Tóth Erika, Schneider Tamás, Melegh Zsombor, Csernák Erzsébet, Udvarhelyi Nóra, Rosta András, Szentirmay Zoltán
Molekuláris Patológiai Osztály, Országos Onkológiai Intézet, Budapest 1122, Hungary.
Magy Onkol. 2005;49(2):135-40. Epub 2005 Oct 24.
In the Western world the second most common type of non-Hodgkin's lymphomas is follicular lymphoma (FL) comprising 30-35% of all cases. According to the data of the National Cancer Registry and our institute, this ratio is lower in Hungary and is about 15-20%, but the occurrence shows an increasing tendency.
Our aim was to survey and revise FLs that had been diagnosed at the National Institute of Oncology between 1990-1995. We studied the diagnostic relevance of histology, immunohistochemistry and the detection of immunoglobulin heavy chain (IgH) and bcl-2 gene rearrangements.
We surveyed 53 cases that were previously diagnosed as follicular or centrocytic, centroblastic lymphoma. Following histological re-examination, immunohistochemistry (CD20, CD3, bcl-2, CD10, bcl-6, CD5, p53, cyclin D1 and Ki-67) was performed on each case. We also studied the IgH and bcl-2 (major breakpoint region=MBR) gene rearrangement on paraffin embedded samples with conventional PCR methods. The classification was made according to the new WHO classification.
After the revision of the 53 cases we found 37 follicular, 11 diffuse large B-cell, 1 mantle cell and 1 marginal zone lymphomas, 1 nodular lymphocyte predominant Hodgkin's lymphoma and 2 follicular hyperplasias. The grade of the FLs correlated with the expression of different antigens. CD10, bcl-2 expression and the proliferation index with Ki-67 showed good correlation with the grade of FLs. We could detect bcl-2 gene rearrangement in 55% of the FLs.
Considering the diagnostic relevance of the different methods we can conclude that histology alone is not sufficient to make a correct diagnosis. Ninety percent of our cases were solvable with the help of immunohistochemistry and in 10% of the cases the diagnosis was partly based on the molecular pathological results.
在西方世界，非霍奇金淋巴瘤的第二大常见类型是滤泡性淋巴瘤（FL），占所有病例的30 - 35%。根据国家癌症登记处和我们研究所的数据，匈牙利的这一比例较低，约为15 - 20%，但发病率呈上升趋势。
我们的目的是调查和修订1990 - 1995年间在国家肿瘤研究所诊断的滤泡性淋巴瘤。我们研究了组织学、免疫组织化学以及免疫球蛋白重链（IgH）和bcl - 2基因重排检测的诊断相关性。
我们调查了53例先前诊断为滤泡性或中心细胞性、中心母细胞性淋巴瘤的病例。在进行组织学重新检查后，对每个病例进行了免疫组织化学检测（CD20、CD3、bcl - 2、CD10、bcl - 6、CD5、p53、细胞周期蛋白D1和Ki - 67）。我们还采用常规PCR方法研究了石蜡包埋样本中的IgH和bcl - 2（主要断裂区域=MBR）基因重排。分类依据新的世界卫生组织分类标准。
在对这53例病例进行修订后，我们发现37例滤泡性淋巴瘤、11例弥漫性大B细胞淋巴瘤、1例套细胞淋巴瘤和1例边缘区淋巴瘤、1例结节性淋巴细胞为主型霍奇金淋巴瘤以及2例滤泡增生。滤泡性淋巴瘤的分级与不同抗原的表达相关。CD10、bcl - 2表达以及Ki - 67增殖指数与滤泡性淋巴瘤的分级显示出良好的相关性。我们在55%的滤泡性淋巴瘤中检测到bcl - 2基因重排。
考虑到不同方法的诊断相关性，我们可以得出结论，仅靠组织学不足以做出正确诊断。我们90%的病例借助免疫组织化学得以解决，10%的病例诊断部分基于分子病理学结果。
