套细胞淋巴瘤的临床病理特征及预后因素分析  

Mantle cell lymphoma:clinicopathologic features and prognostic factors of 102 cases occurring in

作　　者：纪洪[1] 李甘地[1] 李俸媛[1] 白燕琼[2] 陈宇[3] 杨名仲[3] 王连军 唐艳[5] 章培[6] 夏天 李佽[8] 冯江[9] 邹宗楷 益西加措[11] 

机构地区：[1]四川大学华西医院病理科,成都610041 [2]四川省简阳市人民医院病理科 [3]四川大学华西口腔医院病理科 [4]河南省许昌市中心医院病理科 [5]四川省成都市第三人民医院病理科 [6]四川省成都市第二人民医院病理科 [7]解放军第四五二医院病理科 [8]四川省成铁中心医院病理科 [9]四川省广元市人民医院病理科 [10]福建省漳州市人民医院病理科 [11]西藏自治区人民医院病理科

出　　处：《中华病理学杂志》2007年第11期730-735,共6页Chinese Journal of Pathology

摘　　要：目的探讨套细胞淋巴瘤(MCL)的临床病理特征及预后因素。方法对102例经形态学及免疫表型检测确定的 MCL 进行分析,组织病理制片和链霉素抗生物素蛋白过氧化物酶法或EnVision 法染色,并进行了随访。结果 102例患者中位年龄59岁(30～79岁),男女之比约2.92:1。淋巴结是最常受累的部位(98/98,100%),结外常受累的部位:骨髓(29/45,64.4%)、脾脏(36/57,63.2%)、咽淋巴环(15/48,31.3%)、外周血(15/51,29.4%)、肝脏(12/53,22.6%)及胃肠道(15/102,14.7%);87.7%(71/81)初次就诊时处于临床Ⅲ～Ⅳ期,45.5%(25/55)患者有 B 症状;48.7%(19/39)患者血清乳酸脱氢酶升高。除7例(6.9%)因组织取材小无法区分病变模式外,余95例中12例(11.76%)为套区增生型,41例(40.2%)结节型,42例(41.2%)弥漫型。75.5%(77)经典型,24.5%(25例)瘤细胞呈母细胞样变型。102例均表达 B 细胞标记而不表达 T 细胞标记,96例(94.1%)肿瘤细胞表达细胞周期蛋白 D1,70例(71.4%)CD5弱阳性。68例获得随访,中位生存时间10个月(0～89个月)。套区增生型+结节型、经典型的核分裂象≤15/10 HPF,增殖指数≤15%;骨髓无受累,提示患者预后好,而其他临床病理因素对患者生存未见影响。结论国内 MCL 患者病征与国外患者基本一致,其病变模式、细胞变型、核分裂象、增殖指数、骨髓是否受累及受累程度与预后有关。Objective To study the clinicopathologic features and prognostic factors of Chinese patients with mantle cell lymphoma. Methods One hundred and two cases of mantle cell lymphoma occurring in Chinese patients were studied by light microscopy and immunohistochemistry. The follow-up information was also analyzed. The cases were classified as mantle zone, nodular or diffuse patterns and as typical or blastoid variants. Age, Ann-Arbor staging, B symptoms, hematologic parameters, histologic variants, mitotic index and immunophenotype were assessed for possible prognostic implication. Results The median age of the patients was 59 years （ range. 30 to 79 years ） and the male-to-female ratio was 2.92： 1. Seventy-one patients （87. 65% ） presented with advanced stage disease （Ann Arbor stage Ⅲ to Ⅳ）. B symptoms were present in 45.45% of patients. The commonest site of involvement was lymph node （ 100% ）. The other involved sites included bone marrow （64. 44% ）, spleen （63.16%）, Waldeyer＇s ring （31.25%）, peripheral blood （29.41%）, liver （22. 64% ） and gastrointestinal tract （ 14. 71% ）. All cases expressed B-cell markers but were negative for T-cell marker. Majority of cases were positive for cyclin DI （94. 12%） and CD5 （71.43%）. Blastoid variant accounted for 24.51% of cases. Amongst the 68cases with follow-up data available, the median survival was 10 months. Parameters associated with shorter survival included diffuse pattern, blastoid variant, high mitotic index, high proliferative activity and presence of bone marrow involvement. Conclusions The clinicopathologic features and prognostic factors of mantle cell lymphoma occurring in Chinese are similar to those in Caucasians. Diffuse pattern, blastoid variant, high mitotic index, high proliferative activity and involvement of bone marrow indicate poor prognosis.

关 键 词：淋巴瘤 膜细胞 细胞周期蛋白D1 诊断 预后 

分 类 号：R733.1[医药卫生—肿瘤]