Bhattacharyya Indraneel, Chehal Hardeep K, Cohen Donald M, Al-Quran Samer Z
Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610, USA.
Head Neck Pathol. 2010 Sep;4(3):181-91. doi: 10.1007/s12105-010-0184-4. Epub 2010 Jun 9.
Primary lymphomas of the oral cavity are rare and the most frequent type is diffuse large B-cell lymphoma (DLBCL). Recently, several reports have highlighted the value of classifying DLBCL into prognostically important subgroups, namely germinal center B-cell like (GCB) and non-germinal center B-cell like (non-GCB) lymphomas based on gene expression profiles and by immunohistochemical expression of CD10, BCL6 and MUM-1. GCB lymphomas tend to exhibit a better prognosis than non-GCB lymphomas. Studies validating this classification have been done for DLBCL of the breast, CNS, testes and GI tract. Therefore we undertook this study to examine if primary oral DLBCLs reflect this trend. We identified 13 cases (age range 38-91 years) from our archives dating from 2003-09. IHC was performed using antibodies against germinal center markers (CD10, BCL6), activated B-cell markers (MUM1, BCL2) and Ki-67 (proliferation marker). Cases were sub-classified as GCB subgroup if CD10 and/or BCL6 were positive and MUM-1, was negative and as non-GCB subgroup if CD10 was negative and MUM-1 was positive. Immunoreactivity was noted in 2/13 cases for CD10, in 12/13 for BCL6, in 8/13 for MUM-1, and in 6/13 for BCL2. Therefore, 8/13 (58%) were sub-classified as non-GCB DLBCLs and 5/13 (42%) as GCB subgroup. All tumors showed frequent labeling with Ki-67 (range 40-95%). Four of the 8 patients with non-GCB subgroup succumbed to their disease, with the mean survival rate of 16 months. Two patients in this group are alive, one with no evidence of disease and another with disease. No information was available for the other 3 patients in this group. Four of the 5 patients in the GCB subgroup were alive with no evidence of disease and one patient succumbed to complications of therapy and recurrent disease after 18 months. In conclusion, our analysis shows that primary oral DLBCL predominantly belongs to the non-GCB subgroup, which tends to exhibit a poorer prognosis. These findings could allow pathologists to provide a more accurate insight into the potential aggressive behavior and poorer prognosis of these lymphomas.
口腔原发性淋巴瘤较为罕见，最常见的类型是弥漫性大B细胞淋巴瘤（DLBCL）。最近，一些报告强调了根据基因表达谱以及CD10、BCL6和MUM-1的免疫组化表达将DLBCL分为具有重要预后意义的亚组的价值，即生发中心B细胞样（GCB）和非生发中心B细胞样（非GCB）淋巴瘤。GCB淋巴瘤的预后往往比非GCB淋巴瘤更好。针对乳腺、中枢神经系统、睾丸和胃肠道的DLBCL进行了验证这种分类的研究。因此，我们开展了这项研究，以检验原发性口腔DLBCL是否反映了这一趋势。我们从2003年至2009年的存档病例中识别出13例（年龄范围38 - 91岁）。使用针对生发中心标志物（CD10、BCL6）、活化B细胞标志物（MUM1、BCL2）和Ki-67（增殖标志物）的抗体进行免疫组化检测。如果CD10和/或BCL6阳性且MUM-1阴性，则病例被分类为GCB亚组；如果CD10阴性且MUM-1阳性，则分类为非GCB亚组。13例病例中，CD10有2例呈免疫反应性，BCL6有12例，MUM-1有8例呈免疫反应性，BCL2有6例呈免疫反应性。因此，13例中有8例（58%）被分类为非GCB DLBCL，5例（42%）为GCB亚组。所有肿瘤的Ki-67标记率均较高（范围为40% - 95%）。8例非GCB亚组患者中有4例死于疾病，平均生存率为16个月。该组中有2例患者存活，1例无疾病证据，另1例仍患有疾病。该组另外3例患者的信息不详。GCB亚组的5例患者中有4例存活且无疾病证据，1例患者在18个月后死于治疗并发症和疾病复发。总之，我们的分析表明，原发性口腔DLBCL主要属于非GCB亚组，其预后往往较差。这些发现可以让病理学家更准确地了解这些淋巴瘤潜在的侵袭性和较差的预后。
