Eostein—Barr病毒IgA／VCA抗体变动规律和鼻咽癌发…

对苍梧县Ｅｐｓｔｅｉｎ－Ｂａｒｒ病毒抗体阳性的９３１人每年进行观察，连续１０年追踪发现他们中２９４人抗体转阴，６６人抗体波动，１２０人抗体下降，这些人中未出现鼻咽癌病人。在３７５例抗体无明显改变者中出现６例病人，检出率为１．６％，在抗体上升的７６人中出现了１７例病人，检出北为２２．４％，抗体持续阳性特别是滴度升高者是鼻咽癌的高危险人群。     

用Mac ELISA法检测病毒性心肌炎患者血清中柯萨奇B组病毒IgM抗体

目的 了解北京地区病毒性心肌炎的病毒感染状况。方法 用ＩｇＭ抗体捕捉ＥＬＩＳＡ（Ｍａｃ ＥＬＩＳＡ）,检测１９３例临床诊断为病毒性心肌炎患者血清中的Ｃｏｘ Ｂ１～６型病毒特异性ＩｇＭ抗体。结果 ＣｏｘＢ病毒ＩｇＭ抗体阳性检出率为６９．９％（１３５／１９３）,其中阳性检出率最高为Ｂ３型,占４０％（５４例）;其余依次为Ｂ２型,占２９．６％（４０例）;Ｂ４型占１８．５％（２５例）;Ｂ１型占７．４％（１０例）;Ｂ５型占３．０％（４例）;Ｂ６型占１．５％（２例）。而１８１例同年龄组非心肌炎患者ＩｇＭ抗体阳性检出率为２０．４％（３７／１９３）。病毒性心肌炎患者血清中的ＣｏｘＢ ＩｇＭ抗体阳性检出率明显高于非心肌炎患者,两者差异有显著性,Ｕ＝９．５６,Ｐ〈０．０１。结论 Ｃｏｘ Ｂ感染是病毒性心肌炎的主要病因。     

良、恶性鼻咽活检组织中EB病毒DNA检测、EBNA的分型及表达

应用ＥＢ病毒ＤＮＡＢａｍＨＩＷ片段、ＥＢＮＡ一２Ａ、Ｂ型分了探针，检测我区鼻咽癌（包括鼻咽原位癌）、临床高度怀疑鼻咽癌（包括鼻咽上皮细胞非典型增生、颈淋巴结肿大及鼻咽结节）和慢性鼻咽炎等活检组织共９６例。各组均以Ａ型病毒感染为主：鼻咽癌组阳性为２７／３５（７７．１％）；临床疑癌组７／１０（７０．０％）；慢性鼻咽炎织１８／２７（６６．７％）。Ｗ和Ａ型均阳性的鼻咽癌组为２０／２９（６９．０％）；非癌组为８／２５（３２．０％）。同时用抗补体免疫荧光法检测ＥＢＮＡ的表达，鼻咽癌组阳性为１９／２０（９５．０％），而慢性炎组为１／１５（６．７％）。以ＥＢ病毒ＤＮＡＢａｍＨＩＷ片段、ＥＢＮＡ一２Ａ型片段和ＥＢＮＡ表达检测中任一项阳性作为ＥＢ病毒感染、整合或表达的依据，则鼻咽癌组与非癌组之间有明显的差别（Ｐ＜０．００１）。这从另一角度提示ＥＢ病毒（特别是ＥＢＮＡ一２Ａ型）感染与我区鼻咽癌病因、发病有密切关系。     

ELISA法检测血清中柯萨奇B组病毒抗体

以柯萨奇Ｂ组１－６型病毒感染的Ｖｅｒｏ细胞上清液作抗原，建立了间接ＥＬＩＳＡ法，用于检测心肌炎患者血清中ＣｏｘＢ１－６型病毒ＩｇＧ抗体，ＩｇＧ抗体滴度≥６４００者定为阳性，在４４例心肌炎患者中有３１例为阳性占７０．４５％，其阳性检出率明显高于正常对照组，后者仅占７．４１％。     

GOR抗体与HCV感染的相关性研究

用工合成的ＧＯＥ肽与ＢＳＡ交联后包被反应板，作为捕获抗原，建立了检测ＧＯＲ抗体的间接ＥＬＩＳＡ。共检测临床各类病人２７８例，正常供血员４８名。结果慢性丙肝患者抗ＧＯＲ阳性检出率为６０．０％（３６／６０），血透患者为４３．６％（１７／３９），白血病患者为５０．０％（６／１２），甲亢患者为４０．４％（１９／４７）。对抗ＧＯＲ抗体阳性的意义进行了分析。     

胃癌与EB病毒关系的观察

中国是鼻咽癌的高发地区，而鼻咽癌的发生又与ＥＢ病毒有着密切的关系。为了了解与ＥＢ病毒有关的胃癌发生率，我们利用ＥＢ病毒核酸分子探针通原位分子杂交技术检测了沈阳市及长沙市两地区１１０例中国人的胃癌标本，结果沈阳市４９例中有３例（６．１％），长沙市６１例中有１例１．６％），其癌细胞内被证实了有ＥＢ病毒的存在，结果，中国人胃癌的ＥＢ病毒阳性率明显低于美国人和日本人。     

良,恶性鼻咽活检组织中EB病毒DNA检测,EBNA的分…

应用ＥＢ病毒ＤＮＡＢａｍＨＩＷ片段，ＥＢＮＡ－２Ａ，Ｂ型分子探针，检测我区鼻咽癌（包括鼻咽原位癌），临床高度怀疑鼻咽癌（包括鼻咽上皮细胞非典型增生，颈淋巴结肿大及鼻咽结节）和慢性鼻咽炎等活检组织共９６例。各组均以Ａ型病毒感染为主：鼻咽癌组织性为２７／３５（７７．１％）。临床疑癌组７／１０（７０．０％）；慢性鼻咽炎组１８／２７（６６．７％）。Ｗ和Ａ型均阳性的鼻咽癌组为２０／２９（６９．０％）；非癌组     

用基因工程表达的抗原早期诊断鼻咽癌

目的为了建立鼻咽癌（ＮＰＣ）早期诊断方法。方法以基因工程表达的、经纯化的ＥＢ病毒（Ｅｐｓｔｅｉｎ－Ｂａｒｖｉｒｕｓ，ＥＢＶ）早期抗原（ＥＡ）成分ＥＡ－Ｄ和ＥＡ－Ｒ作为诊断抗原，建立了酶联免疫吸附试验（ＥＬＩＳＡ），检查３０例ＮＰＣ病人及４９例正常人血清中的ＥＡ／ＩｇＡ抗体。结果用ＥＬＩＳＡ检测抗体较用细胞涂片免疫酶方法（ＩＥ）敏感。ＥＬＩＳＡ检测ＮＰＣ病人血清中ＥＡ／ｌｇＡ抗体，阳性率为１００％，ＥＡ／ｌｇＡ抗体效价均≥１∶１００。而用ＩＥ法，平行检测３０例ＮＰＣ病人血清中ＥＡ／ｌｇＡ抗体效价，结果６例为阴性（＜１∶１０），抗体阳性率为７０％。ＥＬＩＳＡ明显地提高了ＮＰＣ的检出率。以ｐ１３８（ＥＡ－Ｒ）和ｐ５４（ＥＡ－Ｄ）分别或混合包被，检测对ＥＢＶ特异的ＥＡ－Ｄ和ＥＡ－Ｒ的抗体。结论表明在ＮＰＣ病人血清中存在对ＥＡ两种抗原的抗体，对ＥＡ－Ｄ的抗体滴度高于对ＥＡ－Ｒ的抗体。因此，以两种抗原混合包被作为诊断抗原建立的ＥＬＩＳＡ方法，为ＮＰＣ的早期诊断提供更敏感、特异和简便的手段。     

汕头市中枢神经系统感染的肠道病毒病原学分析

对汕头市２３６例临床诊断中枢神经系统（ＣＮＳ）感染患者进行肠道病毒（ＥＶ）病原学及血清学检测，结果从２３６例的２５７份标本中分离出病毒６２株（５５例），检出率为２４．１％。５７例患者做了双份血清检测，中和抗体≥４倍增高者４８例，阳性率为８４．２％。以上患者病毒分离和／或血清学阳性而确诊者７８例，确诊率为３３．１％，患者感染的病毒型别分布及构成比分别为：脊髓灰质炎（Ｐｏｌｉｏ）病毒３３例（０．４２３１），其中Ⅰ型６例、Ⅱ型１８例、Ⅲ型４例和多型混合感染５例；柯萨奇（Ｃｏｘ）病毒２１例（０．２６９２），其中Ａ２４型６例、Ｂ１型７例、Ｂ４型２例和Ｂ５型６例；埃可（ＥＣＨＯ）病毒１１例（０．１４１０），其中７型５例、２４型２例和１１、１２、１５、２７型各１例；肠道病毒１０例（０．１２８０），其中７０型３例、７１型７例及多种病毒混合感染３例（０．０３８５）。     

血清乙型肝炎病毒前S1抗原检测及其与病毒复制的关系

用抗Ｓ和抗前Ｓ１单抗的双抗体夹心ＥＬＩＳＡ法检测１５０例慢性乙型肝炎患者、乙型肝炎病毒表面抗原（ＨＢｓＡｇ）携带者和健康人血清中的ＨＢＶ前Ｓ１抗原，其结果和ＨＢＶＤＮＡ聚合酶链反应（ＰＣＲ）、乙型肝炎血清标志的检测结果进行比较。结果表明：前Ｓ１抗原在乙型肝炎病毒ｅ抗原（ＨＢｅＡｇ）阳性组中的检出率和相对滴度显著高于ＨＢｅＡｇ阴性组（Ｐ＜０．０１）；在ＨＢｅＡｇ阴性组中，抗－ＨＢｅ阴性人群前Ｓ１抗原的检出率和相对滴度也显著高于抗－ＨＢｅ阳性人群（Ｐ＜０．０１）。前Ｓ１抗原和ＨＢＶＤＮＡ检测结果的符合率达８０％，两者检出率的相关系数ｒ＝０．９８２６（Ｐ＜０．０１）。结论：血清前Ｓ１抗原和乙型肝炎病毒的存在关系密切。     

2771例肺肿瘤临床病理特征分析

目的：根据WHO(2015版)肺肿瘤组织学分类标准,探讨军事医学科学院附属医院肺肿瘤的病理类型及分布特点。方法：收集2010年11月1日至2015年3月31日病理诊断2771例肺肿瘤,复习其临床资料、HE切片及免疫组织化学切片。按WHO(2015版)分类标准进行病理诊断及分类。结果：2771例肺肿瘤中多数为男性1671例(60.30%),少数为女性1100例(39.70%);左肺1286例(46.41%)、右肺1456例(52.54%)、双肺29例(1.05%);年龄16~91岁。腺癌1622例(58.53%)、鳞癌424例(15.30%)、腺鳞癌32例(1.15%)、神经内分泌肿瘤465例(16.78%)、大细胞癌19例(0.69%)、梭形细胞癌1例(0.04%)、巨细胞癌1例(0.04%)、癌肉瘤17例(0.61%)、淋巴上皮样癌1例(0.04%)、唾液腺型肿瘤4例(0.14%)、腺瘤11例(0.40%)、间叶性肿瘤55例(1.98%)、淋巴瘤7例(0.25%)、异位起源性肿瘤13例(0.47%)、转移性肿瘤99例(3.57%)。非小细胞肺癌-非特指型,倾向于腺癌小活检中TTF-1抗体阳性率为92.60%(1263/1364)、NapsinA抗体阳性率为97.07%(1324/1364);非小细胞肺癌-非特指型,倾向于鳞癌小活检中CK5/6阳性率为96.99%(290/299)、P40阳性率为98.51%(66/67)、P63阳性率为93.72%(343/366)。非小细胞肺癌分子亚型首次活检中EGFR基因突变率34.77%(378/1087),KRAS基因突变率2.92%(24/823),BRAF基因突变率0.87%(5/572),ALK融合基因阳性率11.99%(41/342),ALK-D5F3抗体阳性率22.23%(66/296),ROS1融合基因阳性率2.56%(7/273),c-Met基因扩增率4.40%(12/273),c-Met基因突变率6.67%(1/15),Her-2基因突变率0.73%(2/273),PIK3CA基因突变率13.33%(2/15),PTEN基因突变率6.67%(1/15),RET融合基因阳性率0(0/15)和NTRK1融合基因阳性率0(0/15)。二次活检率EGFR基因4.76%(18/378),ALK融合基因2.44%(1/41)。结论：肺肿瘤在男性患者中高发,病变部位最常见于右肺,腺癌已经成为最常见的病理类型。首次活检中非小细胞肺癌驱动基因中EGFR基因、ALK融合基因存在较高的突变率,其他基因突变率虽低但不容忽视。二次活检率较低,需引起重视。     

Anatomy of the portal branches and the hepatic veins in the caudate lobe of the liver

The objective of this study was to analyze the caudate portal branches and their relationships with the hepatic caudate veins and propose a new nomenclature for the caudate branches based on their territory of distribution. We realized the fine dissection of the veins of the caudate lobe in 40 human livers fixed and preserved in formalin. In 15/40 (37.5%) cases there was a single branch to the caudate lobe. In 25/40 (62.5%) cases there was more than one branch, with a posterior caudate branch in 20/40 (50%) cases, an anterior caudate branch in 15/40 (37.5%) cases, a left caudate branch in 14/40 (35%) cases, and a right caudate branch in 8/40 (20%) cases. The most frequent combination detected (11/40, 27.5% of cases) was that of the posterior and anterior branches. The venous drainage of the caudate lobe and its papillary process was provided by the superior caudate hepatic vein in 23/40 (57.5%) cases, by the middle caudate vein in 35/40 (87.5%) cases (which was the only vein in 12/35 cases), and by the inferior caudate vein in 16/40 (40%) cases. In 11/40 (12.5%) cases there were accessory caudate veins, which emptied into the left and intermediate hepatic veins. The portal branches and the hepatic veins related to the caudate process were studied. In conclusion, the new nomenclature analyzes more precisely the distribution of the caudate portal branches.     

Immunohistochemical localization of gross cystic disease fluid protein-15, -24 and -44 in ductal carcinoma in situ of the breast: relationship to the degree of differentiation

AIMS: Three major proteins present in breast gross cystic disease fluid and expressed by the cyst lining apocrine epithelium are gross cystic disease fluid protein-15 (GCDFP-15), apolipoprotein-D (APO-D; GCDFP-24) and zinc alpha2-glycoprotein (ZnGP; GCDFP-44). The aim of this study was to investigate the expression of these proteins in ductal carcinoma in situ (DCIS) of the breast and to relate their expression with the degree of differentiation of DCIS. METHODS AND RESULTS: An immunohistochemical study of these proteins was performed in 57 cases of DCIS and nine cases of morphologically apocrine DCIS. Positivity was seen in 24/57 (42.1%) cases with anti-GCDFP-15, 20/57 (35.1%) cases with anti-GCDFP-24 and 22/57 (38.6%) cases with anti-GCDFP-44. GCDFP-15 positivity was noted in 5/13 (38.5%) of the well-differentiated, 11/19 (57.9%) intermediately differentiated and 8/25 (32.0%) of the poorly differentiated cases (P=0.217). GCDFP-24 positivity was seen in 3/13 (23.0%) well-differentiated, 9/19 (47.4%) intermediately differentiated and 8/25 (32.0%) poorly differentiated cases (P=0.336). GCDFP-44 was detected in 5/13 (38.5%) of well-differentiated cases, 11/19 (57.9%) intermediately differentiated and 6/25 (24.0%) poorly differentiated cases (P=0.074). In the nine cases of apocrine DCIS, GCDFP-15 positivity was detected in seven (77.8%), while five (55.6%) and six (66.7%) cases were positive for GCDFP-24 and GCDFP-44, respectively. CONCLUSIONS: The results indicate that there is no significant association between the expression of the studied proteins and the degree of differentiation of DCIS of the breast. Moreover, some morphologically apocrine DCIS cases appear to lose expression of these proteins.     

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

Desmoplastic melanoma is subclassified into pure and mixed variants with a higher rate of lymph node metastasis in the latter. Given that reasons for these biological differences are not currently known, we investigated these subtypes with techniques that included genetic and immunohistochemical analyses of 43 cases of desmoplastic melanoma (24 pure, 19 mixed). Direct DNA sequencing was performed on BRAFV600E, RET gene (coding region on exon 11) and KIT (exons 11, 13 and 17). Immunohistochemical stains were performed with antibodies to markers of significance with respect to biological potential of nevomelanocytic proliferations and/or desmoplastic melanoma (Ki-67, CD117, nestin, clusterin, SOX10 and CD271/p75NTR). Polymorphism at the RET coding region (RETp) was noted in 33% of pure (8/24 cases) versus 24% of mixed (4/17 cases); BRAFV600E was absent in all cases of pure (0/24 cases) versus 6% of mixed (1/17 cases); no mutations were found in any of the cases on analyses of exons 11, 13 and 17 of the c-KIT gene (P=NS for all). For immunohistochemical analyses of pure versus mixed: mean percentage of Ki-67 nuclear positivity was 5% (s.d.=5.6) versus 28% (s.d.=12.6, P<0.001); CD117 stained 26% (6/23 cases) versus 78% (14/18 cases, P<0.01); nestin stained 83% (n=19/23 cases) versus 89% (16/18 cases, P=NS); clusterin stained 4% (1/23 cases) versus 6% (1/18 cases, P=NS); SOX10 87% (20/23 cases) versus 94% (17/18 cases, P=NS) and CD271 stained 61% (14/23 cases) versus 67% (12/18 cases, P=NS). Increased CD117 staining in the mixed variant suggests that alterations in the KIT protein may be involved in tumor progression. In addition, the proliferative index of the mixed variant was higher than that of the pure variant.     

Clinical and functional assessment after anticoagulant therapy of acute deep vein thrombosis involving the lower limb

We assessed the clinical status after anticoagulant therapy in acute deep vein thrombosis (DVT) involving the lower limbs. Between 1994 and 2001, 139 patients suffering from acute DVT were treated with heparin therapy followed by oral anticoagulant therapy. The coagulation factor assay was done prior to any anticoagulation therapy. The duplex scan was checked serially. The mean follow-up periods was 32 +/- 19 months. There were 32 (23.0%)cases of protein C deficiency, 12 (8.6%) cases of protein S deficiency, 13 (9.4%) cases of AT-III deficiency and 11 (7.9%) cases of abnormal plasminogen level. Fourteen cases had coagulation factor abnormalities within the family. The initial lung scan showed 29 (20.9%) cases with high, 13 (9.4%) cases with intermediate and 70 (50.4%) cases with a low probability of pulmonary embolism (PE) developing. During the follow-up periods, there were 3 cases of non-fatal PE documented with chest CT scan. The patients were divided according to the extent of the thrombus; Group I (38 cases) was limited to the infrainguinal deep vein, Group II (70 cases) extended to the iliac vein and Group III (9 cases) extended to the vena cava. Partial lysis occurred in 20/35/3 (52.6/50.0/33.3%) cases and no change in 10/24/6 (26.3/ 34.3/ 66.7%) cases in Groups I/ II/ III, respectively. Deep vein valvular reflux occurred in 15/25/5 (39.5/35.7/55.6%) cases in Groups I/ II/ III, respectively. With anticoagulation therapy, most of the thrombi remained in unresolved states and there was a high rate of deep vein valvular reflux. However, there was no serious complications which affected the patients' quality of life.     

Acute myocarditis. Serologic diagnosis, clinical findings and follow-up

In a prospective study, 57 patients with a preliminary diagnosis of myocarditis were investigated. Twenty-four patients were considered to have an acute myocarditis, 14 had a suspected myocarditis, while in 19 patients myocarditis was excluded. Episodes of frequent supraventricular and/or ventricular extrasystoles during hospital stay were seen in 8/24 cases (33%) with myocarditis and in 1/19 cases (5%) without myocarditis. On follow-up 1 month later, no supraventricular extrasystoles were observed in either group. Echocardiographic signs consistent with left ventricular insufficiency were noted in 7/24 cases (29%) with myocarditis, in 1/14 cases (7%) with suspected myocarditis and in no case without myocarditis. With a "routine" serologic test battery covering influenza viruses A and B, adenovirus, Coxsackie virus group B, ECHO viruses, Chlamydia psittaci, Mycoplasma pneumoniae and hemolytic streptococci group A, a possible etiology could be documented in 9/24 cases (38%) with myocarditis and in 4/19 cases (21%) without myocarditis. Enterovirus-specific IgM was detected with solid-phase reverse immunosorbent test (SPRIST) in 12/23 (48%) cases with myocarditis and in 3/16 cases (19%) without myocarditis. In SPRIST-IgM-positive cases, IgM antibodies were detected in 15/20 (75%) of the sera taken on admission. The overall serological results indicated a recent infection in 16/24 cases (67%) with myocarditis and in 5/19 cases (26%) without myocarditis (p less than 0.05).     

Human epidermal growth factor receptor 2 expression in urothelial carcinoma of the renal pelvis: correlation with clinicopathologic parameters

The significance of human epidermal growth factor receptor 2 (HER2) overexpression in breast cancer is well established, and these patients are subsequently treated with Trastuzumab. Although HER2 expression in urothelial carcinoma of the urinary bladder has also been recently characterized, it has not been well studied in urothelial carcinoma of the renal pelvis. We investigated the relationship between HER2 overexpression in urothelial carcinoma of the renal pelvis and clinicopathologic parameters. Forty six cases were identified. HER2 overexpression was present in 34/46 (74%) cases. Mean patient age with HER2 overexpression was 68 years (range: 42-87 years). There was a male predominance with 28/34 (82%) patients. High grade urothelial carcinoma was present in 32/34 (94%) cases and 2/34 (6%) cases had low grade urothelial carcinoma. Pathologic staging was as follows; 9/34 (26%) cases were pTa, 10/34 (29%) cases were pT1, 2/34 (6%) cases were pT2, 12/34 (35%) cases were pT3, and 1/34 (3%) cases was pT4. An inverted growth pattern was present in 23/46 (50%) cases. HER2 overexpression was present in 15/23 (65%) cases of urothelial carcinoma with an inverted growth pattern. Our study showed that HER2 overexpression is more common in male patients with high grade urothelial carcinoma, especially those with an inverted growth pattern. It is highly conceivable that patients with urothelial carcinoma of the renal pelvis may be further stratified based on HER2 overexpression, and may also be potential candidates for Trastuzumab therapy in the neoadjuvant or adjuvant setting.     

Diagnostic impact of core-needle biopsy on fine-needle aspiration of non-Hodgkin lymphoma

We retrospectively reviewed 74 fine-needle aspiration (FNA) cases of presumptive non-Hodgkin lymphoma (NHL). All the cases had cytology and core-needle biopsy and 53 cases had concurrent flow cytometric analysis. FNA (cytology and flow cytometry) and core-needle biopsy were evaluated independently. FNA was diagnostic of diffuse large B-cell lymphoma (DLBL) in 25% (13/53) of cases and small B-cell NHL in 15% (8/53) of cases, whereas core-needle biopsy was diagnostic of DLBL in 37% (27/74) of cases and small B-cell NHL in 8% (6/74) of cases. Subclassification of small B-cell NHL was reached in 3/6 cases by core-needle biopsy. Insufficient cases were observed in both FNA (47%; 25/53) and core-needle biopsy (28%; 21/74) groups. With the combination of FNA and core-needle biopsy, diagnostic cases of DLBL increased to 43% (32/74) and insufficient samples were reduced to 16% (12/74). There was no clear advantage in the diagnosis and classification of small B-cell NHL by adding core-needle biopsy to FNA (14%; 10/74). We conclude that core-needle biopsy is a useful adjunct to FNA in the diagnosis of DLBL and shall be encouraged. In small B-cell NHL, core-needle biopsy does not add to the diagnostic ability of FNA. Cases insufficient for diagnosis may be seen in both core-needle biopsy and FNA. A combined approach reduces the number of insufficient cases and is recommended in routine FNA practice.     

原发乳腺淋巴瘤的临床病理学特征与预后关系的分析

目的 探讨原发乳腺淋巴瘤(PBL)的临床病理、免疫组织化学特征及其与预后的关系.方法 按Ann Arbor临床分期标准及Wiseman和Liao的诊断标准对40例PBL患者进行分期,按照WHO(2008年)造血和淋巴瘤系统肿瘤分类分型,并进行了随访.采用SP法行免疫组织化学染色.结果 (1)40例患者均为女性,中位年龄47岁,右侧20例,左侧16例,双侧4例.临床症状大部分表现为逐渐增大的乳腺无痛性包块,肿块数量＜3个31例(77.5%,31/40),≥3个9例(22.5%,9/40);Ann Arbor分期:33例(82.5%)为Ⅰ～Ⅱ期,7例(17.5%)为Ⅲ～Ⅳ期.9例(24.3%,9/37)血清乳酸脱氢酶(LDH)水平升高;体力状况美国东部肿瘤协作组(ECOG)评分:0～1分34例(85.0%),2分以上6例(15.0%);国际预后指数(IPI)评分:29例0～1分(7 8.4%,29/37),2例2分(5.4%,2/37),3例3分(8.1%,3/37),3例4分(8.1%,3/37).21例(53.8%,21/39)累及腋窝淋巴结.(2)40例中27例(67.5%)为弥漫性大B细胞淋巴瘤(DLBCL),8例(20.0%)为黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤,1例伴大细胞转化),2例为滤泡性淋巴瘤(FL,Ⅰ级),1例为淋巴性浆细胞淋巴瘤,1例为淋巴母细胞性淋巴瘤,1例为外周T细胞淋巴瘤.40例细胞角蛋白均呈阴性,95.0%(38/40)的肿瘤细胞表达CD20和(或)CD79a;MUM1(57.6%,19/33)、bcl-6(30.3%,10/33)、bcl-2(72.7%,24/33)呈阳性表达.3例为生发中心B细胞(GCB)亚型,21例为非GCB亚型.(3)37例(92.5%,37/40)获得随访资料,其中23例(62.2%,23/37)存活,14例(37.8%,14/37)死亡.27例DLBCL的5年总生存率为48.0%,5年无病生存率为36.0%.结论 PBL少见,大多为DLBCL,其中又以非GCB亚型为主.LDH水平、肿块数目、IPI指数为影响预后的独立因素.

Abstract：

Objective To study the clinicopathologic features and prognosis of primary lymphoma of breast. Methods Forty cases of primary breast lymphoma, diagnosed according to the 2008 World Health Organization classification of hematopoietic and lymphoid tumors, were retrospectively studied.Immunohistochemistry was performed by SP method. The follow-up data were analyzed. Results ( 1 ) All the patients were females and the median age was 47 years. Unilateral and bilateral breast involvement were noted in 36 and 4 patients, respectively. The number of tumor were 31 cases(77. 5% ,31/40) less than 3 ,and 9 cases (22.5% ,9/40) were 3 and more than 3. According to Ann Arbor staging system, 33 cases (82. 5% ) were in stage Ⅰ to Ⅱ and 7 cases ( 17. 5% ) in stage Ⅲ to Ⅳ. The level of LDH in 9 cases (24. 3% ,9/37) went up. For ECOG scores, 34 cases(85.0% ) were 0 to 1 score and 6 cases ( 15.0%)were more than 2 scores. With respect to international prognostic index, 83. 8% (31/37) were of score 0 to 2 and 16. 2% (6/37) were of score 3 and more than 3. The axillary lymph nodes of 21 patients (53. 8%,21/39) were involved by the malignancy. (2) Histologically, 38 cases (95.0% ,38/40) were classified as B-cell lymphoma [including 27 cases ( 67. 5% ) of diffuse large B-cell lymphoma, 8 cases ( 20. 0% ) of mucosa-associated lymphoid tissue lymphoma, 2 eases of follicular lymphoma and 1 case of lymphoplasmacytic lymphoma]. The remaining cases included one case of peripheral T-cell lymphoma and one case of lymphoblastic lymphoma. Immunohistochemically, expression of CD20 +/- CD79a were demonstrated in the 38 cases ( 95.0% ) of B-cell lymphoma. The staining for CK was negative in all cases.In 33 cases, the positive rates of MUM-1, bcl-6 and bcl-2 were 57. 6% ( 19/33), 30.3% ( 10/33 ) and 72. 7% (24/33), respectively. Three cases were germinal center B cell phenotype and 21 cases were nongerminal center B cell phenotype. (3) Follow-up information was available in 37 patients(92. 5% ,37/40).Twenty-three patients(62. 2% ,23/37) were still alive and fourteen ones (37.8%, 14/37 ) died. For the 27cases with diffuse large B-cell lymphoma, the five-year and disease-free survival rates were 48.0% and 36. 0%, respectively. Conclusions Primary breast lymphoma is a rare disease entity. Diffuse large B-cell lymphoma is the commonest histologic type and the majority show a non-germinal center B cell phenotype.The level of LDH, number of tumor and international prognostic index are of prognostic significance.     

CXCL13、CD10和bcl-6在血管免疫母细胞性T细胞淋巴瘤的诊断及鉴别诊断中的作用

目的 探讨CXCL13、CD10、bcl-6等标志物在血管免疫母细胞性T细胞淋巴瘤(AITL)的诊断和鉴别诊断中的作用.方法 对四川大学华西医院病理科1990年1月至2008年1月诊断的115例AITL、30例非特指外周T细胞淋巴瘤(PTCL,NOS)和30例以副皮质区增生为主的反应性增生(RH)进行回顾性分析.按2008版WHO关于淋巴造血组织肿瘤分类进行组织学分型,采用9种抗原标志物的免疫组织化学(SP法)染色及TCR-γ基因重排检测.结果 (1)7.8%(9/115)的AITL、6.7%(2/30)的PTCL,NOS和83.3%(25/30)的RH病例观察到生发中心;98.3%(113/115)的AITL、63.3%(19/30)的FTCL,NOS和76.7%(23/30)的RH病例观察到显著血管增生.(2)CXCL13、CD10、bcl-6在RH病例的表达局限在生发中心,在AITL的表达率分别为96.5%(111/115)、50.4%(58/115)和78.3%(90/115),在PTCL,NOS的表达率分别为26.7%(8/30)、3.3%(1/30)和3.3%(1/30),以上三个标记在两种淋巴瘤的表达率差异均具有统计学意义.115例AITL病例均见到滤泡外不规则分布的CD21阳性的滤泡树突状细胞网(FDC).TCR-γ基因克隆性重排在AITL中检出率为83%(83/100).结论 AITL是一种来源于生发中心辅助性T细胞(TFH)的高度侵袭性肿瘤,CXCL13、CD10、bcl-6是AITL诊断和鉴别诊断有用标志物.