Raess Philipp W, Moore Stephen R, Cascio Michael J, Dunlap Jennifer, Fan Guang, Gatter Ken, Olson Susan B, Braziel Rita M
a Department of Pathology , Oregon Health & Science University , Portland , OR , USA.
b Knight Diagnostic Laboratories, Department of Molecular and Medical Genetics , Oregon Health & Science University , Portland , OR , USA.
Leuk Lymphoma. 2018 Jun;59(6):1391-1398. doi: 10.1080/10428194.2017.1370547. Epub 2017 Sep 3.
Accurate subclassification of aggressive B cell lymphomas (ABCLs) requires integration of morphologic, immunohistochemical (IHC), and cytogenetic information. Optimal strategies have not been well defined for diagnosis of high grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBLwR) and double expressor lymphomas with MYC and BCL2 protein overexpression. One hundred and eighty seven ABCLs were investigated with complete IHC and FISH analysis. Morphologic and IHC analysis was insufficient to identify clinically relevant HGBLwR. Approximately, 75% of cases classified as HGBLwR showed conventional DLBCL morphologic features. Fourteen percent of MYC-rearranged cases were negative by IHC. Conversely, 60% of cases positive for MYC by IHC did not demonstrate a MYC rearrangement. Analysis by FISH without MYC and BCL2 IHC would miss 41 cases of double expressor lymphoma. Complete IHC and FISH analysis is recommended in the evaluation of all ABCLs.
侵袭性B细胞淋巴瘤（ABCLs）的准确亚分类需要整合形态学、免疫组织化学（IHC）和细胞遗传学信息。对于伴有MYC和BCL2和/或BCL6重排的高级别B细胞淋巴瘤（HGBLwR）以及伴有MYC和BCL2蛋白过表达的双表达淋巴瘤的诊断，最佳策略尚未明确界定。对187例ABCLs进行了完整的免疫组织化学和荧光原位杂交（FISH）分析。形态学和免疫组织化学分析不足以识别具有临床相关性的HGBLwR。大约75%被归类为HGBLwR的病例表现出传统弥漫性大B细胞淋巴瘤（DLBCL）的形态学特征。14%的MYC重排病例免疫组织化学检测为阴性。相反，6例免疫组织化学检测MYC呈阳性的病例未显示MYC重排。在没有MYC和BCL2免疫组织化学检测的情况下进行FISH分析会遗漏41例双表达淋巴瘤病例。在评估所有ABCLs时，建议进行完整的免疫组织化学和FISH分析。
