Feldman Andrew L, Arber Daniel A, Pittaluga Stefania, Martinez Antonio, Burke Jerome S, Raffeld Mark, Camos Mireia, Warnke Roger, Jaffe Elaine S
Laboratory of Pathology, National Cancer Institute, Bethesda, MD 20892-1500, USA.
Blood. 2008 Jun 15;111(12):5433-9. doi: 10.1182/blood-2007-11-124792. Epub 2008 Feb 13.
Rare cases of histiocytic and dendritic cell (H/DC) neoplasms have been reported in patients with follicular lymphoma (FL), but the biologic relationship between the 2 neoplasms is unknown. We studied 8 patients with both FL and H/DC neoplasms using immunohistochemistry, fluorescence in situ hybridization (FISH) for t(14;18), and polymerase chain reaction (PCR)/sequencing of BCL2 and IGH rearrangements. There were 5 men and 3 women (median age, 59 years). All cases of FL were positive for t(14;18). The H/DC tumors included 7 histiocytic sarcomas, 5 of which showed evidence of dendritic differentiation, and 1 interdigitating cell sarcoma. Five H/DC tumors were metachronous, following FL by 2 months to 12 years; tumors were synchronous in 3. All 8 H/DC tumors showed presence of the t(14;18) either by FISH, or in 2 cases by PCR with the major breakpoint region (MBR) probe. PCR and sequencing identified identical IGH gene rearrangements or BCL2 gene breakpoints in all patients tested. All H/DC tumors lacked PAX5, and up-regulation of CEBPbeta and PU.1 was seen in all cases tested. These results provide evidence for a common clonal origin of FL and H/DC neoplasms when occurring in the same patient, and suggest that lineage plasticity may occur in mature lymphoid neoplasms.
滤泡性淋巴瘤（FL）患者中曾有组织细胞和树突状细胞（H/DC）肿瘤的罕见病例报道，但这两种肿瘤之间的生物学关系尚不清楚。我们使用免疫组织化学、针对t(14;18)的荧光原位杂交（FISH）以及BCL2和IGH重排的聚合酶链反应（PCR）/测序，对8例同时患有FL和H/DC肿瘤的患者进行了研究。患者中有5名男性和3名女性（中位年龄59岁）。所有FL病例的t(14;18)均呈阳性。H/DC肿瘤包括7例组织细胞肉瘤，其中5例显示有树突状分化的证据，以及1例交错突细胞肉瘤。5例H/DC肿瘤为异时性，在FL之后2个月至12年出现；3例为同时性。所有8例H/DC肿瘤通过FISH检测均显示存在t(14;18)，2例通过使用主要断裂点区域（MBR）探针的PCR检测显示存在t(14;18)。PCR和测序在所有检测患者中均鉴定出相同的IGH基因重排或BCL2基因断点。所有H/DC肿瘤均缺乏PAX5，在所有检测病例中均可见CEBPβ和PU.1上调。这些结果为FL和H/DC肿瘤在同一患者中发生时的共同克隆起源提供了证据，并表明成熟淋巴肿瘤中可能发生谱系可塑性。
