睾丸弥漫性大B细胞淋巴瘤58例临床病理及免疫表型  

Diffuse large B-cell lymphoma of testis： a clinicopathologic and immunophenotypic study of 58 cases

作　　者：杨志蓉[1] 毕成峰[1] 张文燕[1] 杨群培[1] 刘卫平[1] 

机构地区：[1]四川大学华西医院病理科,成都610041

出　　处：《中华病理学杂志》2013年第9期589-592,共4页Chinese Journal of Pathology

基　　金：国家自然科学基金（30971113,81272626）

摘　　要：目的观察睾丸弥漫性大B细胞淋巴瘤（DLBCL）的临床病理及免疫表型特点，探讨其病理诊断及预后。方法对58例睾丸DLBCL进行回顾性临床病理研究，包括形态学复习、免疫组织化学（EnVision法）染色、EB病毒编码小RNA（EBER）1／2原位杂交以及预后相关因素分析。结果58例睾丸DLBCL患者平均年龄62．1岁，中位年龄65岁。多数病程较短，51例（87．9％）就诊时处于临床I～Ⅱ期；48例（82．8％）为单侧睾丸受累。12例（20．7％）伴同侧腹股沟淋巴结肿大，少有其他器官累及。52例（89．7％）病理形态学表现为中心母细胞样细胞在睾丸间质内弥漫性浸润，并浸润曲细精管。睾丸白膜受侵、血管浸润分别见于14例（24．1％）和10例（17．2％）。Hans分型以非生发中心B细胞型为主（48／58，82．8％）。缺乏EB病毒感染。所有病例行病变睾丸切除，35例（60．3％）接受了术后化疗和（或）放疗。随访率为82．8％（48／58），其中28例（58．3％）患者死亡；1、3、5年总体生存率分别为55．7％、31．6％和27．6％。年龄〉60岁、B症状、血清乳酸脱氢酶水平升高、高临床分期及未接受术后联合治疗者预后差。结论睾丸DLBCL确诊时以局部病变为主，低临床分期，有一定的病理形态学特征，多为非生发中心型DLBCL，预后不良；术后联合化疗可延长患者的生存期。Objective To investigate the clinicopathologic features, immunophenotype, diagnosis and differential diagnosis, and prognostic factors of testicular diffuse large B-cell lympholna （ DLBCL ） . Methods The clinical and pathologic profiles of 58 cases of testieular DLBCL were investigated. Immunohistoehemieal stainings and EBER1/2 in situ hybridization were performed on formalin fixed tissues. Results The average age of the patients was 62. 1 years, and the median age was 65 years. The course of disease was short in most of the cases. Clinical stages at diagnosis were mainly stage I or ]] （87.9%, 51/58 ） . Forty eight patients （82.8%） had unilateral testis involvement. Inguinal lymphadenopathy was observed in 12 （20. 7% ） patients and the other organs were seldom involved. Morphologically, centroblast-like neoplastic cells infiltrated interstitial tissue of testis diffusely and invaded into seminiferous tubules. Tunica albuginea and vessels were involved in 14 （24. 1% ） and 10 （ 17.2% ） patients, respectively. Immunophenotype analysis showed predoufinant non-GCB type of DLBCL （48/58, 82. 8% ） by Hans classification. No EBV infection was detected. Follow-up data were available in 48 （82. 8% ） patients. Twenty eight patients （58.3%） died of the disease. One-year, 3-year, and 5-year overall survivals were 55.7% , 31.6% and 27.6% , respectively. Age （ older than 60 years） , B-symptoms, high serum level of LDH, advanced Ann Arbor stage as well as lack of combination of therapy were associated with a poor prognosis. Conclusions This large series of testicular DLBCL mainly present with local disease at diagnosis. Most cases show non-GCB inmmnophenotype. Despite early clinical stage at presentation, the prognosis is poor. Combined chemotherapy postoperation may prolong survival of the patients.

关 键 词：睾丸肿瘤 淋巴瘤 大B-细胞 弥漫性 免疫表型分型 

分 类 号：R737.21[医药卫生—肿瘤]