Takeshita M, Iwashita A, Kurihara K, Ikejiri K, Higashi H, Udoh T, Kikuchi M
Department of Pathology, Clinical Laboratory, National Kyushu Medical Center Hospital, Fukuoka, Japan.
Am J Surg Pathol. 2000 Dec;24(12):1641-9. doi: 10.1097/00000478-200012000-00008.
It has been considered that gastric large B cell lymphoma mainly consists of mucosa-associated lymphoid tissue lymphoma (MALToma) with large cell transformation. However, debate continues about the cell lineage. We analyzed 61 operated cases of gastric B cell lymphoma, mainly focusing on 40 cases of diffuse large cell lymphoma (DLCL). Immunohistologically, two cases were classified as CD10-positive follicular lymphoma, 19 cases were low-grade MALToma, 11 CD10-negative DLCL with a component of low-grade MALToma (high-grade MALToma), 12 CD10-positive DLCL, and 17 CD10-negative DLCL without MALToma (pure DLCL). Lymphoepithelial lesion (LEL) was found in all -cases of high-grade MALToma, and in eight of these its invasion was confined to the mucosa and submucosa. Expression of Bcl-6 was detected in two cases of high-grade MALToma. Only two cases of CD10-positive DLCL had large cell LEL, and seven cases showed tumor invasion beyond the submucosa. All 12 cases were positive for Bcl-6, and a delicate meshwork of CD35 (Ber-MAC-DRC)-positive follicular dendritic cells was detected in eight cases. Pure DLCL of all 17 cases reached the proper muscle layer or more, and expression of Bcl-6 was detected in 10 cases. For patients with pure DLCL, overall survival was significantly (p <0.05) worse than those of high-grade MALToma and CD10-positive DLCL by Kaplan-Meier and log-rank methods. Clinical staging and Bcl-6 expression were also good prognostic factors in patients with DLCL. Three groups of gastric DLCL each had unique histologic findings, immunohistologic characteristics, and prognosis.
一直以来，人们认为胃大B细胞淋巴瘤主要由伴有大细胞转化的黏膜相关淋巴组织淋巴瘤（MALToma）组成。然而，关于细胞谱系的争论仍在继续。我们分析了61例接受手术治疗的胃B细胞淋巴瘤病例，主要集中于40例弥漫性大细胞淋巴瘤（DLCL）。免疫组织学上，2例被分类为CD10阳性滤泡性淋巴瘤，19例为低级别MALToma，11例为伴有低级别MALToma成分的CD10阴性DLCL（高级别MALToma），12例为CD10阳性DLCL，17例为无MALToma成分的CD10阴性DLCL（纯DLCL）。在所有高级别MALToma病例中均发现淋巴上皮病变（LEL），其中8例其浸润局限于黏膜和黏膜下层。在2例高级别MALToma中检测到Bcl-6表达。仅2例CD10阳性DLCL有大细胞LEL，7例显示肿瘤浸润超出黏膜下层。所有12例均为Bcl-6阳性，8例检测到CD35（Ber-MAC-DRC）阳性滤泡树突状细胞的精细网状结构。所有17例纯DLCL均累及固有肌层或更深层，10例检测到Bcl-6表达。对于纯DLCL患者，通过Kaplan-Meier和对数秩检验方法，其总生存期显著（p<0.05）差于高级别MALToma和CD10阳性DLCL患者。临床分期和Bcl-6表达也是DLCL患者的良好预后因素。胃DLCL的三组各有独特的组织学表现、免疫组织学特征和预后。
