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中国西南地区老年人EB病毒阳性弥漫大B细胞淋巴瘤的临床病理特点及预后分析

A Clinicopathologic and Prognosis Study of Epstein-Barr Virus Positive Diffuse Large B-cell Lymphoma in West-southern China

  • 摘要: 目的 探讨中国西南地区老年人EB病毒阳性弥漫大B细胞淋巴瘤(DLBCL)的临床病理特点及预后相关因素。 方法 结合组织芯片技术,对42例老年人EB病毒阳性的DLBCL进行回顾性研究,包括临床特点总结、病理形态学复习、免疫组化染色以及预后相关因素分析。 结果 从586例DLBCL中筛选出42例(7.17%)EB病毒阳性DLBCL。患者发病年龄51 ~87岁,中位年龄62.5岁,男女之比为2.23∶1。其中69.05%(29/42)为淋巴结病变;30.95%(13/42)为结外病变,包括脾脏、胃、扁桃体、鼻腔和鼻咽部。其主要临床表现为淋巴结肿大、脾大、肝大、发热、乏力、体质量减轻。组织学亚型中绝大多数(90.48%,38/42)为多形性亚型,少数(9.52%,4/42)为单形性亚型,“星空”现象、血管浸润和肿瘤性坏死分别占21.43%(9/42)、47.62%(20/42)和45.24%(19/42)。其免疫表型分析示CD30、CD5、BCL-2、 P53、NF-κB/P65的阳性率分别为52.38%(22/42)、54.76%(23/42)、54.76%(23/42)、87.5%(35/40)和0%(0/40);35例(83.33%)为Hans分型的non-GCB型。获得随访的23名患者中有14例(60.87%)患者死亡,中位生存时间为40个月,总体5年生存率为16.5%。多因素分析显示是否LDH升高、具有“星空”现象、肿瘤性坏死、BCL-2阳性表达与预后有关。 结论 中国西南地区老年人EB病毒阳性DLBCL的发生率不低,常见于淋巴结,以多形性组织学亚型多见,LDH升高、具有“星空”现象和BCL-2阳性者预后更差。

     

    Abstract: Objective To investigate the clinicopathologic features, immunophenotype, and the prognosis related factors of Epstein-Barr virus (EBV) positive diffuse large B-cell lymphoma (DLBCL) in west-southern China. Methods There were 42 cases of EBV+ DLBCL in a total 586 DLBCL, the clinical and pathologic profiles of these patients were evaluated. Immunohistochemical study and in situ hybridization (ISH) of EBER1/2 were performed on formalin fixed tissues by tissue chips. The prognosis related factors were analyzed. Results The median age of these 42 EBV+ DLBCL patients was 62.5 years. The male-to-female ratio was 2.23∶1.The site of occurrence included lymph node (69.05%) and spleen, stomach, tonsil, nasal cavity and nasopharynx. The mostly common initial clinical presentations were non-specific symptoms, such as lymphadenopathy, splenomegaly, hepatomegaly, fever, and fatigue. Morphologically, the majority (90.48%, 38/42) were pleomorphic subtypes and only 4 cases (9.52%) were simplex subtypes. Immunophenotype showed non-GCB type of DLBCL was predominance (83.33%, 35/42) by Hans classification. The expression of CD30, CD5, BCL-2, P53 and NF-κB/P65 were 52.38%(22/42), 54.76%(23/42), 54.76%(23/42), 87.5%(35/40) and 0%(0/40) respectively. Follow-up data was available in 23(54.76%) patients, 14(60.87%) patients died of the tumor. 5-years overall survival was 16.5%. The median survival time was 40 months. The expression of BCL-2, increased LDH level and starry-sky morphologic character were associated with a poor prognosis. Conclusion EBV positive DLBCL is not uncommon. Most lesions locate in lymph nodes. Pleomorphic histologic subtype is predominant. The tumor has worse prognosis with increased LDH level, starry-sky morphologic character and BCL-2 expression.

     

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