原发于中枢神经系统的弥漫性大B细胞淋巴瘤临床病理特征
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摘要
目的探讨原发于中枢神经系统的弥漫性大B细胞淋巴瘤(PCNSL)的临床病理特点及鉴别诊断。方法对5例原发于中枢神经系统的弥漫性大B细胞淋巴瘤的临床病理学特点及免疫表型进行分析,并结合相关文献进行讨论。结果 5例临床表现不同,病变多发生在灰白质交界的额叶、颞叶等部位,病理类型均为弥漫性大B细胞淋巴瘤。肿瘤细胞中等偏大,不规则,泡状核,核仁明显,核分裂象常见。免疫组化染色显示肿瘤细胞CD20、CD79a(+),Ki-67增殖指数达70%。结论多数原发于中枢神经系统的淋巴瘤为弥漫性大B细胞淋巴瘤,其临床表现与其发生部位有关,病理形态学和免疫组化是诊断的重要方法。
Objective To analyze the clinicopathological features and differential diagnosis in primary central nervous system of diffuse large B-cell lymphoma. Methods The histological changes and immunohistochemical phenotypes were analyzed in six cases of primary central nervous system diffuse large B-cell lymphoma with the review of related literatures. Results The clinical manifestations were different in these 5 cases, and most tumors occurred in gray-white border of the frontal lobe, temporal lobe. These tumor cells were enlarged with pleomorphic, vesicular nuclei, prominent nucleoli, and multiple mitotic figures. By immunohistochemistry, neoplastic cell was positive for CD20, CD79 a, with a high Ki-67 proliferation index. Conclusion Clinical manifestations are related to its location of primary central nervous system diffuse large B-cell lymphoma, and it is usually diagnozed by the pathological examination and immunophenotyping of biopsy.
Objective To analyze the clinicopathological features and differential diagnosis in primary central nervous system of diffuse large B-cell lymphoma. Methods The histological changes and immunohistochemical phenotypes were analyzed in six cases of primary central nervous system diffuse large B-cell lymphoma with the review of related literatures. Results The clinical manifestations were different in these 5 cases, and most tumors occurred in gray-white border of the frontal lobe, temporal lobe. These tumor cells were enlarged with pleomorphic, vesicular nuclei, prominent nucleoli, and multiple mitotic figures. By immunohistochemistry, neoplastic cell was positive for CD20, CD79 a, with a high Ki-67 proliferation index. Conclusion Clinical manifestations are related to its location of primary central nervous system diffuse large B-cell lymphoma, and it is usually diagnozed by the pathological examination and immunophenotyping of biopsy.
引文
[1] Kim SJ, Oh SY, Kim JS, et al. Secondary central nervous system (CNS) involvement in patients with diffuse large B-cell lymphoma: a therapeutic dilemma[J]. Ann Hematol, 2011, 90(5): 539-546.
[2] Boehme V, Zeynalova S, Kloess M, et al. Incidence and risk factors of central nervous system recurrence in aggressive lymphoma: a survey of 1693 patients treated in protocols of the german high-grade non-hodgkin’s lymphoma study group (DSHNHL)[J]. Ann Oncol, 2007, 11(1): 149-157.
[3] Ahn Y, Ahn HJ, Yoon DH, et al. Primary central nervous system lymphoma: a new prognostic model for patients with diffuse large B-cell histology[J]. Blood Res, 2017, 52(4): 285-292.
[4] Puligundla CK, Bala S, Karnam AK, et al. Clinicopathological features and outcomes in primary central nervous system lymphoma: a 10-year experience[J]. Indian J Med Paediatr Oncol, 2017, 38(4): 478-482.
[5] Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20): 2375-2390.
[6] Miller DC, Hochberg FH, Harris NL, et al. Pathology with clinical correlations of primary central nervous system non-Hodgkin’s lymphoma. The massachusetts general hospital experience 1958-1989[J]. Cancer, 1994, 74(4): 1383-1397.
[7] Liu J, Wang Y, Liu Y, et al. Immunohistochemical profile and prognostic significance in primary central nervous system lymphoma: analysis of 89 cases[J]. Oncol Lett, 2017, 14(5): 5505-5512.
[8] 严文娟,米秀,杨海燕,等.原发中枢神经系统弥漫性大B细胞淋巴瘤中bcl-2、C-MYC基因异常、蛋白表达及治疗方案选择对患者预后的影响[J].中华病理学杂志,2018, 47(1): 32-38.
[9] Lu L, Zhu F, Zhang M, et al. Gene regulation and suppression of type I interferon signaling by STAT3 in diffuse large B cell lymphoma[J]. Proc Natl Acad Sci USA, 2018,115(3):E498-E505.
[10] Takano S, Hattori K, Ishikawa E, et al. MyD88 mutation in elderly predicts poor prognosis in primary central nervous system lymphoma: multi-institutional analysis[J]. World Neurosurg. 2018, 112: e69-e73.
[11] Naeem SB, Niazi F, Baig A, et al.Primary CNS lymphoma vs. tumefactive multiple sclerosis: a diagnostic challenge[J]. J Coll Physicians Surg Pak, 2018, 28(1): 66-68.
[2] Boehme V, Zeynalova S, Kloess M, et al. Incidence and risk factors of central nervous system recurrence in aggressive lymphoma: a survey of 1693 patients treated in protocols of the german high-grade non-hodgkin’s lymphoma study group (DSHNHL)[J]. Ann Oncol, 2007, 11(1): 149-157.
[3] Ahn Y, Ahn HJ, Yoon DH, et al. Primary central nervous system lymphoma: a new prognostic model for patients with diffuse large B-cell histology[J]. Blood Res, 2017, 52(4): 285-292.
[4] Puligundla CK, Bala S, Karnam AK, et al. Clinicopathological features and outcomes in primary central nervous system lymphoma: a 10-year experience[J]. Indian J Med Paediatr Oncol, 2017, 38(4): 478-482.
[5] Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127(20): 2375-2390.
[6] Miller DC, Hochberg FH, Harris NL, et al. Pathology with clinical correlations of primary central nervous system non-Hodgkin’s lymphoma. The massachusetts general hospital experience 1958-1989[J]. Cancer, 1994, 74(4): 1383-1397.
[7] Liu J, Wang Y, Liu Y, et al. Immunohistochemical profile and prognostic significance in primary central nervous system lymphoma: analysis of 89 cases[J]. Oncol Lett, 2017, 14(5): 5505-5512.
[8] 严文娟,米秀,杨海燕,等.原发中枢神经系统弥漫性大B细胞淋巴瘤中bcl-2、C-MYC基因异常、蛋白表达及治疗方案选择对患者预后的影响[J].中华病理学杂志,2018, 47(1): 32-38.
[9] Lu L, Zhu F, Zhang M, et al. Gene regulation and suppression of type I interferon signaling by STAT3 in diffuse large B cell lymphoma[J]. Proc Natl Acad Sci USA, 2018,115(3):E498-E505.
[10] Takano S, Hattori K, Ishikawa E, et al. MyD88 mutation in elderly predicts poor prognosis in primary central nervous system lymphoma: multi-institutional analysis[J]. World Neurosurg. 2018, 112: e69-e73.
[11] Naeem SB, Niazi F, Baig A, et al.Primary CNS lymphoma vs. tumefactive multiple sclerosis: a diagnostic challenge[J]. J Coll Physicians Surg Pak, 2018, 28(1): 66-68.