老年人EB病毒阳性弥漫大B细胞淋巴瘤临床病理学特点及预后分析

目的 探讨老年人EB病毒阳性（EBV＋）弥漫大B细胞淋巴瘤（DLBCL）的临床病理学特点及预后.方法 采用回顾性研究的方法 ,收集24例老年EBV＋DLBCL患者,以同期EBV-非特指型DLBCL患者为对照,分析老年EBV＋ DLBCL患者的临床病理学特点及预后.结果 24例老年EBV＋DLBCL患者肿瘤细胞形态上主要表现为单一性或多形性肿瘤细胞增生;多形性病例中常可见有地图状坏死.细胞起源免疫分型主要为非生发中心亚型,分别占91.3％（Hans分型）和100.0％（Choi分型）.CD30阳性率为55.0％,高于非特指型EBV-DLBCL（P＜ 0.001）.在总体生存时间方面,R-CHOP方案治疗的老年EBV＋DLBCL患者和＞50岁EBV-DLBCL患者的中位生存时间分别为44.2个月和29.2个月,两者差异无统计学意义（P=0.587）.结论 老年人EBV＋DLBCL肿瘤细胞形态上主要表现为单一性或多形性肿瘤性增生;多形性病例中常可见不规则坏死.CD30阳性率较高,并且主要为非生发中心B细胞亚型.R-CHOP方案治疗的老年EBV＋ DLBCL患者的总体生存时间与同年龄段非特指型EBV-DLBCL患者相近.     

五种异质性弥漫大B细胞淋巴瘤微环境细胞PD-1表达及意义

目的弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)是一组具有明显异质性的大细胞淋巴瘤,通过多种检查手段早期识别DLBCL预后较差的亚群,对于预后判断和治疗选择具有重要作用。本研究选择了几种相对少见免疫表型表达的DLBCL类型(C-myc/Bcl-2共表达、NF-κB/p65阳性、CD5阳性及CD30阳性的DLBCL)和EB病毒(epstein-barr virus,EBV)阳性的DLBCL病例进行研究,通过检测肿瘤微环境细胞中程序性死亡受体-1(programmed death receptor-1,PD-1)表达情况,探讨PD-1表达相关的影响因素及其表达对相应DLBCL发生和发展的影响。方法收集贵州医科大学附属医院2010-01-01-2018-08-31诊断的120例DLBCL患者资料,通过普通免疫组化染色(C-myc、Bcl-2、NF-κB/p65和CD30)、免疫组化双标(CD5、PAX5)及EBER原位杂交检测筛选出上述特殊类型的病例并分组,普通免疫组化染色检测肿瘤微环境中PD-1蛋白表达情况。收集临床病理资料并随访,对实验数据进行统计学分析。结果120例DLBCL患者中,PD-1肿瘤浸润淋巴细胞(tumor infiltraling lymphoeytes,TILs)阳性病例共有63例(52.5%,63/120);其中C-myc/Bcl-2共表达组中PD-1(+)-TILs病例27例(69.25%,27/39),NF-κB/p65阳性组30例(68.2%,30/44),CD30阳性组17例(73.9%,17/23),CD5阳性组14例(77.8%,14/18),EBV阳性组中为5例(55.6%,5/9)。PD-1(+)-TILs与PD-1(-)-TILs组病例之间IPI评分(χ^2=4.514,P=0.034)和Ann Arbor分期(χ^2=4.760,P=0.029)差异有统计学意义,PD-1(+)-TILs组分期晚、IPI指数高;PD-1-TILs表达在阳性组C-myc/Bcl-2共表达(χ^2=6.485,P=0.011)、NF-κB/p65(χ^2=6.851,P=0.009)、CD30(χ^2=5.232,P=0.022)、CD5(χ^2=5.426,P=0.040)表达率明显高于阴性组,差异有统计学意义;PD-1-TILs表达在EBV阳性组与阴性组之间差异无统计学意义,χ^2=0.001,P=0.970。生存分析98例随访病例中,PD-1(+)-TILs组病例的总生存率(overall survival,OS)明显低于PD-1(-)-TILs组患者,χ^2=14.652,P<0.001;在C-myc/Bcl-2共表达(χ^2=4.071,P=0.049)、NF-κB/p65的核表达(χ^2=4.833,P=0.025)及CD30阳性DLBCL(χ^2=5.207,P=0.024)中PD-1(+)-TILs组的生存状况也明显较PD-1(-)-TILs组病例差;多因素回归分析显示,PD-1(+)-TILs是DLBCL的独立危险因素,HR=38.170,P=0.036。结论PD-1表达在C-myc/Bcl-2共表达阳性、NF-κB/p65阳性、CD30阳性和CD5阳性的DLBCL中明显增高,在EBV阳性的DLBCL中增加不明显,PD-1在肿瘤微环境细胞中的表达可能是(C-myc/Bcl-2共表达阳性、NF-κB/p65阳性和CD30阳性)DLBCL不良预后评估的相关因素。     

新疆维吾尔自治区汉族与维吾尔族老年人EB病毒阳性弥漫大B细胞淋巴瘤临床病理分析

目的 分析新疆维吾尔自治区汉族、维吾尔族老年人EB病毒(EBV)阳性弥漫大B细胞淋巴瘤(DLBCL)的临床特征及预后影响因素.方法 回顾性分析新疆维吾尔自治区人民医院病理科250例DLBCL患者中EBV阳性患者的临床资料,应用免疫组织化学技术和原位杂交方法分别进行组织学分型和EBV检测.结果 250例DLBCL患者中,EBV阳性DLBCL老年患者36例(年龄≥60岁28例),其中汉族21例,维吾尔族15例,男女比为2:1;结内病变23例,结外13例.Ann Arbor分期中Ⅰ、Ⅱ期7例,Ⅲ、Ⅳ期29例;血清乳酸脱氢酶升高30例,国际预后指数中-高危险度22例.组织形态学观察:淋巴结及结外组织正常结构破坏,炎性背景中可见弥漫浸润的中心母细胞、免疫母细胞及R-S样巨细胞.免疫组织化学分析:CD20/CD79a强阳性,Ki-67高表达.依据CD10、bcl-6、Mum-1进行组织学分型,非生发中心型31例.新疆维吾尔自治区汉族、维吾尔族老年人EBV阳性DLBCL的年龄和发病部位差异具有统计学意义(P＜0.05),其余临床指标及组织学分型差异均无统计学意义(P＞0.05).结论 新疆维吾尔自治区汉族、维吾尔族老年人EBV阳性DLBCL发病率低,具有DLBCL独特的临床病理亚型,预后不良,且发病与EBV有一定关系.     

EB病毒阳性的胃弥漫大B 细胞淋巴瘤特点及预后

目的:探讨EB病毒阳性患者的胃弥漫大B 细胞淋巴瘤（diffuse large B-celllymphoma,DLBCL ）病理学特点及预后。方法:回顾性分析北京大学基础医学院病理学系2009年1 月至2015年1 月75例胃弥漫大B 细胞淋巴瘤患者的临床资料,15例EB病毒（Epstein-Barr virus,EBV ）阳性者为病例组,60例EBV 阴性者为对照组,采用免疫组织化学法和EB病毒RNA 探针原位杂交法检测Bcl- 2、c-myc 蛋白表达及EBV-EBER 情况,分析EBV 阳性的胃DLBCL 患者的病理学特点及预后。结果:EBV 阳性组在临床表现、年龄、性别、起源、细胞形态等方面与EBV 阴性组相比,差异无统计学意义（P > 0.05）;在Bcl- 2、c-myc 蛋白表达方面,EBV 阳性组与EBV 阴性组相比,差异无统计学意义（P > 0.05）;R-CHOP 方案治疗下,EBV 阳性组与EBV 阴性组相比,中位总生存期（median overallsurvival,OS）分别为15.1 个月和31.4 个月,差异具有统计学意义（P = 0.01）。 结论:发生于胃DLBCL 患者中,EB病毒感染对临床表现、瘤细胞的起源、形态、蛋白表达等方面无明显影响;EB病毒阳性的DLBCL 患者并不局限于老年人;R-CHOP 治疗下EB病毒阳性患者的预后比EB病毒阴性的患者预后差。      

弥漫大B细胞淋巴瘤CD5表达与临床病理特征及疗效关系的研究

目的:检测CD5蛋白在弥漫大B细胞淋巴瘤(DLBCL)的表达情况,并探讨CD5表达与临床病理特征及疗效的关系。方法:采用免疫组化方法(ElivisionTM法)检测232例患者中CD5蛋白的表达,回顾性研究CD5阳性表达DLBCL与CD5阴性表达DLBCL患者的临床病理特征及化疗效果,运用χ2检验比较两者差异。结果:232例DLBCL患者中,CD5阳性表达率19.8%(46/232)。DLBCL中,CD5表达与年龄(χ2=61.061,P=0.001)、性别(χ2=92.115,P=0.001)、分期(χ2=47.508,P=0.001)、KPS评分(χ2=42.178,P=0.001)、B症状(发热、乏力、盗汗和消瘦,χ2=56.344,P=0.001)、血清LDH水平(χ2=33.341,P=0.001)以及侵犯部位(χ2=78.123,P=0.001)相关;而与血清β2-MG水平无关,χ2=2.495,P=0.138。46例CD5表达阳性的患者中,6例化疗有效,有效率为13.0%(6/46);而186例CD5表达阴性DLBCL患者中,131例患者化疗有效,有效率为70.4%(131/186)。两者比较差异有统计学意义,χ2=50.227,P<0.05。结论:CD5阳性表达的DLBCL好发于老年女性,侵袭性高;CD5阳性表达DLBCL患者比CD5阴性表达的患者疗效差。     

弥漫大B细胞淋巴瘤免疫表型及临床参数与其预后的关系

目的探讨采用R-CHOP方案治疗的弥漫大B细胞淋巴瘤(DLBCL)的免疫表型及临床参数与其预后的关系。方法采用免疫组化SP法,检测57例DLBCL中CD10、bcl-6、MUMl和CD5的表达,根据Hans分型将其分为GCB型和non-GCB型。结果 57例DLBCL中表达CD10、bcl-6、MUM1和CD5分别有9例(15.8%)、36例(63.2%)、34例(59.6%)、4例(7.0%);GCB型17例(29.8%)、non-GCB型40例(70.2%)。57例DLBCL中死亡19例,GCB型预后与non-GCB型相比差异无统计学意义(P=0.132);CD5阳性患者死亡率高,但与CD5阴性者相比差异无统计学意义(P=0.594)。Ⅲ~Ⅳ期和年龄>60岁DLBCL患者死亡率高(P=0.001、P=0.017)。结论应用R-CHOP方案治疗的DLBCL其预后与患者年龄和肿瘤临床分期有关,与Hans分型无关。     

弥漫大B细胞淋巴瘤外周血CD13+CD4+CD25hi调节性T细胞的表达及其临床意义

目的 探讨CD13+CD4+CD25hi调节性T细胞(Treg细胞)在弥漫大B细胞淋巴瘤(DLBCL)患者外周血中的表达水平及其临床意义.方法 采用流式细胞术检测58例初诊DLBCL患者及30名健康对照者外周血CD13+CD4+CD25hi Treg细胞亚群在Treg细胞中的表达水平,并分析其与各临床指标的关系.结果 初诊DLBCL患者外周血CD13+CD4+CD25hi Treg细胞的表达高于健康对照者,两者差异有统计学意义[(36.37±11.89)%比(9.03±2.10)%,t=7.168,P<0.001].国际预后指数(IPI)评分3~5分的初诊DLBCL患者外周血CD13+CD4+CD25hi Treg细胞表达水平高于0~2分的患者,两者差异有统计学意义[(44.28±10.10)%比(21.51±6.23)%,t=ˉ9.347,P=0.03].Ⅱ、Ⅲ、Ⅳ期DLBCL患者外周血CD13+CD4+CD25hi Treg细胞表达水平分别为(19.48±1.34)%、(33.98±8.03)%、(47.89±8.25)%,三者差异有统计学意义(F=38.363,P<0.001).而不同年龄、性别、乳酸脱氢酶(LDH)水平患者之间外周血CD13+CD4+CD25hi Treg细胞表达水平差异均无统计学意义(均P>0.05).结论 CD13+CD4+CD25hi Treg细胞亚群在DLBCL患者外周血中的表达水平明显升高,并与患者临床分期及预后相关.     

免疫分型标记物和CD43在非特指弥漫性大B细胞淋巴瘤中的表达及临床意义

目的 探讨免疫分型标记物和CD43在非特指弥漫性大B细胞淋巴瘤(DLBCL NOS)中的表达及其临床意义.方法 收集120例DLBCL NOS临床病理资料进行分析.采用免疫组化法检测CD10、bcl-6、MUM-1和CD43的表达,根据Hans分型将其分为GCB型和non-GCB型.结果 120例DLBCL,NOS中GCB型和non-GCB型分别为38例和82例,Hans分型与DLBCL NOS预后无关(P＞0.05).120例DLBCL NOS中CD43阳性33例(27.5％),CD43表达与性别、临床分期和免疫分型均无关(P＞0.05),与年龄(P=0.036)和生存状态(P=0.004)有关.结论 DLBCL NOS预后差与CD43阳性表达有关,与Hans分型无关.     

Calreticulin在弥漫大B细胞淋巴瘤中的表达及临床意义

背景与目的:淋巴瘤是最常见的淋巴造血系统恶性肿瘤,其中B细胞型非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)发病占淋巴瘤的90%以上,而NHL中最常见的亚型为弥漫大B细胞淋巴瘤(diffuselargeB-cell lymphoma,DLBCL)。探讨钙网蛋白(calreticulin)在DLBCL中的表达及其临床意义。方法:应用免疫组织化学染色,检测复旦大学附属中山医院2015-2018年收治的143例DLBCL患者肿瘤组织中calreticulin等蛋白的表达情况,并分析calreticulin表达与DLBCL患者临床病理学特征及预后的关系。结果:143例DLBCL患者中,calreticulin阳性表达者92例,阳性表达率为64.3%。Calreticulin阳性组死亡患者的比例(26.1%)明显高于calreticulin阴性组(9.8%),差异有统计学意义(χ2=5.381,P=0.020)。Kaplan-Meier生存曲线显示,calreticulin阳性表达组较阴性表达组生存期短(χ2=5.285,P=0.022)。结论:DLBCL患者中,calreticulin表达与DLBCL预后密切相关,检测calreticulin的表达可以作为判断DLBCL预后的依据之一。     

鼻咽癌组织中P16、CD4和CD8的表达及其与预后的关系

目的 探讨鼻咽癌组织中P16、CD4和CD8的表达及其与鼻咽癌患者临床特点及预后的关系.方法 采用免疫组化法检测133例鼻咽癌组织中P16、CD4和CD8的表达情况,分析其表达与鼻咽癌临床病理特征及预后的关系.结果 133例鼻咽癌组织中,P16的阴性表达率为75.9％(101/133),阳性表达率为24.1％(32/133);CD4的阴性表达率为75.2％(100/133),阳性表达率为24.8％(33/133);CD8阴性表达率为76.7％(102/133),阳性表达率为23.3％(31/133).P16与CD4在鼻咽癌组织中的表达差异有统计学意义(P＜0.05),二者呈正相关趋势(r=0.206,P=0.094);P16、CD4和CD8在不同性别、年龄、民族、吸烟史、肿瘤家族史、临床分期患者中的表达差异均无统计学意义(P＞0.05),但P16表达在不同性别患者(P=0.069)、CD8表达在不同临床分期患者(P=0.085)中的差异均为临界值;P16、CD4、CD8阴性表达和阳性表达患者5年总生存率差异无统计学意义(P＞0.05),但CD4阳性表达与阴性表达患者5年无瘤生存率(P=0.002)及5年无局部复发生存率(P=0.024)差异均有统计学意义.结论 P16、CD4和CD8表达与鼻咽癌患者性别、临床分期有关.CD4阳性表达患者预后可能更佳,联合检测P16、CD4和CD8在鼻咽癌中的表达或可作为判定鼻咽癌患者生物学行为及预后评估的依据.     

Epstein-Barr Virus Infection and Expression of B-cell Oncogenic Markers in HIV-Related Diffuse Large B-cell Lymphoma

PURPOSE: Epstein-Barr virus (EBV)-mediated lymphomagenesis in the setting of HIV infection has been widely accepted. However, little is known about how EBV impacts prognosis. We investigated the hypothesis that EBV infection is associated with expression of specific B-cell oncogenic markers in HIV-related diffuse large B-cell lymphoma (DLBCL) and examined the prognostic use of detecting EBV infection. EXPERIMENTAL DESIGN: HIV-related DLBCL cases diagnosed between 1996 and 2007 within Kaiser Permanente California were identified. Immunohistochemical staining was used to analyze the expression of selected markers that are cell-cycle regulators, B-cell activators, and antiapoptotic proteins among others. EBV infection was determined by in situ hybridization of EBV RNA. Correlations between EBV and marker expression were examined using Spearman correlation coefficient. The prognostic use of EBV status was examined in multivariable Cox model adjusting for International Prognostic Index (IPI). Receiver-operating characteristics (ROC) analysis was used to evaluate improvement in model discrimination. RESULTS: Seventy HIV-related DLBCL cases were included (31% EBV±). EBV+ tumor was associated with increased expression of BLIMP1 and CD30 and reduced expression of BCL6 and LMO2. EBV+ tumor was independently associated with elevated 2-year overall mortality [HR, 3.3; 95% confidence interval (CI), 1.6-6.6]. Area under the ROC curve showed improved model discrimination when incorporating tumor EBV status with IPI in the prediction model [0.65 vs. 0.74 (IPI only)]. CONCLUSION: Our results suggest that EBV infection was associated with expression of several tumor markers that are involved in the NF-κB pathway and that detecting tumor EBV status may have prognostic use in HIV-related DLBCLs. Clin Cancer Res; 18(17); 4702-12. ?2012 AACR.     

The t(14;18) is associated with germinal center-derived diffuse large B-cell lymphoma and is a strong predictor of outcome.

The t(14;18) is present in a significant proportion of diffuse large B-cell lymphomas (DLBCLs), however, the prognostic effect of the translocation and the relationship with transformed follicular lymphoma remains controversial. To clarify these uncertainties, interphase fluorescence in situ hybridization (FISH) was used to determine the incidence of the t(14;18) in nodal DLBCL, and this was correlated with BCL2 expression, germinal center (GC) immunophenotype, and patient outcome. FISH was performed on paraffin-extracted nuclei from 137 de novo nodal DLBCLs. Eighteen of 137 de novo DLBCLs were t(14;18) positive. The t(14;18) was most commonly associated with the subset of DLBCLs that expressed a GC phenotype, defined as CD10+, BCL6+ (GC-type DLBCL): positive in 14 of 47 (30%) cases, compared with 4 of 89 (5%) in the non-GC group (Pearson's chi(2) = 28.4; P < 0.0001). All cases with a translocation expressed BCL2 protein, however, 40 expressed BCL2 protein without a t(14;18). GC-type DLBCL patients with a t(14;18) had a significantly worse survival compared with GC-type DLBCL patients without the translocation (2-year survivals were 29 and 63%, respectively; P = 0.006). Of the cases without the translocation, BCL2 protein expression did not affect survival. In contrast, in the non-GC group of DLBCLs, BCL2 protein expression reduced the 2-year overall survival from 64% in the BCL2-negative group to 38%, with a median survival of 15.0 months (P = 0.02). In conclusion, the t(14;18) is common in DLBCLs, particularly in GC-type DLBCLs, where the presence of the translocation has a poor prognostic effect. BCL2 protein expression defines a group of non-GC DLBCL patients with a poor prognosis.     

Age cutoff for Epstein-Barr virus-positive diffuse large B-cell lymphoma–is it necessary?

Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly (EBV+ DLBCL-e) is a molecularly distinct variant of DLBCL, characterized by a monoclonal B-cell proliferation that occurs in patients >50 years of age without a history or clinicopathologic evidence of immunodeficiency. However, patients with EBV+ DLBCL younger than 50-years-old also exist in Western countries. We evaluated the clinicopathologic, immunophenotypic and genetic features in Cacausian patients with EBV+ DLBCL who are ≤50 years of age and compared this patient group to patients who are >50 years. In patients who are ≤50 years, less frequent expression of BCL6 and a trend of more frequent expression of CD30 and pSTAT3 were found in patients with EBV+ DLBCL. In patients who are >50 years, common expression of CD30, p50, pSTAT3 and less frequent expression of BCL6 were observed. Older patients also more commonly had a poor performance status (ECOG≥2). Comparing EBV+ DLBCL patients in ≤50 years versus >50 years, both groups had similar clinicopathologic, immunophenotypic and genetic features. Gene expression profiling, microRNA profiling and treatment outcome of the younger patients with EBV+ DLBCL was not distinctive from tumors in older patients. Based on our data, we suggest that the arbitrary age cutoff for EBV+ DLBCL is unnecessary and should be eliminated in the WHO lymphoma classification scheme.     

Large cleaved and immunoblastic lymphoma may represent two distinct clinicopathologic entities within the group of diffuse large B-cell lymphomas.

PURPOSE: The reliability of immunohistochemistry for subdividing diffuse large B-cell lymphomas (DLBCL) into germinal center B-cell-like (GCB) and non-GCB prognostic subgroups is debated. In this study we evaluated the prognostic significance of such subgrouping on a series of 153 DLBCL patients. Furthermore, we investigated whether both subgroups could comprise clinicopathologic entities recognized by their morphology and characterized by a distinct phenotype, specific genetic abnormalities, and clinical characteristics. PATIENTS AND METHODS: All samples from patients were reviewed and morphologically subdivided into large cleaved, immunoblastic, and not otherwise specified DLBCL. GCB and non-GCB immunohistochemical profiles were established. The presence of chromosomal translocations involving BCL2, BCL6, and MYC and/or rearrangements of these genes was investigated. RESULTS: Subdividing DLBCL with either a GCB or non-GCB immunophenotypic profile was not of prognostic significance. Nevertheless, CD10 expression was a predictor of favorable outcome, whereas high bcl-2 expression and BCL6 rearrangement were adverse predictors of disease-free survival. Interestingly, large cleaved DLBCL was clearly associated with a GCB immunophenotypic profile, CD10 expression, BCL2 rearrangement, age younger than 60 years, and low to low/intermediate International Prognostic Index risk, but was not of prognostic significance. In contrast, immunoblastic morphology was associated with a non-GCB profile and was a significant predictor of unfavorable DFS. CONCLUSION: Subdividing DLBCL into subgroups based on their immunohistochemical profile was not of prognostic significance. Nevertheless, it allowed the additional characterization of two lymphoma subgroups previously recognized in the Working Formulation. Both correspond to two distinct clinicopathologic entities within the DLBCL.     

MYC translocation and/or BCL 2 protein expression are associated with poor prognosis in diffuse large B‐cell lymphoma

Genomic alterations and protein expression levels have been established as prognostic factors for survival in patients with diffuse large B‐cell lymphoma (DLBCL). In particular, double‐hit DLBCL (DHL), which exhibits translocations in MYC and BCL2 and/or BCL6, is known to be associated with a poor prognosis. However, the clinical significance of gene alterations and protein expression levels for MYC, B‐cell lymphoma (BCL)2, and BCL6 are unclear. In this study, we analyzed 61 adult patients diagnosed with DLBCL without DHL, who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, or similar regimens. There were no differences in the distribution of MYC expression rates among the different MYC gene statuses. In log–rank tests, MYC translocation was a prognostic factor for overall survival (OS; P = 0.011), whereas BCL2 and BCL6 translocation were not prognostic indicators (P = 0.999 and P = 0.925, respectively). Although the expression levels of MYC and BCL6 were not significantly associated with OS, the expression of BCL2 was a prognostic factor for OS (P = 0.027). Furthermore, copy number gains in the MYC, BCL2, and BCL6 genes did not affect OS. MYC translocation (hazard ratio, 4.769; range, 1.518–14.98; P = 0.007) and BCL2 protein expression (hazard ratio, 3.072; range, 1.002–9.413; P = 0.049) were independent prognostic factors for survival in multivariate analyses. In conclusion, MYC translocation and BCL2 expression may need to be investigated at the initial diagnosis to predict prognosis in patients with DLBCL.     

弥漫大B细胞性淋巴瘤中t(14;18)易位及BCL2表达的意义

  目的  探讨弥漫大B细胞性淋巴瘤(DLBCL)中t(14;18)易位及BCL2表达的意义。  方法  用石蜡包埋组织免疫组织化学法检测142例淋巴结、胃肠道和咽淋巴环等不同器官或部位发生的DLBCL中CD10、BCL6、MUM1和BCL2的抗原表达, 按免疫表型将DLBCL分成GCB-DLBCL和非GCB-DLBCL两个亚型; 聚合酶链反应(PCR)扩增75例淋巴结结内DLBCL新鲜组织中由t(14;18)易位所形成的MBR/JH和lnfr/JH重组基因。  结果  142例DLBCL中, 75例(52.8%)表达BCL2。分型为GCB-DLBCL的51例中, 18例(35.3%)表达BCL2;分型为非GCB-DLBCL的91例中, 57例(62.6%)表达BCL2, 两者阳性率比较有显著性差异(P=0.002)。同时, BCL2的表达阳性率按不同器官或部位发生的DLBCL作比较, 结果也存在显著性差异(P=0.01)。18.7%的淋巴结结内DLBCL中有t(14;18)易位, 阳性病例主要见于GCB-DLBCL之中。  结论  t(14;18)易位是GCB—DLBCL亚型的遗传学特征, BCL2表达在不同亚型和不同器官或部位发生的DLBCL中有显著性差异。      

p53和MYC在弥漫性大B细胞淋巴瘤组织中的表达及与患者预后的相关性

目的:分析弥漫性大B细胞淋巴瘤（diffuse large B-cell lymphoma,DLBCL)组织中p53和MYC的表达及与DLBCL患者预后的相关性。方法:分析我院收诊确认的149例DLBCL患者，应用Kaplan-Meier法计算生存率；并通过免疫组化法分析瘤组织中p53和MYC表达量，并采用单因素和Cox多因素分析MYC、p53表达与患者预后的相关性。结果:MYC基因的表达和患者年龄、性别以及BCL2/BCL6表达没有统计学差异；但MYC重组导致患者IPI指数较高、疾病分期较晚、乳酸脱氢酶（LDH）水平升高、p53表达升高（均P＜0.05)。生存率分析和Cox回归分析发现，MYC高表达患者中p53表达升高具有较差的预后（IPI指数较高）:生存期（OS）和无进展生存期（PFS）较差。 结论:p53和MYC高表达的协同作用导致DLBCL患者的预后较差。     

80例原发中枢神经系统弥漫大B细胞淋巴瘤的临床病理、免疫表型及EB病毒感染的研究

目的:对80例原发中枢神经系统弥漫大B细胞淋巴瘤（primary diffuse large B cell lymphoma of the central nervous system,PCNS DLBCL）进行临床病理学回顾性研究、免疫表型检测及EB病毒（Epstein-Barr virus,EBV）感染检测。旨在探讨其与预后的关系。方法:对80例PCNS DLBCL进行免疫表型检测及EB病毒检测,并进行Hans、Choi和Tally分型、统计学单因素和多因素预后分析。结果:Bcl-2、CD10、Bcl-6、Mum-1、GCET-1、BLIMP-1、FOXP-1和LMO-2的表达率分别为46.1%、8.8%、75.0%、57.5%、27.5%、11.3%、75.0%和26.3%;Ki-67指数为30%～95%,中位数为80%。Hans、Choi和Tally分型中Non-GCB型/ABC型弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）（63.9%、79.2%和90.0%）为最常见的亚型。EBV及EBER1/2-ISH的表达率均为3.8%。58.8%的患者术后未行其它治疗,其1年、2年和5年生存率分别为36.3%、16.4%和4.6%。术后是否行其它治疗、采用甲氨喋呤（methotrexate,MTX）治疗和环磷酰胺+多柔比星+长春新碱+泼尼松龙（cyclophosphamide,doxorubicin,vincristine,and prednisone,CHOP）治疗是有统计学意义的预后相关因素（P均＜0.001）。结论:80例PCNS DLBCL患者年龄较国内外报道的小;以Non-GCB型/ABC型DLBCL为主;个别病例检出EB病毒感染;术后未行其它治疗组、未采用MTX治疗组和未CHOP治疗组的预后较差。