原发中枢神经系统的弥漫大B细胞淋巴瘤病理学诊断特征  

Pathological diagnostic features of primary central nervous system diffuse large B-cell lymphoma

作　　者：刘双[1] 李道胜[2] 班媛媛[3] 滕清良[1] Liu Shuang;Li Daosheng;Ban Yuanyuan;Teng Qingliang(Department of Hematology,The Central Hospital of Taian,Taian 271000,China;Department of Pathology,The Central Hospital of Taian,Taian 271000,China;Department of Gerontology,The Central Hospital of Taian,Taian 271000,China)

机构地区：[1]泰安市中心医院血液内科,271000 [2]泰安市中心医院病理科,271000 [3]泰安市中心医院老年病一科,271000

出　　处：《中华诊断学电子杂志》2020年第4期265-269,共5页Chinese Journal of Diagnostics(Electronic Edition)

摘　　要：目的探讨原发中枢神经系统的弥漫大B细胞淋巴瘤的病理学诊断特征。方法回顾性分析2010年1月至2015年12月经泰安市中心医院病理科确诊的15例原发中枢神经系统的弥漫大B细胞淋巴瘤患者的临床资料,总结原发中枢神经系统的弥漫大B细胞淋巴瘤的病理形态学特点及免疫表型。结果患者男性10例,女性5例,年龄52~64岁;15例患者临床表现为头痛头晕,反应迟钝或行走不稳。CT检查均发现颅内占位,4例发生了转移,分别转移到睾丸、肝脏、肺脏和乳腺,其余患者正电子发射计算机断层显像(PET-CT)检查均未见全身其他部位肿瘤。光镜下肿瘤细胞表现为弥漫性生长,特征性的分布于血管周隙;肿瘤细胞大多相似于中心母细胞,与反应性小淋巴细胞、巨噬细胞、活化的小胶质细胞以及反应性星形细胞混杂。免疫组织化学染色显示肿瘤细胞均弥漫强表达白细胞分化抗原20(CD20)及B细胞系特异性激活蛋白(PAX5),其中3例表达白细胞分化抗原10(CD10),7例均表达B细胞淋巴瘤因子6(Bcl-6)及多发性骨髓瘤致癌蛋白(MUM1),余5例均表达MUM1,增殖细胞核抗原(Ki-67)指数70%~90%。结论原发中枢神经系统的弥漫大B细胞淋巴瘤是一种相对少见的淋巴瘤,以弥漫性分布于血管周隙的中心母细胞样细胞为特征;临床表现与其发生部位有关,掌握其共同的特征并结合免疫组织化学技术方能正确诊断。Objective To explore the pathological diagnostic features of primary central nervous system diffuse large B-cell lymphoma(CNS DLBCL).Methods The clinical data of 15 cases of CNS DLBCL confirmed by Pathology Department in Taian Central Hospital from January 2010 to December 2015 were retrospectively analyzed.Pathomorphological characteristics and immunophenotype of CNS DLBCL were summarized.Results Among the 15 patients,10 cases were male and 5 cases were female.Their ages at the time of operation ranged from 52 to 64 years.The clinical manifestations of 15 cases were headache,dizziness,slow response or unsteady walking.CT examinations showed intracranial space occupying in all patients.Four cases had metastasis,and spread to testis,liver,lung and breast,respectively.Positron emission computed tomography(PET-CT)of other 11 cases showed no metastasis.Under light microscope,tumor cells showed diffuse growth and characterized by their distribution in the perivascular space.Most tumor cells were similar to central mother cells,and were mixed with reactive small lymphocytes,macrophages,activated microglia and reactive astrocytes.Immunohistochemistry showed that cluster of differentiation 20(CD20)and B cell-specific activator protein(PAX5)were strongly diffused in tumor cells,among which 3 cases expressed CD10,7 cases expressed B cell lymphoma 6(Bcl-6)and multiple myeloma oncogene 1(MUM1),and the remaining 5 cases expressed MUM1.Proliferation cell nuclear antigen(Ki-67)index was 70%-90%.Conclusions CNS DLBCL is a relatively rare form of lymphoma.It is characterized by diffuse growth of central mother cell-like cells distributed in the perivascular space.The clinical manifestation is related to the site of occurrence.Thorough understanding of the associated clinical features and immunohistochemic results is helpful in achieving at the correct diagnosis.

关 键 词：中枢神经系统 弥漫大B细胞淋巴瘤 免疫组织化学 病理诊断学 

分 类 号：R739.4[医药卫生—肿瘤]