原发性乳腺弥漫性大B细胞淋巴瘤5例并文献复习
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摘要
目的探讨原发性乳腺弥漫性大B细胞淋巴瘤(primary breast diffuse large B-cell lymphoma,PB-DLBCL)的临床病理学特点、诊断及鉴别诊断、治疗及预后。方法采用HE染色和免疫组织化学SP法分析5例PB-DLBCL患者的临床表现、病理学及免疫表型特征,并复习相关文献。结果 5例均为女性患者,发病年龄48～70岁,中位年龄59.2岁,均为单侧乳腺肿块,其中左乳3例,右乳2例。镜下见乳腺正常结构被破坏,成片的中等偏大的肿瘤细胞弥漫浸润乳腺小叶、导管周围、间质及周围脂肪组织。根据免疫组织化学表型,4例为非生发中心型,1例为生发中心型;Ki67增殖指数为60%～90%;根据Ann Arbor分期标准,5例均为II E期。病例随访时间截止至2018年6月,随访期内,有2例复发,分别于7和19个月后死亡;2例健在,分别已存活12和72个月;另外一例失访。结论 PB-DLBCL是一种少见的恶性淋巴瘤,临床表现为单侧乳腺无痛性包块进行性增大,以右侧多见。确诊主要依靠病理活检及免疫表型,免疫表型以非生发中心为主,以化疗联合放疗等综合治疗方案为宜。
Objective To investigate the clinicopathological features, diagnosis, differential diagnosis, treatment and prognosis of primary breast diffuse large B-cell lymphoma(PB-DLBCL). Methods The clinical manifestations, pathology and immunophenotypic characteristics of 5 patients with PB-DLBCL were analyzed by HE staining and immunohistochemical SP method, and the related literatures were reviewed. Results All of the 5 patients were women with an onset age of 48～70 years old, the median age of which was 59.2 years. All of them were unilateral breast masses, including 3 cases of left breast and 2 cases of right breast. Under the microscope, the normal structure of the mammary gland was destroyed, and many medium-large size tumor cells in diffuse form infiltrated the lobules of mammary gland as well as the periductal, interstitial tissue and surrounding adipose tissue. According to the immunohistochemical phenotype, 4 cases were non-germinal center B-cell-like(non-GCB) lymphoma, 1 case was germinal center B-cell-like(GCB) lymphoma. Ki67 proliferation indexes were from 60% to 90%. According to Ann Arbor staging criteria, 5 cases were stage II E. The follow-up time of the cases were up to June 2018. During the follow-up period, there were 2 cases of recurrence, who died after 7 and 19 months, respectively. 2 cases were alive and had survived for 12 and 72 months, respectively. Another case was lost to follow-up. Conclusions PB-DLBCL is a rare malignant lymphoma. The clinical manifestation is that the painless mass of the unilateral breast progressively increases, which is more common on the right side. The diagnosis depends mainly on pathological biopsy and immunophenotype. The immunophenotype is mainly non-GCB type, and a comprehensive treatment such as chemotherapy combined with radiotherapy is appropriate.
Objective To investigate the clinicopathological features, diagnosis, differential diagnosis, treatment and prognosis of primary breast diffuse large B-cell lymphoma(PB-DLBCL). Methods The clinical manifestations, pathology and immunophenotypic characteristics of 5 patients with PB-DLBCL were analyzed by HE staining and immunohistochemical SP method, and the related literatures were reviewed. Results All of the 5 patients were women with an onset age of 48～70 years old, the median age of which was 59.2 years. All of them were unilateral breast masses, including 3 cases of left breast and 2 cases of right breast. Under the microscope, the normal structure of the mammary gland was destroyed, and many medium-large size tumor cells in diffuse form infiltrated the lobules of mammary gland as well as the periductal, interstitial tissue and surrounding adipose tissue. According to the immunohistochemical phenotype, 4 cases were non-germinal center B-cell-like(non-GCB) lymphoma, 1 case was germinal center B-cell-like(GCB) lymphoma. Ki67 proliferation indexes were from 60% to 90%. According to Ann Arbor staging criteria, 5 cases were stage II E. The follow-up time of the cases were up to June 2018. During the follow-up period, there were 2 cases of recurrence, who died after 7 and 19 months, respectively. 2 cases were alive and had survived for 12 and 72 months, respectively. Another case was lost to follow-up. Conclusions PB-DLBCL is a rare malignant lymphoma. The clinical manifestation is that the painless mass of the unilateral breast progressively increases, which is more common on the right side. The diagnosis depends mainly on pathological biopsy and immunophenotype. The immunophenotype is mainly non-GCB type, and a comprehensive treatment such as chemotherapy combined with radiotherapy is appropriate.
引文
[1]Sun Y,Joks M,Xu LM,et al.Diffuse large B-cell lymphoma of the breast:prognostic factors and treatment outcomes.Onco Targets Ther,2016,9:2069-2080.
[2]Avenia N,Sanguinetti A,Cirocchi R,et al.Primary breast lymphomas:a multicentric experience.World J Surg Oncol,2010,8:53.
[3]Aviv A,Tadmor T,Polliack A.Primary diffuse large B-cell lymphoma of the breast:looking at pathogenesis,clinical issues and therapeutic options.Ann Oncol,2013,24(9):2236-2244.
[4]Swerdlow SH,Campo E,Pileri SA,et al.The 2016 revision of the World Health Organization classification of lymphoid neoplasms.Blood,2016,127(20):2375-2390.
[5]Hans CP,Weisenburger DD,Greiner TC,et al.Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray.Blood,2004,103(1):275-282.
[6]Mouna B,Saber B,Tijani el H,et al.Primary malignant non-Hodgkin’s lymphoma of the breast:a study of seven cases and literature review.World J Surg Oncol,2012,10:151.
[7]Yang H,Lang RG,Li FU.Primary Breast Lymphoma(PBL):A Literature Review.Cancer Biology&Medicine,2011,8(3):128-132.
[8]Ou CW,Shih LY,Wang PN,et al.Primary breast lymphoma:a single-institute experience in Taiwan.Biomed J,2014,37(5):321-325.
[9]Ryan G,Martinelli G,Kuper-Hommel M,et al.Primary diffuse large B-cell lymphoma of the breast:prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group.Ann Oncol,2008,19(2):233-241.
[10]Franco Perez F,Lavernia J,Aguiar-Bujanda D,et al.Primary Breast Lymphoma:Analysis of 55 Cases of the Spanish Lymphoma Oncology Group.Clin Lymphoma Myeloma Leuk,2017,17(3):186-191.
[11]Jabbour G,El-Mabrok G,Al-Thani H,et al.Primary Breast Lymphoma in a Woman:A Case Report and Review of the Literature.Am J Case Rep,2016,17:97-103.
[12]Aviles A,Neri N,Nambo MJ.The role of genotype in 104cases of diffuse large B-cell lymphoma primary of breast.Am J Clin Oncol,2012,35(2):126-129.
[2]Avenia N,Sanguinetti A,Cirocchi R,et al.Primary breast lymphomas:a multicentric experience.World J Surg Oncol,2010,8:53.
[3]Aviv A,Tadmor T,Polliack A.Primary diffuse large B-cell lymphoma of the breast:looking at pathogenesis,clinical issues and therapeutic options.Ann Oncol,2013,24(9):2236-2244.
[4]Swerdlow SH,Campo E,Pileri SA,et al.The 2016 revision of the World Health Organization classification of lymphoid neoplasms.Blood,2016,127(20):2375-2390.
[5]Hans CP,Weisenburger DD,Greiner TC,et al.Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray.Blood,2004,103(1):275-282.
[6]Mouna B,Saber B,Tijani el H,et al.Primary malignant non-Hodgkin’s lymphoma of the breast:a study of seven cases and literature review.World J Surg Oncol,2012,10:151.
[7]Yang H,Lang RG,Li FU.Primary Breast Lymphoma(PBL):A Literature Review.Cancer Biology&Medicine,2011,8(3):128-132.
[8]Ou CW,Shih LY,Wang PN,et al.Primary breast lymphoma:a single-institute experience in Taiwan.Biomed J,2014,37(5):321-325.
[9]Ryan G,Martinelli G,Kuper-Hommel M,et al.Primary diffuse large B-cell lymphoma of the breast:prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group.Ann Oncol,2008,19(2):233-241.
[10]Franco Perez F,Lavernia J,Aguiar-Bujanda D,et al.Primary Breast Lymphoma:Analysis of 55 Cases of the Spanish Lymphoma Oncology Group.Clin Lymphoma Myeloma Leuk,2017,17(3):186-191.
[11]Jabbour G,El-Mabrok G,Al-Thani H,et al.Primary Breast Lymphoma in a Woman:A Case Report and Review of the Literature.Am J Case Rep,2016,17:97-103.
[12]Aviles A,Neri N,Nambo MJ.The role of genotype in 104cases of diffuse large B-cell lymphoma primary of breast.Am J Clin Oncol,2012,35(2):126-129.