Plaza Jose A, Kacerovska Denisa, Sangueza Martin, Schieke Stefan, Buonaccorsi Noelle, Suster Saul, Kazakov Dmitry V
*Department of Pathology, Division of Dermatopathology, The Medical College of Wisconsin, Milwaukee, WI; †Sikl's Department of Pathology, Pilsen, Czech Republic; ‡Department of Pathology and Dermatology, Hospital Obrero, La Paz, Bolivia; and §Department of Dermatology, The Medical College of Wisconsin, Milwaukee, WI.
Am J Dermatopathol. 2014 Jun;36(6):478-82. doi: 10.1097/DAD.0000000000000009.
Low-grade B-cell lymphomas of the skin, especially, primary cutaneous follicle center cell lymphoma has several distinctive features when compared with nodal/systemic follicular lymphomas, as they are frequently negative for bcl-2 and CD10, and only fewer than 25% of the cases show a bcl-2 rearrangement. The risk of transformation of a cutaneous low-grade B-cell lymphoma, such as primary cutaneous follicle center cell lymphoma, to primary cutaneous diffuse large B-cell lymphomas (PCDLBCL) has not been clearly delineated in the literature. Transformation of systemic/nodal follicular lymphoma into aggressive DLBCL is associated with rapid disease progression, refractoriness to treatment, and poor prognosis. The authors studied 82 cases of primary cutaneous DLBCL using antibodies for follicular dendritic cells (FDCs), CD21, and CD35 to detect networks of FDCs that could possibly indicate transformation of preexisting low-grade B-cell lymphoma to PCDLBCL. All cases were classified as PCDLBCL using strict histologic and immunophenotypic criteria. Fifty-three cases were classified as primary cutaneous DLBCL of "leg type," and 29 cases were classified as primary cutaneous DLBCL, "NOS" category. Immunohistochemical studies were performed in all 82 cases; in 15 cases, a CD21/CD35+ network of FDCs was noted within the tumor, indicating the presence of remnants of residual germinal centers, suggesting the possibility of a transformed low-grade B-cell lymphoma. In summary, the authors' findings seem to indicate that some cases of primary cutaneous DLBCL may result from transformation of a low-grade B-cell lymphoma. Further studies are necessary to evaluate the significance of their findings by using ancillary techniques including genetic analysis.
皮肤低度B细胞淋巴瘤，尤其是原发性皮肤滤泡中心细胞淋巴瘤，与淋巴结/系统性滤泡性淋巴瘤相比有几个显著特征，因为它们bcl-2和CD10常为阴性，且只有不到25%的病例显示bcl-2重排。皮肤低度B细胞淋巴瘤，如原发性皮肤滤泡中心细胞淋巴瘤，转化为原发性皮肤弥漫性大B细胞淋巴瘤（PCDLBCL）的风险在文献中尚未明确界定。系统性/淋巴结滤泡性淋巴瘤转化为侵袭性弥漫性大B细胞淋巴瘤与疾病快速进展、治疗难治性及预后不良相关。作者使用针对滤泡树突状细胞（FDC）、CD21和CD35的抗体研究了82例原发性皮肤弥漫性大B细胞淋巴瘤，以检测可能表明先前存在的低度B细胞淋巴瘤转化为PCDLBCL的FDC网络。所有病例均根据严格的组织学和免疫表型标准分类为PCDLBCL。53例被分类为“腿部型”原发性皮肤弥漫性大B细胞淋巴瘤，29例被分类为原发性皮肤弥漫性大B细胞淋巴瘤，“未另行分类”类别。对所有82例病例进行了免疫组织化学研究；15例在肿瘤内发现了CD21/CD35+FDC网络，表明存在残留生发中心残余，提示低度B细胞淋巴瘤转化的可能性。总之，作者的研究结果似乎表明，一些原发性皮肤弥漫性大B细胞淋巴瘤病例可能由低度B细胞淋巴瘤转化而来。需要进一步研究以通过使用包括基因分析在内的辅助技术来评估其研究结果的意义。
