淋巴样增强结合因子1蛋白表达在淋巴母细胞淋巴瘤/急性淋巴细胞白血病中的诊断及鉴别诊断研究  

A study of LEF1 protein expression in diagnosis and differential diagnosis of lymphoblastic lymphoma/acute lymphoblastic leukemia

作　　者：陈雪 芮炜玮 毕珂 吴运瑾[1] 张素霞[1] 张龙[1] 余捷 修冰[3] 易祥华[1] 曾郁[1] Chen Xue;Rui Weiwei;Bi Ke;Wu Yunjin;Zhang Suxia;Zhang Long;Yu Jie;Xiu Bing;Yi Xianghua;Zeng Yu(Department of Pathology,Tongji Hospital,Tongji University School of Medicine,Shanghai 200065,China;Department of Pathology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200010,China;Department of Hematology,Tongji Hospital,Tongji University School of Medicine,Shanghai 200065,China)

机构地区：[1]上海市同济医院病理科,200065 [2]上海交通大学医学院附属瑞金医院病理科,200010 [3]上海市同济医院血液科,200065

出　　处：《中华病理学杂志》2021年第3期207-212,共6页Chinese Journal of Pathology

基　　金：国家自然科学基金(81401882);上海市同济医院临床研究培育项目[ITJ(QN)1907];同济大学“中央高校基本科研业务费专项资金”(22120170004)。

摘　　要：目的研究淋巴样增强结合因子1(LEF1)蛋白在淋巴母细胞淋巴瘤/急性淋巴细胞白血病(LBL/ALL)和小B细胞淋巴瘤中的表达,探讨其在LBL/ALL病理诊断及鉴别诊断中的价值。方法收集2012年1月至2019年12月上海市同济医院就诊及会诊的53例LBL/ALL石蜡组织标本,采用免疫组织化学法检测LEF1、末端脱氧核苷酸转移酶(TdT)蛋白表达,比较LEF1和TdT诊断的特异度、灵敏度。检测小B细胞淋巴瘤包括慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)、滤泡性淋巴瘤、套细胞淋巴瘤、边缘区B细胞淋巴瘤、华氏巨球蛋白血症/淋巴浆细胞淋巴瘤共77例LEF1蛋白表达,比较LBL/ALL与各亚型小B细胞淋巴瘤LEF1蛋白表达差异。单因素分析LEF1蛋白表达与LBL/ALL患者总生存与无进展生存的相关性。结果LBL/ALL中LEF1蛋白表达阳性率为100%(53/53),中位值90%;TdT阳性率为84.9%(45/53;T-LBL/ALL为78.1%,B-LBL/ALL为95.2%),中位值80%;LEF1和TdT阳性率及中位值差异均有统计学意义(P值分别为0.008,0.001)。CLL/SLL LEF1蛋白表达阳性比例为14/18,中位值45%;滤泡性淋巴瘤(0/16)、套细胞淋巴瘤(0/16)、边缘区B细胞淋巴瘤(0/19)、华氏巨球蛋白血症/淋巴浆细胞淋巴瘤(0/8)LEF1蛋白均为阴性。B-LBL/ALL与小B细胞淋巴瘤比较,LEF1阳性率有显著差异。本组LBL/ALL病例中位随访时间16个月,LEF1蛋白表达与LBL/ALL总生存和无进展生存差异无统计学意义。结论LEF1免疫组织化学检测诊断LBL/ALL有很高的灵敏度和较好的特异度,与TdT联用可提高LBL/ALL诊断率。Objective To evaluate the expression of LEF1 protein in lymphoblastic lymphoma/acute lymphoblastic leukemia(LBL/ALL)and small B-cell lymphomas,and its value in pathologic diagnosis and differential diagnosis of LBL/ALL.Methods 53 cases of LBL/ALL were collected at shanghai Tongji Hospital from January 2012 to December 2019.The protein expression of LEF1 and TdT was detected by immunohistochemistry in 53 paraffin-embedded tissue samples of LBL/ALL.The specificity and sensitivity of LEF1 and TdT in the diagnosis of LBL/ALL were compared.The expression of LEF1 protein in 77 cases of small B-cell lymphomas including chronic lymphocytic leukemia/small lymphoid lymphoma(CLL/SLL),follicular lymphoma,mantle cell lymphoma,marginal zone lymphoma and Waldenstrom′s macroglobulinemia/lymphoplasmacytic lymphoma was studied.The correlation between LEF1 expression and overall survival(OS)and progression-free survival(PFS)was performed by univariate analysis.Results The expression of LEF1 in LBL/ALL was 100%(53/53),the median value was 90%;the expression of TdT was 84.9%(T-LBL/ALL 78.1%,B-LBL/ALL 95.2%),the median value was 80%;the expression rate and median value of LEF1 and TdT were significantly different(P=0.008 and 0.001 respectively).The expression of LEF1 in CLL/SLL was 14/18,the median value was 45%;LEF1 was not expressed in follicular lymphoma(0/16),mantle cell lymphoma(0/16),marginal zone lymphoma(0/19),and Waldenstrom′s macroglobulinemia/lymphoplasmacytic lymphoma(0/8).LEF1 expression was significantly different between B-LBL/ALL and small B-cell lymphomas.The median follow-up time of LBL/ALL cases in this group was 16 months.There was no statistical difference between LEF1 expression and the OS and PFS in LBL/ALL patients.Conclusions Immunohistochemical staining of LEF1 has high sensitivity and good specificity in the diagnosis of LBL/ALL,and its combination with TdT can improve the diagnostic rate of LBL/ALL.

关 键 词：白血病 淋巴样 诊断 鉴别 免疫组织化学 淋巴样增强结合因子1 

分 类 号：R733.1[医药卫生—肿瘤]