。随访3～6个月,1例死亡。结论老年人EBV阳性的DLBCL罕见,是最近正在被逐渐认识的新淋巴瘤类型,其临床和病理特征独特,诊断需与淋巴瘤样肉芽肿和EBV阳性的霍奇金淋巴瘤鉴别。     

乳腺原发性弥漫性大B细胞性淋巴瘤22例临床病理分析

目的 观察乳腺原发性弥漫性大B细胞性淋巴瘤(DLBCL)的临床病理特征、免疫表型,探讨乳腺DLBCL的诊断、鉴别诊断、治疗及预后.方法 按WHO(2008)淋巴瘤分类标准,收集22例乳腺原发性DLBCL,分析其临床病理特征、免疫分型并随访.结果 22例DLBCL均为女性,年龄29～ 74岁,中位年龄50岁.其中左乳10例,右乳11例,双乳1例.Ann Arbor分期1例为Ⅲ期,1例为Ⅳ期,其余均为Ⅰ期或Ⅱ期.单侧乳腺肿块是最常见的首发症状.镜下多表现为中等大小或较大的肿瘤性淋巴细胞弥漫浸润,部分呈“列兵样”排列,可残存乳腺结构,部分可见淋巴上皮病变,有/无坏死.可行免疫分型的病例均为非生发中心B细胞(GCB)型.11例获得随访资料,其中7例存活,存活时间为18～ 80个月;4例死亡,生存时间为5～15个月.结论 乳腺原发性DLBCL少见,表型多为非GCB型,免疫组化标记有助于确诊,治疗以手术治疗辅助联合化、放疗等方案为宜.     

肠道复合性弥漫性大B细胞淋巴瘤及周围T细胞淋巴瘤临床病理观察

目的 探讨罕见的肠道复合性淋巴瘤的临床病理特征.方法 采用形态学、免疫组化及分子遗传学方法对1例肠道复合性弥漫性大B细胞淋巴瘤及周围T细胞淋巴瘤进行临床病理分析并复习文献.结果 本例肠道复合性B与T细胞淋巴瘤在形态上有弥漫性大B细胞淋巴瘤和非特殊性周围T细胞淋巴瘤的两种区域,免疫组化ClY20和CD3(+),分子遗传学上同时有IgH和TCR基因重排.结论 肠道复合性淋巴瘤罕见,诊断需结合形态、免疫表型和分子遗传学特征.     

Intravascular variant of diffuse large B-cell lymphoma with combined endocrine involvement

The intravascular variant of diffuse large B-cell lymphoma (IVBL) is a rare form of non-Hodgkin lymphoma that is frequently diagnosed at autopsy because the symptoms are nonspecific or confusing. We report a case of IVBL in a woman with pre-existing myelodysplastic syndrome manifested as a fever of unknown origin, bilateral adrenal enlargement and subsequent development of panhypopituitarism. Lymphomatous infiltration or osteomyelitis of the sella was supposed. Despite antibiotic and corticosteroid therapy the patient died within three months. An intravascular variant of B-cell lymphoma with intravascular collections of lymphomatous cells predominantly localized in the adrenal and pituitary glands was found at autopsy. The association of panhypopituitarism with bilateral adrenal enlargement is uncommon in endocrinological praxis and the occurrence of combined endocrine involvement in a patient with IVBL has not been described in previous literature.