Shiozawa Eisuke, Yamochi-Onizuka Toshiko, Yamochi Tadanori, Yamamoto Yutsuki, Naitoh Hideki, Kawakami Keiichiro, Nakamaki Tsuyoshi, Tomoyasu Shigeru, Kushima Miki, Ota Hidekazu
2nd Department of Pathology, School of Medicine, Showa University, Tokyo, Japan.
Pathol Res Pract. 2003;199(5):293-302. doi: 10.1078/0344-0338-00421.
Some follicular lymphomas histologically transform into diffuse aggressive lymphomas, the prognosis of which is poor. There are, however, no reliable histological criteria for predicting which cases will later undergo such transformation. In low-grade B-cell lymphomas, follicular dendritic cells form dense mesh-like networks that contain accumulating neoplastic B-cells. These are rare in high-grade lymphomas. We immunohistochemically analyzed CD21-positive follicular dendritic cells in 32 follicular lymphomas, including 3 transformed lymphomas, in addition to immunohistological study using P-glycoprotein, p53, and Ki-67. We found that the mesh-like networks in follicles are more clearly defined in low-grade lymphomas than in high-grade lymphomas (p = 0.015). Neoplastic follicles in 2 transformed lymphomas lost the networks of follicular dendritic cells before transformation despite the existence of morphologically clear follicles. This differed from the non-transformed cases of the same cytological grades. Prognosis was statistically better for patients with low-grade tumor than for those with high-grade tumor (p = 0.026), and there was a trend toward poorer survival among CD21-negative cases (p = 0.186). P-glycoprotein, p53, and Ki-67 expressions did not provide sufficient information to predict the transformation of follicular lymphoma. The presence of CD21-positive follicular dendritic cells in neoplastic follicles might help predict the potential of follicular lymphoma to transform to diffuse large B-cell lymphoma.
一些滤泡性淋巴瘤在组织学上会转变为弥漫性侵袭性淋巴瘤，其预后较差。然而，目前尚无可靠的组织学标准来预测哪些病例会发生这种转变。在低级别B细胞淋巴瘤中，滤泡树突状细胞形成密集的网状结构，其中包含聚集的肿瘤性B细胞。这些在高级别淋巴瘤中很少见。我们对32例滤泡性淋巴瘤进行了免疫组化分析，检测CD21阳性滤泡树突状细胞，其中包括3例转化性淋巴瘤，此外还使用P糖蛋白、p53和Ki-67进行了免疫组织学研究。我们发现，低级别淋巴瘤中滤泡内的网状结构比高级别淋巴瘤中更清晰（p = 0.015）。2例转化性淋巴瘤的肿瘤滤泡在转化前失去了滤泡树突状细胞网络，尽管形态上滤泡清晰。这与相同细胞学分级的未转化病例不同。低级别肿瘤患者的预后在统计学上优于高级别肿瘤患者（p = 0.026），并且CD21阴性病例有生存较差的趋势（p = 0.186）。P糖蛋白、p53和Ki-67的表达未能提供足够信息来预测滤泡性淋巴瘤的转化。肿瘤滤泡中CD21阳性滤泡树突状细胞的存在可能有助于预测滤泡性淋巴瘤转化为弥漫性大B细胞淋巴瘤的可能性。
