49例弥漫大B细胞淋巴瘤累及骨髓的病理诊断分析  

Pathological diagnosis and analysis of 49 cases of diffuse large B-cell lymphoma involving bone marrow

作　　者：张益清 ZHANG Yiqing(Department of Pathology,Beijing Hightrust Diagnostics,Beijing,100176,China)

机构地区：[1]北京海思特医学检验实验室病理科,北京100176

出　　处：《当代医学》2024年第18期128-131,共4页Contemporary Medicine

摘　　要：目的探讨弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)累及骨髓的临床病理特征、免疫表型、诊断及鉴别诊断。方法回顾性分析2020年1月至2022年1月北京海思特医学检验实验室收检的49例DLBCL累及骨髓的患者的临床病理资料,对所有患者进行骨髓活检、免疫组织化学、流式细胞免疫表型检查,并复习相关文献。结果49例DLBCL累及骨髓的患者中,男28例,女21例;年龄51~75岁,中位年龄为65岁。大部分患者仅表现为淋巴结快速增大,临床症状不明显。肿瘤性淋巴细胞累及骨髓的异常细胞比例在1%~90%,以间质浸润为主,占比48.9%,20.4%为弥漫性骨髓浸润,30.6%为结节性骨髓浸润,骨髓纤维化均较明显,其中有1例累及骨髓转为小B细胞淋巴瘤。49例均表达B细胞相关抗原,100%表达CD20、CD19、PAX-5,10.2%表达CD5,2%表达CD30,81.6%表达BCL-2,以40%阳性为阈值,22.4%表达C-MYC;22.4%双表达C-MYC与BCL-2。生发中心B淋巴细胞来源亚型占30.6%,非生发中心活化B淋巴细胞来源亚型占69.4%,Ki67增殖指数在20%~95%,侵袭性强。49例行流式细胞学免疫分型,均可见单克隆B淋巴细胞,异常细胞约占有核细胞的0.5%~8.0%,比例明显低于骨髓活检。结论DLBCL是一种较常见的非霍奇金淋巴瘤,11%~27%的病例会累及骨髓,累及骨髓的亚型以非生发中心活化B淋巴细胞来源为主,早期骨髓间质浸润很容易漏诊,诊断需结合髓外肿瘤病理诊断,骨髓活检加免疫组化及相关基因检测综合诊断。Objective To investigate the clinical pathological characteristics,immunophenotype,diagnosis,and differential diagnosis of diffuse large B-cell lymphoma(DLBCL)involving bone marrow.Methods The clinicopathological data of 49 patients with DLBCL involvement in bone marrow were retrospectively analyzed from January 2020 to January 2022 in Beijing Hightrust Diagnostics.Bone marrow biopsy,immunohistochemistry and flow cytometric immunophenotype were performed on all patients,and relevant literature was reviewed.Results Among 49 patients with DLBCL involvement in bone marrow,there were 28 males and 21 females,age ranged from 51 to 75 years,with a median age of 65 years.Most patients only showed rapid enlargement of lymph nodes,and the clinical symptoms were not obvious.The proportion of abnormal cells involved in bone marrow by tumor induced lymphocytes ranges from 1%to 90%,with interstitial infiltration being the main type,accounting for 48.9%,20.4%being diffuse bone marrow infiltration,and 30.6%being nodular bone marrow infiltration.Bone marrow fibrosis was more pronounced,with 1 case involving bone marrow turning into small B-cell lymphoma.All 49 cases expressed B cell related antigens,with 100%expressed CD20,CD19 and PAX-5;10.2%expressed CD5;2%expressed CD30;81.6%expressed BCL-2,at a threshold of 40%positivity,22.4%expressed C-MYC;22.4%expressed both C-MYC and BCL-2.The germinal center B lymphocyte derived subtype accounted for 30.6%,while non germinal center activated B lymphocyte derived subtype accounted for 69.4%.The Ki67 proliferation index was between 20%-95%,indicating strong invasiveness.49 routine flow cytometry immunophenotyping showed monoclone B lymphocytes,with abnormal cells accounting for approximately 0.5%-8.0%of nuclear cells,significantly lower than bone marrow biopsy.Conclusion DLBCL is a common type of non Hodgkin's lymphoma,with approximately 11%-27%of cases involving the bone marrow.The subtypes of bone marrow involvement are mainly derived from non germinal center activated B lymphocytes.Earl

关 键 词：弥漫大B细胞淋巴瘤 免疫组化 流式细胞学 

分 类 号：R733.4[医药卫生—肿瘤]