摘要
目的探讨表达间变性淋巴瘤激酶(ALK)蛋白的弥漫性大 B 细胞淋巴瘤(DLBCL)的临床病理特点。方法根据2001年版 WHO 淋巴造血组织肿瘤分类收集945例 DLBCL,以 LSAB 法作 ALK-11染色。对阳性病例再用 EnVision 法作 ALK-11染色,仅 EnVision 法阳性病例为最终纳入病例。对纳入病例标本用 LSAB 法加做 CD20、CD3、CD30、上皮细胞膜抗原(EMA)、粒酶 B、T 细胞胞质内抗原(TIA)-1和浆细胞(PC)抗体等免疫表型检测,进行 IgH 基因重排检测并收集随访资料。结果945例弥漫性大 B 细胞淋巴瘤中仅5例表达 ALK 蛋白。4例男性,1例女性,年龄34～72岁,全部原发于淋巴结。临床分期Ⅰ期1例、Ⅱ期2例、Ⅲ期2例。5例随访最长32个月,最短4个月。随访截止时死亡4例,死亡病例最长存活时间32个月。表达 ALK 蛋白的 DLBCL 包括中心母细胞性2例、免疫母细胞性1例、间变性1例、浆母细胞性1例;2例中心母细胞性、1例免疫母细胞性和1例间变性均表达 CD20。浆母细胞性表达κ轻链而不表达 CD20。5例均检测到 IgH 基因重排。ALK 蛋白表达:在 CD20阳性4例中,1例免疫母细胞性为胞膜和胞质阳性,2例中心母细胞性和1例间变性为胞质颗粒状阳性;1例浆母细胞性为胞核和胞质弥漫阳性。结论 ALK 蛋白阳性表达 DLBLC 是一种罕见的,临床过程具侵袭性且预后较差的淋巴瘤,可见于浆母细胞性、中心母细胞性、免疫母细胞性和间变性的大 B 细胞淋巴瘤。发现1例 ALK 蛋白表达于胞膜和胞质。
Objective To study the clinicopathologic features of diffuse large B-cell lymphoma （DLBCL） with expression of anaplastic lymphoma kinase （ALK） protein. Methods Nine hundred and forty-five（945 ） cases of DLBCL （including 177 consultation cases） diagnosed according to the 2001 World Health Organization classification of tumors of hematopoietic and lymphoid tissues were enrolled into the study. Immunohistochemical study for anti-ALK-11 was performed using LSAB technique. The ALK-positive cases were further confirmed by immunohistochemical study using EnVision technique. Only ALK-positive cases by EnVision technique were further analyzed by immunostaining for antigens including CD20, CD3, CD30, EMA, granzyme-B, TIA-1 and PC. Immunoglobulin heavy chain gene rearrangement study was also performed and follow-up data collected. Results There were altogether 5 （4 males and 1 female） cases of DLBCL showing expression of ALK protein. The age of the patients ranged from 34 to 72 years. All were primary nodal DLBCL. One case belonged to clinical stage Ⅰ , 2 in stage Ⅱ and 2 in stage Ⅲ. The duration of follow up ranged from 4 to 32 months. Three patients subsequently died and the longest survival was 32 months. Morphologic subtypes included centroblastic 2, anaplastic 1, immunoblastic with plasmacytoid differentiation 1 and plasmablastic 1. Immunohistochemically, 4 cases were CD20 positive （including 2 centroblastic, 1 anaplastic and 1 immunoblastic cases）. The plasmablastic case expressed kappa light chain and was negative for CD20. Rearrangement of immunoglobulin heavy chain gene was demonstrated in all 5 cases studied. As for ALK protein staining, a mixed membranous and cytoplasmic （ 1 immunoblastic case） , granular cytoplasmic （2 centroblastic and 1 anaplastic cases ） and mixed nuclear and cytoplasmic （1 plasmablastic case） patterns were observed. Conclusion Expression of ALK protein is a rare phenomenon in DLBCL and can be seen in centroblastic, anaplastic, immunoblastic and plasmablastic subtypes. It is often associated with aggressive clinical behavior and worse prognosis. A new pattern of ALK protein expression, mixed membranous and cytoplasmic, is reported.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2006年第9期529-534,共6页
Chinese Journal of Pathology
作者简介
通信作者：李甘地（Email：gandi@mail．sc．cninfo．net）
