结内外弥漫性大B细胞淋巴瘤的免疫表型和分化特征及预后的比较

目的探讨弥漫性大B细胞淋巴瘤（DLBCL）的临床生物学特征和预后并比较结内与结外的差异。方法分析142例DLBCL的临床病理资料,结内90例,结外52例（胃肠30例,其他22例）,并随访2～108个月,制备组织芯片,并经免疫组织化学EnVision法染色,观察CD10、bcl-6、MUM1蛋白的表达并进一步区分其生发中心B细胞（GCB细胞）和非生发中心B细胞的分化特征。结果胃肠道DLBCL常为Ⅰ～Ⅱ期,国际预后指标评分低,预后也好于结内及其他结外DLBCL。单个抗原的表达率,CD10为19％（27例）,bcl-6为51％（72例）,MUM1为58％（82例）。36％（51例）的DLBCL显示GCB细胞分化特征,64％（91例）的DLBCL显示非GCB细胞分化特征。结外DLBCL的bcl-6的表达（63％）高于结内DLBCL（43％）。在不同的结外部位,甲状腺等部位多见为GCB细胞分化的DLBCL;睾丸等部位多见为非GCB细胞分化的DLBCL。结论DLBCL显示生发中心B细胞和非生发中心B细胞分化特征,结内外以及结外不同部位的DLBCL有着不同的生物学特征和预后。

Nodal versus extranodal diffuse large B-cell lymphoma: comparison of clinicopathologic features, immunophenotype and prognosis

OBJECTIVE: To study the clinicopathologic features and outcome of patients with diffuse large B-cell lymphoma (DLBCL), and to compare the differences between DLBCL of nodal and extranodal origins. METHODS: One hundred and forty-two cases of de novo DLBCL collected during a 10-year period were reviewed. The clinicopathologic features and follow-up (2 - 108 months) data were analyzed. Tissue microarray blocks were performed and immunohistochemical studies using antibodies against CD10, bcl-6 and MUM1 were carried out. The cases were then further categorized into germinal center B cell-like (GCB) and non-GCB subtypes. RESULTS: Primary gastrointestinal DLBCL often presented as early-stage disease (stage I or II) and was associated with low international prognostic index. They showed better prognosis than DLBCL of nodal and other extranodal origins. The positivity rates of CD10, bcl-6 and MUM1 were 19%, 51% and 58%, respectively. 36% of the cases belonged to GCB, while the remaining 64% were non-GCB. In general, DLBCL of extranodal origin showed more frequent bcl-6 expression than nodal DLBCL. As for extranodal DLBCL, GCB immunophenotype was often seen in thyroid and breast tumors, while testicular DLBCL usually carried a non-GCB immunophenotype. CONCLUSIONS: DLBCL of various origins show a diversified GCB and non-GCB differentiation. Nodal and extranodal DLBCL, as well as extranodal DLBCL from different primary sites, carry different biologic characteristics and prognostic implications.