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目的探讨弥漫性大 B 细胞淋巴瘤(DLBCL)的临床生物学特征和预后并比较结内与结外的差异。方法分析142例 DLBCL 的临床病理资料,结内90例,结外52例(胃肠30例,其他22例),并随访2～108个月,制备组织芯片,并经免疫组织化学 EnVision 法染色,观察 CD10、bcl-6、MUM1蛋白的表达并进一步区分其生发中心 B 细胞(GCB 细胞)和非生发中心 B 细胞的分化特征。结果胃肠道 DLBCL 常为Ⅰ～Ⅱ期,国际预后指标评分低,预后也好于结内及其他结外 DLBCL。单个抗原的表达率,CD10为19%(27例),bcl-6为51%(72例),MUM1为58%(82例)。36%(51例)的 DLBCL 显示 GCB 细胞分化特征,64%(91例)的 DLBCL 显示非 GCB 细胞分化特征。结外 DLBCL的 bcl-6的表达(63%)高于结内 DLBCL(43%)。在不同的结外部位,甲状腺等部位多见为 GCB 细胞分化的 DLBCL;睾丸等部位多见为非 GCB 细胞分化的 DLBCL。结论 DLBCL 显示生发中心 B 细胞和非生发中心 B 细胞分化特征,结内外以及结外不同部位的 DLBCL 有着不同的生物学特征和预后。
Objective To investigate the clinical features and prognosis of diffuse large B-cell lymphoma (DLBCL) and to compare the differences between intra-and extra-nodules. Methods The clinical data of 142 cases of DLBCL were analyzed. Totally 90 cases were included in the study, 52 cases were extranodular (30 cases of gastrointestinal tract and 22 cases were in other groups), followed by 2 to 108 months. Tissue microarray was prepared and stained with immunohistochemistry EnVision The expression of CD10, bcl-6 and MUM1 proteins were observed and the differentiation characteristics of germinal center B cells (GCB cells) and non-germinal center B cells were further distinguished. Results The gastrointestinal DLBCL was often stage Ⅰ ~ Ⅱ with low international prognostic score and better prognosis than intracapsular and other extranodal DLBCL. The expression rate of single antigen was 19% (27 cases) for CD10, 51% (72 cases) for bcl-6 and 58% (82 cases) for MUM1. Sixty-six percent (51 cases) of DLBCL showed GCB cell differentiation characteristics, and 64% (91 cases) of DLBCL showed non-GCB cell differentiation characteristics. The expression of bcl-6 in extranodal DLBCL was higher (63%) than in DLBCL in node (43%). In different extranodal sites, thyroid gland and other parts of the more common for the differentiation of DLBCL cells; testicular and other parts of more common non-GCB cell differentiation DLBCL. Conclusion DLBCL shows the characteristics of B cell differentiation in germinal center and non-germinal center. DLBCL has different biological characteristics and prognosis.