Gualco Gabriela, Weiss Lawrence M, Bacchi Carlos E
Consultoria em Patologia, 18602-010 Botucatu, Sao Paulo, Brazil.
Hum Pathol. 2008 Oct;39(10):1505-10. doi: 10.1016/j.humpath.2008.02.016. Epub 2008 Jul 11.
Immunohistochemical determination of p63 protein is frequently used in the pathologic diagnosis of nonhematological solid tumors. In malignant hematological disease, p63 expression has been reported in 22% of follicular lymphoma, about 35% of diffuse large B-cell lymphoma, 23% of chronic lymphocytic leukemia, and in some cases of blast crisis of chronic myelogenous leukemia. Anaplastic large cell lymphoma is a rare disease that accounts for less than 5% of all cases of non-Hodgkin's lymphoma. There is little information concerning p63 expression in this specific type of lymphoma. In some cases, the morphological and phenotypic features between anaplastic large cell lymphoma and classical Hodgkin's lymphoma are similar, making this differential diagnosis challenging. We studied p63 expression using a tissue microarray approach in 154 cases of anaplastic large cell lymphoma, including 38% anaplastic large cell kinase positive and 62% anaplastic large cell kinase negative, and 58 Hodgkin's lymphoma cases. Sixty-eight cases of anaplastic large cell lymphoma (44%) showed p63 nuclear positivity (41% of anaplastic large cell kinase positive and 47% of anaplastic large cell kinase negative). Of 130 cases of systemic-anaplastic large cell lymphoma, 42% showed p63 positivity. The neoplastic cells expressed p63 in 38% of the cases of CD45-negative/anaplastic large cell kinase-negative null cell-type anaplastic large cell lymphoma, a subgroup that offers the most difficulties in the differential diagnosis with classical Hodgkin's lymphoma. In contrast, none of the cases of classical Hodgkin's lymphoma demonstrated any p63 expression. These results demonstrate that p63 protein expression is frequently expressed in a subset of anaplastic large cell lymphoma cases and may be used as a potential tool in the differential diagnosis between anaplastic large cell lymphoma and classical Hodgkin's lymphoma.
p63蛋白的免疫组织化学测定常用于非血液系统实体瘤的病理诊断。在恶性血液病中,据报道22%的滤泡性淋巴瘤、约35%的弥漫性大B细胞淋巴瘤、23%的慢性淋巴细胞白血病以及部分慢性粒细胞白血病急变期病例中存在p63表达。间变性大细胞淋巴瘤是一种罕见疾病,占所有非霍奇金淋巴瘤病例的比例不到5%。关于这种特定类型淋巴瘤中p63表达的信息很少。在某些情况下,间变性大细胞淋巴瘤与经典霍奇金淋巴瘤之间的形态学和表型特征相似,这使得鉴别诊断具有挑战性。我们采用组织芯片方法研究了154例间变性大细胞淋巴瘤(其中38%为间变性大细胞激酶阳性,62%为间变性大细胞激酶阴性)以及58例霍奇金淋巴瘤病例中的p63表达情况。68例间变性大细胞淋巴瘤(44%)显示p63核阳性(间变性大细胞激酶阳性病例中占41%,间变性大细胞激酶阴性病例中占47%)。在130例系统性间变性大细胞淋巴瘤中,42%显示p63阳性。在CD45阴性/间变性大细胞激酶阴性空细胞型间变性大细胞淋巴瘤(该亚组在与经典霍奇金淋巴瘤的鉴别诊断中最具困难)的病例中,38%的肿瘤细胞表达p63。相比之下,经典霍奇金淋巴瘤病例均未显示任何p63表达。这些结果表明,p63蛋白表达在部分间变性大细胞淋巴瘤病例中经常出现,可作为间变性大细胞淋巴瘤与经典霍奇金淋巴瘤鉴别诊断的潜在工具。