原发性中枢神经系统弥漫大B细胞淋巴瘤临床病理学观察  

Primary central nervous system diffuse large B-cell lymphoma:A clinical pathological investigation

作　　者：王翠翠[1] 杨淑云 钟定荣[3] 孙希炎[4] 郑金锋[1] 

机构地区：[1]济南军区总医院病理科,山东济南2500313 [2]武警山西省总队医院病理科,山西太原030000 [3]北京协和医院病理科,北京100730 [4]济南军区总医院神经外科,山东济南2500313

出　　处：《现代肿瘤医学》2014年第9期2044-2049,共6页Journal of Modern Oncology

基　　金：济南军区十一五计划课题(编号:J115Z004)

摘　　要：目的:观察原发性中枢系统弥漫大B细胞淋巴瘤(PCNS-DLBCL)临床病理学、影像学特点,探讨其免疫组化、基因重排检测及microRNA表达特征。方法:收集确诊的PCNS-DLBCL 25例,观察并分析影像学、病理组织学、免疫组化标记特点,并进行重链和轻链基因重排检测。对其中10例典型PCNS-DLBCL、10例颅外生发中心来源的弥漫大B细胞淋巴瘤(GC-DLBCL)和10例颅外非生发中心来源的弥漫大B细胞淋巴瘤(NGC-DLBCL)的石蜡包埋组织块微切割提取microRNA,进行芯片杂交,对三者间的差异性进行比较。结果:PCNS-DLBCL多累及两个或两个以上脑叶(10/25例),其中额叶受累最为常见(6/25例)。所有病例均可见中心母细胞样的大淋巴细胞围绕血管呈靶环样生长。免疫组化染色结果显示,25/25例均弥漫强阳性表达CD20、CD79a,不表达CD3、CD5、CD23、CyclinD1,Ki-67阳性率在50%-90%(平均80%),仅有3例表达CD10(占12%),19例表达Bcl-6(占76%),22例表达Mum-1(88%)。基因重排检测显示24/25例呈B细胞单克隆性(96%)。microRNA芯片杂交显示,与NGC-DLBCL比较,升高2倍及以上者788个microRNA或片段,下降0.5倍以下者401个microRNA或片段;与GC-DLBCL比较,升高2倍及以上者611个microRNA或片段,下降0.5倍以下者229个microRNA或片段。结论:PCNS-DLBCL以老年男性好发,常累及多个部位,免疫组化显示大部分为活化B细胞来源,基因重排检测B细胞单克隆性高,microRNA芯片杂交显示,PCNS-DLBCL microRNA表达明显不同于颅外NGC-DLBCL和GC-DLBCL,可能存在microRNA诊断性标志物。从microRNA表达差异的数量看,PCNS-DLBCL与颅外GC-DLBCL差异较小,此与二者的预后接近相关。Objective:To evaluate the clinical pathology and imaging profile of the primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL),and to investigate the features of PCNS-DLBCL with regard to immunohistochemistry,gene rearrangement and microRNA expression.Methods:The imaging,pathological and immu-nohistochemical data from 25 patients with identified PCNS-DLBCL were collected and analyzed,and a gene rear-rangement examination was performed for the heavy and light chains.The microRNA was extracted from paraffin-em-bedded tissue blocks of the patients with typical PCNS -DLBCL (n=10),germinal center-diffuse large B-cell lymphoma (GC-DLBCL,n=10)and non-germinal center-diffuse large B-cell lymphoma (NGC-DLBCL,n=10),and subject to microarray hybridization,in order to evaluate the difference between the three patient populations. Results:For the PCNS-DLBCL,≥2 involved cerebral lobes were usually observed (10/25),particularly including the frontal lobe (6/25 ).As seen in all the patients,large lymphocytes with an appearance similar to that of the lym-phoblasts were distributed around the blood vessels in a ring-like manner.The immunohistochemical study revealed a diffuse strong expression of CD20 and CD79a and absent expression of CD3,CD5,CD23 and CyclinD1 in 25/25 pa-tients with PCNS-DLBCL.The presence of CD10 (3/25,12%),Bcl -6 (19/25,76%)and Mum -1 (22/25, 88%)was also confirmed.Gene rearrangement determination showed a monoclonality of B -lymphocyte in 24/25 (96%)patients.As revealed by microRNA microarray hybridization,the 788 microRNAs or corresponding fragments increased ≥2 folds,and 401 microRNAs or corresponding fragments decreased ≥0.5 folds,were detected in PCNS-DLBCL when compared with those in NGC-DLBCL;and 611 increased≥2 folds and 229 decreased≥0.5 folds were found when compared with the GC-DLBCL.Conclusion:PCNS-DLBCL is commonly seen in old males and characterized by multiple involvements.The immunohistochemical examination showed an origin from activated B-lymphocytes in the majori

关 键 词：中枢神经系统 弥漫大B细胞淋巴瘤 基因重排 MICRORNA 

分 类 号：R739.41[医药卫生—肿瘤]