伯基特淋巴瘤伴肉芽肿反应的临床病理特征及文献复习  

Clinicopathological Features of Burkitt Lymphoma with Granulomatous Reaction and Literature Review

作　　者：周智俊[1] 陈艳[1] 郑凤春[1] ZHOU Zhijun;CHEN Yan;ZHEN Fengchun(Department of Pathology,Xiamen Third Hospital,Xiamen 361100,China)

机构地区：[1]厦门市第三医院病理科,厦门361100

出　　处：《中国医药指南》2024年第31期59-63,共5页Guide of China Medicine

摘　　要：目的探讨伯基特淋巴瘤(BL)伴肉芽肿反应的研究进展及分析患者临床病理特征、预后。方法回顾性分析1例BL伴肉芽肿反应患者临床病理资料并复习国内外相关文献。结果患者为46岁男性,因右颌下无痛肿物入院检查,术后病理显示淋巴结中央见肉芽肿形成及大量多核巨细胞,肉芽肿周边见大量成片异型淋巴样细胞弥漫浸润,免疫组化示Ki-67阳性(>90%),CD20弥漫阳性,CD10阳性,C-myc阳性(>90%),FISH检测示MYC重排,病理诊断为右侧颌下淋巴结BL伴肉芽肿反应。患者术后未进行治疗,随访5年内未见肿瘤复发及淋巴结肿大。查阅国内外关于BL伴肉芽肿反应相关的文献,选择病理活检确诊的BL伴肉芽肿反应病例11例,显示淋巴结非霍奇金BL伴肉芽肿反应发生在下颌4例,颈部淋巴结2例,右腋窝淋巴结2例,腹部3例;EBV阳性率100%;MYC重排阳性100%,其中MYC基因异常基因1例t(8;22),5例t(8;24);随访10例,预后完全缓解4例,健康6例,未知1例。结论BL伴肉芽肿反应病例极为罕见,给临床诊断带来一定挑战性,这类患者往往预后较好,可能不需要进一步的放化疗。Objective To investigate the clinicopathological features and prognosis of Burkitt lymphoma(BL)with granulomatous reaction.Methods The clinicopathological data of 1 case of BL with granulomatous reaction were analyzed retrospectively and the relevant literatures were reviewed.Results A 46-year-old male patient was admitted to hospital for examination due to a right submaxillary tumor.Postoperative pathology revealed granuloma formation and a large number of multinucleated giant cells in the central lymph node,and a large number of sheets of heterogeneous lymphoid cells permeated around the granuloma.Immunohistochemical findings showed Ki-67 positive(>90%),CD20 diffuse positive,and CD10 positive.C-myc positive(>90%),FISH test showed MYC rearrangement,pathological diagnosis of right submaxillary lymph node BL with granulomatous reaction.The patient was not treated after surgery,and no tumor recurrence or lymph node enlargement was observed during 5 years of follow-up.To review literature related to BL with granulomatous reaction both domestically and internationally,11 cases of BL with granulomatous reaction confirmed by pathological biopsy were selected.The results showed that 4 cases of non Hodgkin BL with granulomatous reaction occurred in the lower jaw,2 cases in the neck lymph nodes,2 cases in the right axilla lymph nodes,and 3 cases in the abdomen,The EBV positivity rate is 100%,MYC rearrangement was 100%positive,including 1 case of abnormal MYC gene t(8,22)and 5 cases of t(8,24),Follow up of 10 cases revealed complete remission in 4 cases,healthy in 6 cases,and unknown in 1 case.Conclusions BL with granulomatous reaction is extremely rare,which brings certain challenges to clinical diagnosis.These patients often have a good prognosis and may not need further chemoradiotherapy.

关 键 词：伯基特淋巴瘤 肉芽肿反应 预后 

分 类 号：R733.1[医药卫生—肿瘤]