结内边缘区B细胞淋巴瘤临床病理学分析  

Clinicopathologic analysis of nodal marginal zone B cell lymphoma

作　　者：王小燕[1] 李敏[1] 黄欣[1] 何耀鑫[1] 薛学敏[1] 孙琳[1] 赖玉梅[1] 王洁玮[1] 高子芬[1] 刘翠苓[1] 

机构地区：[1]北京大学医学部病理学系,100191

出　　处：《中华血液学杂志》2012年第5期388-391,共4页Chinese Journal of Hematology

基　　金：北京市自然科学基金（7102101）

摘　　要：目的探讨原发结内边缘区B细胞淋巴瘤（NMZL）临床病理学特点。方法对22例NMZL患者淋巴结活检组织采用HE、免疫组织化学（EnVision二步法）染色，观察其形态及免疫表型特点，其中9例患者标本采用间期荧光原位杂交技术（FISH）检测t（11；18）（q21；q21）及t（14；18）（q32；q21），并对部分病例进行随访。结果22例NMZL患者中位年龄62（16-77）岁，男女比例为1．2：1。22例患者中肿瘤累及部位以颈部淋巴结最为常见（11例），其后依次为腋下（9例）、腹股沟（7例）、颌下（6例）、纵隔（4例）、锁骨上（2例）及腹膜后淋巴结（1例）。AnnArbor分期：13例（59％）为Ⅰ／Ⅱ期，9例（41％）为Ⅲ／Ⅳ期。免疫表型检测显示所有患者标本肿瘤细胞均一致强表达CD20，不表达CD3a、CD10、CyclinD1、CD21、CD23、Bcl-6。CD5及Bcl-2阳性率分别为39％（18例中有7例）、30％（10例中有3例）。FISH检测结果显示2例患者存在t（11；18），1例患者同时存在t（11；18）及t（14；18）。13例患者获完整随访资料，随访时间为6-44个月，其中3例死亡，3年累积生存率为67％。结论NMZL好发于中老年人，临床主要表现为多发淋巴结肿大，很少累及结外器官，临床分期较早，诊断时需结合临床相关检查及病理学改变综合分析，尤其是存在t（11；18）及t（14；18）的病例。Objective To investigate the clinicopathologic features of primary nodal marginal zone B- cell lymphoma （NMZL）. Methods Hematoxylin-Eosin staining and immunohistochemistry were used to e- valuate the histological and immunophenotypic characteristics of lymph node（LN） tissue in 22 NMZL cases. Additionally, interphase fluorescence in-situ hybridization （FISH） was carried out to detect the presence of t（11;18）（q21;q21）/API2-MALT1 and/or t（14;18）（q32;q21）/IGH-MALT1 in9 cases. Results The median age of the 22 patients was 62（ 16 -77） ys. The male-to-female ratio was 1.2： 1. All patients exhibi- ted asymptomatic lymphadenopathy with the cervical region as the most often site to be involved （ n = 11 ）, fol- lowed by axillary （ n = 9 ）, inguinal （ n = 7 ）, submandibular （ n = 6 ）, mediastinal （ n = 4 ）, supraclavicular （ n = 2） and retroperitoneal lymph nodes （ n = 1 ）. The Ann Arbor stages were Ⅰ / Ⅱ in 13 （59%） cases and Ⅲ/Ⅳ in 9 （41%）. Immunohistochemical study showed a consistently strong expression of CD20 and an ab- sence in the expression of CD3e, CD10, CyclinD1, CD21, CD23 and Bcl-6 by the tumor cells in all the ca- ses. Frequency of expression of CD5 and Bcl-2 were 39% （7/18） and 30% （3/14） respectively. Among the 9 cases performed with FISH, 2 cases harbored t（14;18）and another 1 case positive for t（ 11; 18） and t（14;18）. Complete follow-up data were available for 13 cases. The follow-up time was 6 to 44 months. 3 of them died. 3-year cumulative survival rate was 67%. Conclusions NMZL patients are often elderly, which mainly present with multiple lymphadenopathy, rare involvement of extranodal organ and early stage. The di- agnosis must be based on a combination of clinicopathologic features, especially those patients detected t（11 ;18） and/or t（14;18）.

关 键 词：淋巴瘤 B细胞 病理学 临床 诊断 预后 

分 类 号：R733.1[医药卫生—肿瘤]