原发乳腺淋巴瘤的临床病理、免疫表型及预后分析  

Primary lymphoma of breast： a clinicopathologic, immunophenotypic and prognostic study of 21 cases

作　　者：王晓卿[1] 张乐星 毕成峰[1] 罗添友[1] 林莉[1] 闵敏[1] 赵涌[3] 何桂香[4] 冯江[5] 刘卫平[1] 

机构地区：[1]四川大学华西医院病理科,成都610041 [2]重庆市三峡医药高等专科学校病理学教研室 [3]重庆医科大学附属第一医院病理科 [4]成都市青白江区人民医院病理科 [5]广元市中心医院病理科

出　　处：《中华病理学杂志》2010年第5期302-307,共6页Chinese Journal of Pathology

基　　金：卫生行业科研专项基金部分资助（200802011）

摘　　要：目的探讨原发乳腺淋巴瘤（PBL）的病理诊断和预后。方法复习21例PBL的临床资料并进行随访。病理诊断依据WHO关于淋巴造血组织肿瘤的分类（2008版）进行。采用免疫组织化学SP法行免疫表型检测，选用的抗体有CD20、CD3ε、CD10、bcl-6、MUM-1、CD5、bcl-2、CD23、CD10、细胞周期蛋白D1、CIM3和Ki-67等。结果（1）21例均为女性，中位年龄48岁，右乳11例（52．4％），左乳10例（47．6％）。最常见的临床表现是受累乳腺单发、无痛性肿块。AnnArbor分期：20例为Ⅰ～Ⅱ期（95．2％），1例为Ⅳ期（4．8％）。国际预后指数：19例为0—1分，2例为2～3分。东方肿瘤协作组织（ECOG）体力状态评分：19例为0分，2例为1分。（2）21例（100％）均为弥漫性大B细胞淋巴瘤。免疫表型检测：21例均表达CD20抗原，14例（66．7％）表达MUM-1，5例（23．8％）表达bcl-6，CD10均为阴性表达，1例（4．8％）表达CD5，13例（61．9％）表达bcl-2。Ki-67阳性指数：10例（47．6％）≤59％，7例（33．3％）为60％～89％，4例（19．1％）≥90％，其中位数为60％。21例均符合非生发中心B细胞样型肿瘤。（3）13例（64％）获得随访资料，其1年、3年和5年生存情况分别为11例、7例和3例。结论该组21例PBL均为DLBCL，且均符合非生发中心B细胞来源的肿瘤。其诊断应充分排除系统性淋巴瘤累及乳腺。Objective To investigate the clinicopathologic and immunophenotypic features of primary breast lymphoma （PBL） and to discuss the diagnosis of the tumor. Methods Twenty-one cases of PBL with follow up data were clinically reviewed. The histologic diagnosis of the tumor was based on the updated WHO Classification of tumors of hematopoietic and lymphoid tissues （2008）. Immunohistochemistry was performed by SP method and antibodies selected were as follows： CD20, CD3ε, CD10, Bcl-6, MUM-1, CD5, Bcl-2, CD23, CD10, cyclin D1, CD43 and Ki67. Results （1） All 21 patients were female and the median age of patients was 48 years. The right and the left breasts were involved in 11 （ 52. 4% ） and 10 patients （47. 6% ）, respectively. According to Ann Arbor staging system, 20 cases were stage Ⅰ-Ⅱ （95.2%）, and the remaining case was stage Ⅳ （4. 8% ）. For the international prognostic index （IPI）, 19 cases were score 0 - 1, and 2 cases were score 2 - 3. For ECOG score, 19 cases were 0, and the remaining 2 cases were 1. （ 2 ） Histologically, all 21 cases （ 100% ） were DLBCL. Immunohistochemically, the frequency of antigen expression was as follows： CD20 （ 100% ）, MUM-1 （ 14/21,66. 7% ）, bcl-6 （5/21, 23.8%）, CD10 （0）, bcl-2 （13/21,61.9%）, CD5 （1/21,4.8%）; Ki-67 index： 10 cases （47.6%） were less than 59% , with the expression of seven cases （33.3%） being 60% -89% , and more than 90% in the remaining four cases （ 19. 1% ）. The median Ki-67 index was 60%. All the cases were considered non germinal center B-cell-like type of DLBCL. （3） Follow-up data was available in 64% of the cases.One, two and five-year survival rates were 11 cases, 7 cases and 3 cases, respectively. Conclusion All the cases of PBL in the current study were DLBCL, non germinal center B-cell-like type, and a diagnosis of PBL can only be established after excluding breast involvement in systemic lymphoma.

关 键 词：乳腺肿瘤 淋巴瘤 免疫表型分型 诊断 预后 

分 类 号：R737.9[医药卫生—肿瘤]