在临床发现、组织学和免疫组织化学背景下，分子诊断在原发性皮肤 B 细胞淋巴瘤中的价值。

The value of molecular diagnostics in primary cutaneous B-cell lymphomas in the context of clinical findings, histology, and immunohistochemistry.

机构信息

Department of Dermatology, University Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.

出版信息

J Am Acad Dermatol. 2011 Jan;64(1):135-43, 143.e1-4. doi: 10.1016/j.jaad.2009.12.062.

DOI:10.1016/j.jaad.2009.12.062

PMID:21167409

Abstract

BACKGROUND

Primary cutaneous B-cell lymphoma (PCBCL) is classified into 3 major subtypes: primary cutaneous follicle center lymphoma (PCFCL); primary cutaneous marginal zone B-cell lymphoma (PCMZL); and primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT). Diagnosis of PCBCL is mainly based on clinical and (immuno)-histochemical grounds.

OBJECTIVE

We investigated the diagnostic value of the BIOMED-2 Concerted Action BMH4 CT98-3936 protocol in PCBCL.

METHODS

We analyzed with the BIOMED-2 Concerted Action BMH4 CT98-3936 protocol skin specimens from patients with well-defined clinical and (immuno)-histologic PCBCL (n = 18) in comparison with benign lymphocytic infiltrates (n = 9). For molecular staging we also investigated 13 extracutaneous samples from 6 patients with PCLBCL, LT. Each sample was investigated at least twice.

RESULTS

Monoclonality was detected in all of 5 PCFCL; 5 of 6 PCMZL; all of 6 PCLBCL, LT; and 2 of 9 benign lymphocytic infiltrates. In 5 of 6 patients with PCLBCL, LT, a clone corresponding to the clone detected in the skin was detected in 3 of 5 bone-marrow, 4 of 5 blood, and 1 of 3 lymph node specimens. DNA amplification using tubes A and B of IgH was not possible in PCFCL/PCMZL, benign lymphocytic infiltrates, and extracutaneous specimens of PCLBCL, LT, even after repeated analysis up to 11 times. Pseudomonoclonality was identified by repeated analyses in one case of PCMZL and in one case of benign lymphocytic infiltrate.

LIMITATIONS

A multicentric, randomized, blinded study is necessary to confirm our results.

CONCLUSION

Molecular diagnosis supports the clinical and (immuno)-histologic diagnosis in PCBCL. In PCLBCL, LT, molecular staging may be useful. Tubes C through E of IgH and Igκ analyses seem to be superior to tubes A and B of IgH. Each sample should be analyzed at least twice to assess the possibility of pseudomonoclonality.

摘要

背景

原发性皮肤 B 细胞淋巴瘤（PCBCL）分为 3 个主要亚型：原发性皮肤滤泡中心淋巴瘤（PCFCL）；原发性皮肤边缘区 B 细胞淋巴瘤（PCMZL）；原发性皮肤弥漫性大 B 细胞淋巴瘤，腿型（PCLBCL，LT）。PCBCL 的诊断主要基于临床和（免疫）组织化学依据。

目的

我们研究了 BIOMED-2 协同行动 BMH4 CT98-3936 方案在 PCBCL 中的诊断价值。

方法

我们使用 BIOMED-2 协同行动 BMH4 CT98-3936 方案分析了 18 例具有明确临床和（免疫）组织学特征的 PCBCL 患者的皮肤标本，并与 9 例良性淋巴细胞浸润进行了比较。为了进行分子分期，我们还研究了 6 例 PCLBCL，LT 患者的 13 份皮肤外样本。每个样本至少分析两次。

结果

在所有 5 例 PCFCL、6 例 PCMZL、6 例 PCLBCL，LT 中均检测到单克隆性，在 9 例良性淋巴细胞浸润中 5 例检测到单克隆性。在 6 例 PCLBCL，LT 患者中，有 5 例患者的骨髓、5 例患者的血液和 3 例患者的淋巴结标本中均检测到与皮肤中检测到的克隆相对应的克隆。即使重复分析多达 11 次，也无法在 PCFCL/PCMZL、良性淋巴细胞浸润和 PCLBCL，LT 的皮肤外标本中使用 IgH 的管 A 和管 B 进行 DNA 扩增。在 1 例 PCMZL 和 1 例良性淋巴细胞浸润中通过重复分析确定了假性单克隆性。