原发性乳腺弥漫大B细胞淋巴瘤临床病理分析(附8例)

目的:探讨原发性乳腺弥漫大B细胞淋巴瘤(primary breast diffuse large B-cell lymphoma,PB-DLBCL)的临床病理特征。方法:对8例PB-DLBCL患者进行回顾性分析,观察其组织病理学形态、免疫表型、诊断及预后,并复习相关文献。结果:根据2008版和2016年修订版的WHO关于淋巴造血系统肿瘤分类标准,8例患者确诊为PB-DLBCL,均为女性,发病年龄47~76岁,中位年龄54岁,6例发生于右侧乳腺,2例发生于左侧乳腺。病例随访9~52个月,2例失访。乳酸脱氢酶(LDH)156~238 U/L,均在正常参考范围内。免疫组化CD20、CD79a均(+),Ki67约70%~90%,7例为非生发中心B细胞样型(非GCB亚型),1例为生发中心B细胞样型(GCB亚型)。8例患者EBER检测均(-)。结论:PB-DLBCL发病少见,恶性程度高,容易误诊,诊断主要依靠病理活检及免疫组织化学表型,且具有较高的增殖活性,预后较差。

Clinicopathological analysis of 8 cases of primary breast diffuse large B-cell lymphoma

Objective:To investigate the clinicopathological features of primary breast diffuse large B-cell lymphoma（PB-DLBCL).Methods:Eight patients with PB-DLBCL were retrospectively analyzed for histopathological morphology,immunophenotype,diagnosis and prognosis,and related literature was reviewed.Results:According to the 2008 WHO classification criteria for lymphoid hematopoietic tumors and the 2016 revised edition,8 patients were diagnosed with PB-DLBCL,and all of them were females.The age of onset ranged from 47 to 76 years old.The median age was 54 years old.6 cases occurred in the right breast,and 2 cases occurred in the left breast.The patients were followed up for 9 to 52 months,and 2 cases were lost.Lactate dehydrogenase（LDH) 156~238 U/L,are within the normal reference range.Immunohistochemical CD20,CD79a were（+).Ki67 was about 70% to 90%,7 cases were non-germinal center B cell type（non-GCB subtype),and 1 was germinal center B cell type（GCB subtype).Eight patients underwent EBER in situ hybridization（-).Conclusion:The incidence of PB-DLBCL is rare.The degree of malignancy is high,and it is easy to be misdiagnosed.The diagnosis mainly depends on pathological biopsy and immunohistochemical phenotype,and it has high value-added activity and poor prognosis.