Carreras Joaquim, Kikuti Yara Yukie, Miyaoka Masashi, Hiraiwa Shinichiro, Tomita Sakura, Ikoma Haruka, Kondo Yusuke, Ito Atsushi, Nagase Shunsuke, Miura Hisanobu, Roncador Giovanna, Colomo Lluis, Hamoudi Rifat, Campo Elias, Nakamura Naoya
Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan.
Monoclonal Antibodies Unit, Spanish National Cancer Research Center (Centro Nacional de Investigaciones Oncologicas, CNIO), Melchor Fernandez Almagro 3, 28029 Madrid, Spain.
Hematol Rep. 2023 Mar 12;15(1):188-200. doi: 10.3390/hematolrep15010020.
Diffuse large B-cell lymphoma with spindle cell morphology is a rare variant. We present the case of a 74-year-old male who initially presented with a right supraclavicular (lymph) node enlargement. Histological analysis showed a proliferation of spindle-shaped cells with narrow cytoplasms. An immunohistochemical panel was used to exclude other tumors, such as melanoma, carcinoma, and sarcoma. The lymphoma was characterized by a cell-of-origin subtype of germinal center B-cell-like (GCB) based on Hans' classifier (CD10-negative, BCL6-positive, and MUM1-negative); EBER negativity, and the absence of , , and rearrangements. Mutational profiling using a custom panel of 168 genes associated with aggressive B-cell lymphomas confirmed mutations in , , , , , , and . Based on the LymphGen 1.0 classification tool, this case had an ST2 subtype prediction. The immune microenvironment was characterized by moderate infiltration of M2-like tumor-associated macrophages (TMAs) with positivity of CD163, CSF1R, CD85A (LILRB3), and PD-L1; moderate PD-1 positive T cells, and low FOXP3 regulatory T lymphocytes (Tregs). Immunohistochemical expression of PTX3 and TNFRSF14 was absent. Interestingly, the lymphoma cells were positive for HLA-DP-DR, IL-10, and RGS1, which are markers associated with poor prognosis in DLBCL. The patient was treated with R-CHOP therapy, and achieved a metabolically complete response.
具有梭形细胞形态的弥漫性大B细胞淋巴瘤是一种罕见的变异型。我们报告了一例74岁男性患者，最初表现为右锁骨上（淋巴）结肿大。组织学分析显示梭形细胞增殖，细胞质狭窄。使用免疫组织化学检测排除其他肿瘤，如黑色素瘤、癌和肉瘤。根据汉斯分类法（CD10阴性、BCL6阳性和MUM1阴性），该淋巴瘤的起源细胞亚型为生发中心B细胞样（GCB）；EBER阴性，且无 、 和 重排。使用与侵袭性B细胞淋巴瘤相关的168个基因的定制检测板进行突变分析，证实 、 、 、 、 、 和 存在突变。根据LymphGen 1.0分类工具，该病例预测为ST2亚型。免疫微环境的特征是M2样肿瘤相关巨噬细胞（TMA）中度浸润，CD163、CSF1R、CD85A（LILRB3）和PD-L1呈阳性；PD-1阳性T细胞中度，FOXP3调节性T淋巴细胞（Treg）低。PTX3和TNFRSF14的免疫组织化学表达缺失。有趣的是，淋巴瘤细胞HLA-DP-DR、IL-10和RGS1呈阳性，这些是与弥漫性大B细胞淋巴瘤预后不良相关的标志物。该患者接受了R-CHOP治疗，并实现了代谢完全缓解。
