潘毅, 孟斌, 付凯, 孙保存. 98例滤泡性淋巴瘤组织学及遗传学的初步研究[J]. 中国肿瘤临床, 2011, 38(18): 1075-1080. DOI: 10.3969/j.issn.1000-8179.2011.18.005
引用本文: 潘毅, 孟斌, 付凯, 孙保存. 98例滤泡性淋巴瘤组织学及遗传学的初步研究[J]. 中国肿瘤临床, 2011, 38(18): 1075-1080. DOI: 10.3969/j.issn.1000-8179.2011.18.005
Yi PAN, Bin MENG, Kai FU, Baocun SUN. Ninety-eight Cases of Follicular Lymphoma: The Study of Histology and Genetics[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2011, 38(18): 1075-1080. DOI: 10.3969/j.issn.1000-8179.2011.18.005
Citation: Yi PAN, Bin MENG, Kai FU, Baocun SUN. Ninety-eight Cases of Follicular Lymphoma: The Study of Histology and Genetics[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2011, 38(18): 1075-1080. DOI: 10.3969/j.issn.1000-8179.2011.18.005

98例滤泡性淋巴瘤组织学及遗传学的初步研究

Ninety-eight Cases of Follicular Lymphoma: The Study of Histology and Genetics

  • 摘要: 探讨滤泡性淋巴瘤FL的诊断、分级、鉴别诊断及染色体的易位状态。方法:回顾性分析98例FL的临床病理资料,对原始HE切片进行形态学观察,选取具有代表性的福尔马林固定并石蜡包埋的肿瘤组织制作成组织芯片,采用免疫组织化学方法,检测Bcl-2、CD10及Ki-67等抗原的表达,并采用双色荧光原位杂交技术FISH检测FL中Bcl-2-IgH及Bcl-6的易位状态。结果:98例FL的临床病理资料中,男性51例,女性47例,男女比例约为1.09:1;年龄范围25~83岁,中位年龄59岁。本组病例1~2级共54例,其中1级24例,2级30例,3a级26例,3b级18例。FL在形态学上具有典型特征,联合应用Bcl-2、CD10及Ki-67等免疫标记对其诊断及鉴别诊断有重要意义。免疫组织化学表型:Bcl-2阳性率为87.8%,CD10阳性率为62.2%,Ki-67高表达(≥25%)的阳性率为50.0%。FISH检测结果为FL的Bcl-2-IgH易位总的发生率是58.5%,1级、2级、3a级及3b级者分别为91.7%、63.0%、52.0%及16.7%16.7%。Bcl-2-IgH易位的状态与CD10的表达呈正相关,与Ki-67的表达呈负相关。FL中Bcl-6易位总的发生率为16.3%(15/92), 其中1~2级的发生率为0,3级总的发生率为35.7%(15/42),易位的发生均存在于高级别FL中。结论:FL的发病年龄较晚,中位年龄超过50岁,组织结构和构成细胞均具有典型的形态学特征;联合应用Bcl-2、CD10及Ki-67等抗体可基本明确诊断,辅以CD5、CD23、Cyclin D1和CD43可与反应性增生及其他B细胞性非霍奇金淋巴瘤进行鉴别;FL中Bcl-2-IgH易位的发生率随着分级的增高逐渐降低,易位的状态与肿瘤分级及CD10和Ki-67的表达率相关;Bcl-6易位的出现与肿瘤分级相关,易位均存在于高级别FL中。

     

    Abstract: To study the diagnosis, grading, differential diagnosis, and translocation status of follicular lymphoma ( FL ). Methods: Ninety-eight cases of FL were retrieved and the hematoxylin and eosin-stained slides were reviewed; the representative blocks were selected to construct the tissue microarray. Antigens such as BCL-2, CD10, and Ki-67 were detected by the immunohistochemistry. The bcl-2-MBR and bcl-6-MBR translocation status in FL were tested by dual color FISH. Results: The clinicopathologic findings were as follows: 98 FL patients including 51 males and 47 females ( M:F ratio = 1.09:1 ) with an age range of 25 to 83 years ( median, 59 years ). Up to 54 cases were classified into the low-grade group, 26 cases were grade 3a, and 18 cases were grade 3b. Morphologically, FL presented with typical features, which would play an important role in diagnosis and differential diagnosis through the application of antibodies such as BCL-2, CD10, and Ki-67. In our cohort, the positivity of these three markers was 62.2%, 87.8%, and 50.0%, respectively. FISH: The incidence of bcl-2-MBR in FL was 58.5%, with 91.7% in grade 1, 63.0% in grade 2, 52.0% in grade 3a, and 16.7% in grade 3b, respectively. The translocation frequency was decreased along with the increase of grading. The translocation status had correlation with Ki-67 expression. The incidence of bcl-6-MBR in FL was 16.3%, with 0 in grade 1-2, 35.7% in grade 3, 41.7% in grade 3a, and 27.8% in grade 3b, respectively. All bcl-6-MBR translocations occurred in high grade FL. Conclusion: 1) FL predominantly affected adults, with a median age in the 5th decade. It had a predominantly follicular pattern and typical neoplastic cells. 2) Applying antibodies such as BCL-2, CD10, and Ki-67 could help to make the final diagnosis, combining CD5, CD23, CyclinD1, and CD43 could differentiate FL from reactive hyperplasia and other small B cell NHL. 3) The translocation frequency of bcl-2-MBR was decreased along with the increase of FL grading. The bcl-2-MBR had a correlation with FL grading and Ki-67 expression. 4) The bcl-6-MBR translocation had relationship with FL grading; all translocations occurred in high grade FL.

     

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