黏膜相关淋巴组织结外边缘区淋巴瘤171例临床病理与预后分析  

Clinical and pathological characteristics and prognosis of 171 cases of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue

作　　者：陈青 杨含金[1] 滕晓东[1] CHEN Qing;YANG Han-jin;TENG Xiao-dong(Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China)

机构地区：[1]浙江大学医学院附属第一医院病理科,杭州310000

出　　处：《临床与实验病理学杂志》2020年第11期1301-1306,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨黏膜相关淋巴组织结外边缘区(extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue,MALT)淋巴瘤的临床病理学特征和预后的关系。方法收集171例MALT淋巴瘤标本进行病理学形态观察和免疫表型分析,其中23例行基因重排检测,分析患者的临床病理学特征及预后,并复习相关文献。结果171例患者的中位年龄为59岁,发病部位以胃肠道、肺部多见,分期为ⅠE期的患者占78.9%(135例)。镜下肿瘤细胞呈弥漫性分布,表现为数量不等的小淋巴细胞样细胞、中心细胞样细胞和单核样B细胞浸润,可见淋巴上皮病变及滤泡殖入等特征性改变。免疫表型:肿瘤细胞CD20、CD79a、BCL-2均阳性,CD3、CD5、CD10、CD23、Cyclin D1均阴性,CD43可呈阳性或阴性;肿瘤组织Kappa或Lambda可呈限制性表达;基因重排检测可出现IgH或Igκ克隆性重排条带。Ki-67>10%组分期级别显著高于Ki-67≤10%组(P=0.022),且进展为侵袭性大B细胞淋巴瘤的风险显著高于Ki-67≤10%组(P=0.004);MALT淋巴瘤分期级别高及组织学转化为大B细胞淋巴瘤是患者死亡的风险因素(P均<0.001)。中位随访时间31.6(8.5~63.0)个月,其中20例患者出现肿瘤复发,11例患者死于MALT淋巴瘤进展。结论MALT淋巴瘤属于惰性淋巴瘤,临床进展缓慢,患者预后良好;诊断及鉴别诊断依赖于病理组织学观察、免疫表型及基因重排分析等;MALT淋巴瘤分期高及组织学出现向大B细胞淋巴瘤转化,均与MALT淋巴瘤患者不良预后相关。Purpose To explore the clinical and pathological characteristics and prognosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue(MALT)lymphoma.Methods 171 cases of MALT lymphoma were collected for pathological morphological observation and immunohistochemical analysis,of which 23 cases were performed gene rearrangement analysis.The clinicopathological characteristics and prognosis of the patients were analyzed,and the relevant literatures were reviewed.Results The median age of 171 patients was 59 years old.The most common organs of MALT lymphoma were gastrointestinal tract and lung,and the patients with in stageⅠE accounted for 78.9%(135 cases).Microscopically,the tumor cells were diffusely distributed and showed infiltration of samll lymphocyte-like cells,centrocyte-like cells and monocytoid B cells.Characteristic changes such as lymphoepithelial lesions and follicular colonization could be found.Immunohistochemistry showed that tumor cells expressed CD20,CD79a and BCL-2,and did not express CD3,CD5,CD10,CD23 or Cyclin D1,CD43 could express or not.The expression of Kappa or Lambda could be restricted in tumor tissues,and IgH or Igκclonal rearrangement bands could be found in the detection of gene rearrangement.The tumor stage of Ki-67>10%group(P=0.022)and the risk of developing invasive large B-cell lymphoma(P=0.004)were significantly higher than that of Ki-67≤10%group.The higher MALT lymphoma stage at the time of diagnosis and the histological transformation to invasive large B-cell lymphoma were risk factors for patients’death(both P<0.001).Among all cases,the median follow-up time was 31.6(8.5 to 63.0)months,and there were 20 cases that had occurred tumor recurrence and 11 patients died of MALT lymphoma progression.Conclusion MALT lymphoma is an indolent lymphoma with slow clinical progress and good prognosis.Diagnosis and differential diagnosis depend on histopathology,immunohistochemistry and gene rearrangement analysis.The higher tumor stage of MALT lymphoma and converting to

关 键 词：MALT淋巴瘤 病理诊断 基因重排 预后 

分 类 号：R733.4[医药卫生—肿瘤]