原发CD5阳性弥漫大B细胞淋巴瘤9例临床病理分析  

Clinicopathologic analysis of 9 cases of de novo CD5-positive diffuse large B cell lymphoma

作　　者：李青[1] 张云岗[1] 路军[1] 曹勍[1] 潘静 金木兰[1] LI Qing;ZHANG Yun-gang;LU Jun;CAO Qing;PAN Jing;JIN Mu-lan(Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院病理科,北京100020

出　　处：《临床与实验病理学杂志》2019年第4期388-392,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨原发CD5阳性弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)临床病理特征、诊断及鉴别诊断。方法回顾性分析9例DLBCL临床特点、组织学特征及免疫表型,并进行随访。结果 8例患者为女性,1例为男性,年龄56～83岁,中位年龄70岁。9例均有结外累及,包括骨髓、肺及肾上腺、鼻咽部、回盲部、脾脏、乳腺、胸壁。光镜下见中-大异型淋巴样细胞弥漫浸润,核仁显著。免疫表型:9例CD5、CD20、CD79a呈弥漫阳性,8例BCL-2呈阳性,6例BCL-6呈阳性,5例MUM-1呈阳性,4例CD10呈阳性,Ki-67增殖指数40%～80%。Hans分型:6例为生发中心B细胞(germinal center B-cell,GCB)亚型,3例为活化B细胞(activated B-cell,ABC)亚型。随访6. 5～23. 5个月,1例死亡,6例存活,但病情均进展或复发,2例失访。结论 CD5阳性DLBCL患者的病程呈侵袭性,多见于老人,常累及结外。免疫组化标记BCL-2多为阳性,CD10多为阴性。常规化疗效果不佳,预后较差。Purpose To investigate the clinicopathological features,diagnosis and differential diagnosis of de novo CD5 positive diffuse large B cell lymphoma (CD5 +DLBCL). Methods Clinical features,histological morphology and immunophenotypes of 9 cases of CD5^+DLBCL were analyzed retrospectively. All except 2 patients were followed up. Results All patients were female except 1 case was male,aged from 56 to 83 years,with a median age of 70 years. All 9 cases had an involvement of extranodal sites,including bone marrow,bilateral lung and bilateral adrenal,nasopharynx,ileocecal junction,spleen and the left mammary gland,chest wall. Microscopically all tissues involved were diffusely infiltrated by medium to large atypical lymphoid cells with marked nucleoli. The neoplastic cells expressed CD5(9/9),CD20(9/9),CD79a(9/9),BCL-2(8/9),BCL-6(6/9),MUM-1(5/9),CD10(4/9),C-MYC(1/9),and negative to Cyclin D1,CD23,CD30,SOX-11 in all cases. Ki-67 index varied with a range of 40%-80%. 1 patient died at 6.5 months after surgery and 6 patients were survived but all with the disease progression or relapse after treatment. Conclusion CD5 +DLBCL is a highly aggressive subtype which mostly involves elderly female patients,often involves extranodal sites,and shows a poor response to routine chemotherapy and a dim prognosis. The malignant cells in most cases are positive for BCL-2 and negative for CD10.

关 键 词：弥漫大B细胞淋巴瘤 CD5 临床 病理 免疫组织化学 

分 类 号：R733.4[医药卫生—肿瘤]