在活化 B 细胞型弥漫性大 B 细胞淋巴瘤患者的骨髓中，存在低水平的单克隆小 B 细胞，但在生发中心 B 细胞型弥漫性大 B 细胞淋巴瘤患者的骨髓中不存在。

Low levels of monoclonal small B cells in the bone marrow of patients with diffuse large B-cell lymphoma of activated B-cell type but not of germinal center B-cell type.

机构信息

Department of Pathology, The Norwegian Radium Hospital and University of Oslo, Montebello, N-0310 Oslo, Norway.

出版信息

Haematologica. 2010 Aug;95(8):1334-41. doi: 10.3324/haematol.2009.014100. Epub 2010 Feb 9.

DOI:10.3324/haematol.2009.014100

PMID:20145271

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2913082/

Abstract

BACKGROUND

Multiparameter flow cytometry allows the detection of minor monoclonal B-cell populations. Using this technique combined with morphology, we were struck by the presence of minor populations of small monoclonal B cells in bone marrows of patients with diffuse large B-cell lymphoma in routine diagnostic samples and performed a systematic retrospective study.

DESIGN AND METHODS

Bone marrows of 165 patients with primary diffuse large B-cell lymphoma without histological evidence of concurrent non-Hodgkin's lymphoma were studied by routine microscopy of trephines and smears, immunohistochemistry and multiparameter flow cytometry.

RESULTS

Diffuse large B-cell lymphoma infiltration in marrows was documented in 11 of 165 patients. Morphological examination consistently revealed a higher tumor load than evidenced by flow cytometry. Of interest, only 3 of 119 patients with diffuse large B-cell lymphoma not otherwise specified, the largest subtype, showed marrow infiltration. By contrast, flow cytometry revealed a minor monoclonal B-cell population in 24 of 165 patients, none of whom showed diffuse large B-cell lymphoma infiltration by morphology. Of interest, morphological examination revealed the presence of small B cells in the marrows of those patients. Moreover, 11 of 39 (28.2%) of patients with diffuse large B-cell lymphoma not otherwise specified of ABC subtype and only 3 of 80 (3.7%) with the GCB subtype showed these monoclonal small B cells (P=0.0002). In addition 4 of 8 (50%), 4 of 15 (26.7%) and 2 of 3 (66.7%) patients with primary testicular, primary central nervous system and leg-type diffuse large B-cell lymphoma, respectively, showed monoclonal small B cells.

CONCLUSIONS

Bone marrow infiltration with diffuse large B-cell lymphoma in patients with diffuse large B-cell lymphoma not otherwise specified is rare at diagnosis. By contrast, a high number of diffuse large B-cell lymphoma not otherwise specified of the ABC subtype but not of GCB subtype is associated with monoclonal small B cells in the marrow. Whether these monoclonal small B cells are precursors of diffuse large B-cell lymphoma of the ABC type or arise in a common background that favors clonal B-cell expansion remains to be demonstrated.

摘要

背景

多参数流式细胞术可检测到较小的单克隆 B 细胞群体。我们使用该技术结合形态学，在常规诊断样本中发现弥漫性大 B 细胞淋巴瘤患者的骨髓中存在较小的单克隆 B 细胞亚群，因此进行了一项系统的回顾性研究。

设计和方法

对 165 例无组织学证据合并非霍奇金淋巴瘤的原发性弥漫性大 B 细胞淋巴瘤患者的骨髓进行研究，方法包括常规钻取和涂片显微镜检查、免疫组织化学和多参数流式细胞术。

结果

165 例患者中，有 11 例骨髓中有弥漫性大 B 细胞淋巴瘤浸润。形态学检查始终显示肿瘤负荷高于流式细胞术的检测结果。有趣的是，最大的亚型——弥漫性大 B 细胞淋巴瘤非特指型中，仅 3 例患者骨髓中有浸润。相比之下，流式细胞术显示 24 例患者中有较小的单克隆 B 细胞群，其中无一例患者的形态学检查显示弥漫性大 B 细胞淋巴瘤浸润。有趣的是，形态学检查显示这些患者的骨髓中有小 B 细胞。此外，11 例 ABC 亚型弥漫性大 B 细胞淋巴瘤非特指型患者和仅 3 例 GCB 亚型患者中存在这些单克隆小 B 细胞（P=0.0002）。此外，原发性睾丸、原发性中枢神经系统和腿部弥漫性大 B 细胞淋巴瘤患者中，分别有 4 例（50%）、4 例（26.7%）和 2 例（66.7%）存在单克隆小 B 细胞。

结论

弥漫性大 B 细胞淋巴瘤非特指型患者在诊断时骨髓弥漫性大 B 细胞淋巴瘤浸润罕见。相比之下，ABC 亚型而非 GCB 亚型的弥漫性大 B 细胞淋巴瘤非特指型患者中有大量弥漫性大 B 细胞淋巴瘤与骨髓中单克隆小 B 细胞有关。这些单克隆小 B 细胞是否为 ABC 型弥漫性大 B 细胞淋巴瘤的前体，还是在有利于克隆性 B 细胞扩增的共同背景下出现，尚待证实。