Gualco Gabriela, Weiss Lawrence M, Barber Glen N, Bacchi Carlos E
Consultoria em Patologia, Botucatu, São Paulo, Brazil.
Int J Surg Pathol. 2011 Feb;19(1):44-50. doi: 10.1177/1066896910386476. Epub 2010 Nov 17.
Lymphomas involving the central nervous system are recognized increasingly in immunocompetent as well as immunosuppressed individuals, and the majority of the cases are diffuse large B-cell lymphoma (DLBCL). The aim of this study was to compare the immunophenotype, clinicopathological features, and association with Epstein-Barr virus (EBV) of DLBCL of the central nervous system (CNS) in 3 different clinical situations: primary, in immunocompetent patients; "primary," in immunosuppressed patients; and in patients with secondary involvement by systemic lymphoma. The authors reviewed the clinicopathological features, morphology, immunophenotype (according to germinal-center B-cell-like and nongerminal B-cell-like subtypes), and association with EBV in 36 cases of DLBCL of the CNS, including 25 primary cases, 5 associated with immunosuppression, and 6 cases with secondary involvement. Survival was evaluated in 15 cases of primary CNS lymphomas. Of the 36 patients, 19 were male and 18 female. Only 2 cases of lymphomas were EBV-positive; both occurred in immunosuppressed patients. Separation into germinal-center and non-germinal center subtypes by an immunohistochemistry panel showed that 68% of primary, 80% of secondary, and 83% of the cases associated with immunosuppression were of non-germinal-center subtype, respectively. Patients with non-germinal-center immunophenotype showed significantly worse survival than those with CNS lymphomas of the germinal-center subtype.
中枢神经系统淋巴瘤在免疫功能正常以及免疫抑制的个体中越来越多地被发现，并且大多数病例为弥漫性大B细胞淋巴瘤（DLBCL）。本研究的目的是比较3种不同临床情况下中枢神经系统（CNS）DLBCL的免疫表型、临床病理特征以及与EB病毒（EBV）的相关性：免疫功能正常患者的原发性DLBCL；免疫抑制患者的“原发性”DLBCL；以及系统性淋巴瘤继发性累及的患者。作者回顾了36例CNS DLBCL的临床病理特征、形态学、免疫表型（根据生发中心B细胞样和非生发中心B细胞样亚型）以及与EBV的相关性，其中包括25例原发性病例、5例与免疫抑制相关的病例以及6例继发性累及的病例。对15例原发性CNS淋巴瘤患者的生存情况进行了评估。36例患者中，19例为男性，18例为女性。仅2例淋巴瘤为EBV阳性；均发生在免疫抑制患者中。通过免疫组化检测将病例分为生发中心和非生发中心亚型，结果显示原发性病例中68%、继发性病例中80%以及与免疫抑制相关病例中83%分别为非生发中心亚型。非生发中心免疫表型的患者生存率明显低于生发中心亚型的CNS淋巴瘤患者。
