胃复合性弥漫性大B细胞性淋巴瘤与经典型霍奇金淋巴瘤临床病理观察  

Clinicopathologic features of gastric composite diffuse large B cell lymphoma and classical Hodgkin's lymphoma

作　　者：王宏伟[1] 陆云龙[1] 吕蓓蓓[1] 丁会珍 杨文霞[1] 陆江阳[1] 

机构地区：[1]解放军总医院第一附属医院病理科,北京100048

出　　处：《诊断病理学杂志》2013年第11期673-677,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨胃复合性弥漫性大B细胞性淋巴瘤(DLBCL)和经典型霍奇金淋巴瘤(cHL)的临床病理学特征及鉴别诊断。方法应用光镜、免疫组化及原位杂交技术对1例胃复合性DLBCL和cHL进行分析,并复习相关文献。结果患者女性,53岁。手术切除远端胃,肉眼观察胃体及幽门部多发性溃疡及结节状肿物。组织学形态及免疫组化显示,胃体部中等偏大异型淋巴细胞弥漫浸润胃壁全层,瘤细胞CD20、CD79a、Pax-5和Mum-1弥漫(+),Ki-67增殖率为80%。胃幽门部散在分布较大的RS及HRS细胞,瘤细胞CD30、CD15、Mum-1(+),Pax-5弱(+),Ki-67增殖率为100%,背景为大量反应性炎细胞。瘤细胞EB病毒检测均为(-)。患者术后进行8个周期CHOP方案化疗及2个周期RCHOP方案化疗,术后11个月因肿瘤复发导致多器官功能衰竭而死亡。结论胃复合性DLBCL和cHL均十分罕见,密切结合病史并依据形态学和免疫表型特征是诊断及鉴别诊断的关键,EB病毒感染与其不良预后具有相关性。Objective To investigate the clinicopathological features and differential diagnosis of gastric composite diffuse large B cell lymphoma （DLBCL） and classical Hodgkin＇ s lymphoma （cHL）. Methods A case of gastric composite DLBCL and cHL was analyzed by light microscopy, immunohistochemistry and in situ hybridization, with review of the literature. Results The patient was a 53-year-old female and she underwent distal stomach resection. Grossly, there were multiple ulcers and tumor nodules in the gastric corpus and pylorus. Histologically, the gastric corpus was diffusely infiltrated by medium to large-sized atypical lymphocytes which were diffusely positive for CD20, CD79a, Pax-5 and Mum- 1, and nuclear proliferation rate as assessed by Ki-67 staining was approximately 80%. Large-sized RS and HRS cells dispersively infiltrated the gastric pylorus and these cells were positive for CD30, CD15 and Mum-1 and weakly positive for Pax-5, and nuclear proliferation rate as assessed by Ki-67 staining was approximately 100%. There were massive reactive leukocytes. Epstein-Barr virus （EBV） infection was not detected in the cells from the two tumors. The patient was treated with eight courses of standard CHOP and two courses of RCHOP chemotherapy regimen after operation. Unfortunately, she died of multiple organ failure due to tumor recurrence 11 months after operation. Conclusions The combination of DLBCL and cHL coexisting in the stomach is extremely rare. It is important for diagnosis and differential diagnosis to closely combine with medical history, morphological feathers and immunophenotype analysis. EBV infection could correlate with poor prognosis of this composite lymphoma.

关 键 词：弥漫性大B细胞性淋巴瘤 霍奇金淋巴瘤 胃 

分 类 号：R735.7[医药卫生—肿瘤]