乳腺淋巴瘤72例临床病理分析  

Breast lymphoma:a clinicopathologic analysis of 72 cases

作　　者：周晓蝶 戚荣鑫 余波 王璇 李锐 叶胜兵 石群立 饶秋 周晓军 鲍炜 ZHOU Xiaodie;QI Rongxin;YU Bo;WANG Xuan;LI Rui;YE Shengbin;SHI Qunli;RAO Qiu;ZHOU Xiaojun;BAO Wei(Department of Pathology,General Hospital of Eastern Theater Command/Jinling Hospital,Nanjing University School of Medicine,Nanjing 210002,China;Department of NucleaRMedicine,General Hospital of Eastern Theater Command/Jinling Hospital,Nanjing University School of Medicine,Nanjing 210002,China)

机构地区：[1]解放军东部战区总医院/南京大学医学院附属金陵医院病理科,南京210002 [2]解放军东部战区总医院/南京大学医学院附属金陵医院核医学科,南京210002

出　　处：《临床与实验病理学杂志》2023年第8期925-930,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：江苏省第十六批六大人才高峰项目(WSN-043)、江苏省第六期333高层次人才项目[(2022)3-28-020]、江苏省青年医学重点人才项目(QNRC2016918)。

摘　　要：目的探讨乳腺淋巴瘤(breast lymphoma,BL)的临床病理学特征、诊断及鉴别诊断。方法收集72例BL的临床病理资料,采用免疫组化EnVision两步法染色,应用FISH法检测C-myc、BCL-2、BCL-6基因扩增及断裂重排情况;应用BIOMED-2 PCR检测T/B细胞基因重排;运用原位杂交法检测EBER,分析其与临床病理特征的关系。结果72例BL中女性69例,男性3例;发病年龄24~83岁,中位年龄55岁。BL影像学特征具有非特异性,与乳腺癌的临床表现相似;72例BL中弥漫大B细胞淋巴瘤(diffused large B cell lymphoma,DLBCL)52例,结外黏膜相关淋巴组织边缘区淋巴瘤(extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue,MALT)7例,T淋巴母细胞性淋巴瘤(T lymphoblastic lymphoma,T-LBL)6例,其余少见类型为7例。52例DLBCL经原位杂交检测EBER均阴性,FISH检测2例有BCL-6基因断裂。16例患者具有完整临床病理资料,原发性乳腺淋巴瘤(primary breast lymphoma,PBL)12例,继发性乳腺淋巴瘤(secondary breast lymphoma,SBL)4例,两组患者预后均较差,差异无统计学意义(P>0.05)。结论BL的病理类型以DLBCL为主,男性患者罕见。BL通过影像学鉴别难度较大,主要通过穿刺活检病理诊断;PBL和SBL的临床病理特征及预后,差异无统计学意义。Purpose To investigate the clinicopathologic features and differential diagnosis of breast lymphoma(BL).Methods The clinicopathologic data of 72 cases of breast lymphoma were collected.EnVision two-step immunohistochemical staining and FISH was used to detect the amplification and break rearrangement of C-myc,BCL-2 and BCL-6 genes.T/B cell gene rearrangement was detected by capillary electrophoresis;EBV was detected with in situ hybridization.Its relationship with clinicopathological features were analyzed.Results Of the 72 patients with breast lymphoma,69 were female and 3 were male.The age of onset ranged from 24 to 83 years with a median age of 55 years.The imaging features of breast lymphoma were nonspecific and similaRto those of breast cancer.The most common pathological type was diffused large B cell lymphoma(DLBCL)in 52 cases,followed by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue(MALT)(7 cases),T lymphoblastic lymphoma(T-LBL)(6 cases),the remaining 7 cases were rare types.Pathological diagnosis of all types of BL were combined with relevant immunohistochemical markers and/oRT/B cell gene rearrangement results.Among them,EBERin situ hybridization test of DLBCL was negative in 52 cases,and BCL-6 gene disruption was detected in 2 cases by FISH.16 patients had complete clinical and pathological data,12 cases had primary breast lymphoma(PBL)and 4 cases had secondary breast lymphoma(SBL).Patients with PBL and SBL had a pooRprognosis,but there was no statistically difference(P>0.05).Conclusion The pathological type of breast lymphoma is mainly DLBCL,and male cases are very rare.Imaging identification of breast lymphoma is difficult;its diagnosis is mainly through biopsy and puncture pathology.There is no significant difference in clinicopathological features and prognosis between PBL and SBL.

关 键 词：乳腺肿瘤 淋巴瘤 临床病理特征 鉴别诊断 

分 类 号：R737.9[医药卫生—肿瘤]