具有轻链限制的浆细胞样淋巴瘤 - 浆细胞样髓外浆细胞瘤？

Plasmablastic lymphomas with light chain restriction - plasmablastic extramedullary plasmacytomas?

机构信息

Department of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa.

出版信息

J Oral Pathol Med. 2010 May;39(5):435-9. doi: 10.1111/j.1600-0714.2009.00874.x.

DOI:10.1111/j.1600-0714.2009.00874.x

PMID:20537055

Abstract

BACKGROUND

It is diagnostically difficult to differentiate plasmablastic lymphomas (PBLs) from plasma cell neoplasms with plasmablastic differentiation. Plasmablastic lymphomas are currently classified as 'PBL of the oral mucosa' and 'PBL with plasmacytic differentiation'.

METHODS

Forty-five cases of PBL were retrieved from the Departments of Oral Pathology of the Universities of Pretoria and Limpopo, South Africa. Clinical features and HIV status were recorded and each case was classified as 'PBL of the oral mucosa type' or as 'PBL with plasmacytic differentiation'. Immunohistochemistry included: CD45, CD3, CD20, CD79a, CD38, CD138, MUM1, Ki-67 and kappa and lambda light chains. Positivity was recorded based on the percentage of positive staining cells as focal (5-20%); intermediate (20-70%) or diffuse (>70%). In situ hybridization was performed for Epstein-Barr virus (EBV) and HHV-8. Results were recorded as positive or negative.

RESULTS

All cases showed some degree of plasmacytic differentiation. All were negative for CD20 with reactive T cells detected with CD3. Diffuse and strong positive staining was found with Ki-67 and MUM1, but variable immunoreactivity was found with CD79a, CD45, CD38 and CD138. Twenty cases (47%) showed light chain restriction. Epstein-Barr virus was detected in 44/45 cases and HHV-8 in none.

CONCLUSIONS

The morphological classification of PBLs is not valid as all cases showed some degree of plasmacytic differentiation. We propose that PBLs with light chain restriction be reclassified as 'plasmablastic extramedullary plasmacytomas' and managed accordingly. The rest represents true PBLs. The true nature of these neoplasms as an entity should be further investigated with molecular and genetic studies.

摘要

背景

从诊断角度来看，浆母细胞淋巴瘤（PBL）与具有浆母细胞分化的浆细胞肿瘤难以区分。浆母细胞淋巴瘤目前被归类为“口腔黏膜 PBL”和“具有浆母细胞分化的 PBL”。

方法

从南非比勒陀利亚大学和林波波大学的口腔病理学系中检索了 45 例 PBL 病例。记录了临床特征和 HIV 状态，并将每个病例归类为“口腔黏膜型 PBL”或“具有浆母细胞分化的 PBL”。免疫组织化学包括：CD45、CD3、CD20、CD79a、CD38、CD138、MUM1、Ki-67 和κ 和 λ 轻链。阳性记录基于阳性染色细胞的百分比，分为局灶性（5-20%）、中等强度（20-70%）或弥漫性（>70%）。进行了 EBV 和 HHV-8 的原位杂交。记录结果为阳性或阴性。

结果

所有病例均显示出一定程度的浆细胞分化。所有病例均为 CD20 阴性，用 CD3 检测到反应性 T 细胞。Ki-67 和 MUM1 呈弥漫性强阳性染色，但 CD79a、CD45、CD38 和 CD138 的免疫反应性存在差异。20 例（47%）显示轻链限制。45 例中有 44 例检测到 EBV，无一例检测到 HHV-8。