Mou Kun, Shi Ming-Liang, Yang Fu-Li, Wu Xi-Feng, Guo Xiao-Qing, Qi Jiu-De
Department of Oncology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan 271199, Shandong Province, China.
Department of Hematology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan 271199, Shandong Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Apr;29(2):508-514. doi: 10.19746/j.cnki.issn.1009-2137.2021.02.031.
To investigate the clinicopathological features of intestinal diffuse large B-cell lymphoma (DLBCL).
The clinical features, pathological morphology, immunophenotype, and EBER in situ hybridization of 136 DLBCL patients diagnosed in Jinan People's Hospital Affiliated to Shandong First Medical University from January 2007 to October 2014 were analyzed retrospectively. A total of 136 DLBCL samples were obtained, the DLBCL sites were categorized as: duodenum (n=23), ileocecal region (n=63), other small intestine (n=29), rectum (n=7), and other large intestine (n=14). Survival curves for the DLBCL patients were plotted using the Kaplan-Meier method and judged by the Log-rank test.
Patients with DLBCL of the ileocecal region and other small intestine except duodenum were mainly male (P=0.042), and had a higher proportion of limited-stage tumors(P=0.015), and lower International Prognostic Index (IPI) (P=0.001). Patients with DLBCL of ileocecal region had higher incidence of lactate dehydrogenase elevation (P=0.007), and higher incidence of intestinal obstruction or perforation (P<0.001) than those with DLBCL of other regions. The 5-year overall survival and 5-year progression-free survival of patients with DLBCL in ileocecal and other small intestine sites were higher than those in other sites, but the differences were not statistically significant (P=0.135, 0.459). Fifty percent of intestinal DLBCL were germinal center B cell-like (GCB) subtypes. A low-grade B-cell lymphoma was found in 21% of 136 tumor samples. In ileocecal and other small intestinal specimens, the proportion of low-grade B-cell lymphoma was 29%, and the difference was statistically significant(P=0.025). About 16% of 136 DLBCL samples expressed follicular lymphoma while no mucosa-associated lymphoid tissue lymphoma . The Epstein-Barr virus-encoded RNA-1 (EBER1) positive rate of duodenal DLBCL was significantly higher than that of other sites (5/23, 22% vs 2/63, 3%, P=0.001).
The intestinal DLBCL is commonly observed in male, and ileocecal is the most primary site. Patients with DLBCL of the ileocecal region and small intestine except duodenum have low IPI, high proportion of limited-stage tumors, low level of lactate dehydrogenase, high incidence of intestinal obstruction or perforation, and low incidence of inert lymphoma. The EBER1 positive rate of DLBCL in duodenal is higher.
探讨肠道弥漫性大B细胞淋巴瘤（DLBCL）的临床病理特征。
回顾性分析2007年1月至2014年10月在山东第一医科大学附属济南人民医院确诊的136例DLBCL患者的临床特征、病理形态、免疫表型及EBER原位杂交情况。共获取136例DLBCL样本，DLBCL部位分类为：十二指肠（n = 23）、回盲部（n = 63）、其他小肠（n = 29）、直肠（n = 7）和其他大肠（n = 14）。采用Kaplan-Meier法绘制DLBCL患者的生存曲线，并通过对数秩检验进行判断。
回盲部及除十二指肠外其他小肠部位的DLBCL患者以男性为主（P = 0.042），局限期肿瘤比例较高（P = 0.015），国际预后指数（IPI）较低（P = 0.001）。回盲部DLBCL患者乳酸脱氢酶升高的发生率较高（P = 0.007），肠梗阻或穿孔的发生率高于其他部位（P < 0.001）。回盲部和其他小肠部位DLBCL患者的5年总生存率和5年无进展生存率高于其他部位，但差异无统计学意义（P = 0.135，0.459）。50%的肠道DLBCL为生发中心B细胞样（GCB）亚型。在136例肿瘤样本中，21%发现有低级别B细胞淋巴瘤。在回盲部和其他小肠标本中，低级别B细胞淋巴瘤的比例为29%，差异有统计学意义（P = 0.025）。136例DLBCL样本中约16%表达滤泡性淋巴瘤，未发现黏膜相关淋巴组织淋巴瘤。十二指肠DLBCL的爱泼斯坦-巴尔病毒编码RNA-1（EBER1）阳性率显著高于其他部位（5/23，22% 对2/63，3%，P = 0.001）。
肠道DLBCL多见于男性，回盲部是最主要的发病部位。回盲部及除十二指肠外小肠部位的DLBCL患者IPI低、局限期肿瘤比例高、乳酸脱氢酶水平低、肠梗阻或穿孔发生率高、惰性淋巴瘤发生率低。十二指肠DLBCL的EBER1阳性率较高。
