EBV阳性弥漫性大B细胞性淋巴瘤临床病理观察  

Epstein-Barr virus positive diffuse large B cell lympgoma: a clinicopathological analysis and review of literature

作　　者：陈定宝[1] 沈丹华[1] 张银华[2] 张焕[2] 宋秋静[1] 周梅[2] 李依群[2] 赵峰[2] 房新志[2] 

机构地区：[1]北京大学人民医院病理科,北京100044 [2]新疆医科大学附属肿瘤医院病理科,乌鲁木齐830000

出　　处：《诊断病理学杂志》2017年第1期11-15,共5页Chinese Journal of Diagnostic Pathology

基　　金：新疆维吾尔自治区自然科学基金(2014211C107)

摘　　要：目的探讨新疆地区EBV阳性弥漫性大B细胞性淋巴瘤(DLBCL)的临床病理学特征、诊断、发病机制及治疗,并进行汉族与少数民族之间对比分析。方法将108例DLBCL组织制成组织芯片,按WHO(2008)造血与淋巴组织肿瘤分类标准分类,应用光镜观察、免疫组化染色、原位杂交方法,筛选出EBV(+)DLBCL7例,其中EBV(+)老年性DLBCL5例,另收集会诊病例EBV(+)老年性DLBCL2例,结合文献,对9例EBV(+)DLBCL进行临床病理学分析。结果 108例DLBCL中,确定可进行分析的病例为103例,其中汉族80例,少数民族23例。EBV(+)8例,其中1例因重新诊断为浆母细胞性淋巴瘤,从本组删除。7例EBV阳性DLBCL占所有病例的6.8%,其中2例年龄<50岁,分别为40岁(维吾尔族)、48岁(回族);其余5例均>50岁,诊断为EBV阳性老年性DLBCL,占所有病例的4.9%。7例中,外周血淋巴细胞百分比6%~44%,1例升高;LDH水平184~1965U/L,3例升高。7例EBV阳性老年性DLBCL(包括2例会诊病例)中,维吾尔族仅1例。在DLBCL中,汉族占7.5%(6/80),少数民族占4.3%(1/23),维吾尔族占7.1%(1/14)。7例EBV阳性老年性DLBCL中,男性6例,女性1例,年龄52~81岁,平均年龄63.6岁,中位年龄56岁。病理形态多形性4例,单一型大细胞3例,3例可见坏死;临床分期Ⅰ期1例,Ⅱ期3例,Ⅲ期2例,3例经CHOP相关方案化疗,其中1例应用RCHOP方案。9例EBV阳性DLBCL中,7例有随访资料,随访1~48个月,3例放弃治疗死亡。结论新疆地区EBV阳性DLBCL少见,具有独特的临床病理特征和地区特点,对化疗反应远比EBV阴性者差,预后不良。对该地区汉族与少数民族之间以及该地区与内地人群之间淋巴瘤的对比研究具有重要意义。Objective To investigate the clinicopathological features, diagnosis, pathogenesis and therapy of EBV positive diffuse large B cell lympgoma （ EBV ＋ DLBCL） , and to compare the characteristics of eases between the Han nationality and Minorities. Methods Tissue mieroarray containing 108 cases of DLBCL were prepared, and 103 were analyzed finally, which were studied by microscopy, immunohistochemistry and in situ hybridization according to WHO classification of tumours of haematopoietic and lymphoid tissues, with review of the related literature. 7 cases of EBV ＋ DLBCL were selected, in which 5 were EBV ＋ DLBCL of the elderly. 2 consultant cases of EBV ＋ DLBCL of the elderly were also selected. The clinicopatholgical comparative analysis of 9 cases of EBV ＋ DLBCL were made. Results In 103 cases of DLBCL, 80 were Han nationality and 23 minorities. 8 were EBV positive, in which 1 was diagnosed as p/asmablastic lymphoma and deleted. In 7 cases of EBV ＋ DLBCL （6. 8% ）, 2 aged 40 （ Uygur nationality） and 48 years （Hui nationality） , respectively. The range of lymphocyte percentage in peripheral blood was 6% - 44%, and 1 case was elevated. The range of LDH level was 184 - 1965U/L, and 3 cases were elevated. The remainder 5 cases were older than 50 years of age, who were diagnosed as EBV ＋ DLBCL of the elderly. In 7 such cases （including 2 consultant cases） , 1 was Uygur nationality. In DLBCL, EBV ＋ DLBCL of the elderly accounted for 7.5% （6/80） in the Han nationality, and 4. 3% （1/23） in the minorities, 7. 1% （1/14） in Uygnr. 6 case were male, and 1 was female. The age rapge was 52 - 81 years （mean： 63.6; meadian： 56）. 4 cases were polymorphous in pathological findings, 3 were monomorphic, and necrosis was seen in 3 cases. 1 case presented as stage I in Ann Arbor stage, 3 as stage Ⅱ , and 2 as stage Ⅲ. 3 cases were treated by CHOP related chemotherapy, and 1 by RCHOP. 7 cases were followed up for 1 - 48 months, and 3 died. Conclusion EBV ＋ DLBCL is rare in Xi

关 键 词：淋巴瘤 弥漫性大B细胞淋巴瘤 EB病毒 老年性 新疆 

分 类 号：R733[医药卫生—肿瘤]