Alsabeh R, Medeiros L J, Glackin C, Weiss L M
Division of Pathology, City of Hope National Medical Center, Duarte, California 91010, USA.
Am J Surg Pathol. 1997 May;21(5):528-36. doi: 10.1097/00000478-199705000-00004.
The natural history of follicular lymphoma is to accrue large cells and become diffuse, resulting in progression/transformation to a higher-grade lymphoma. Histologic transformation occurs in approximately 60% of patients. Most often, follicular lymphomas transform into diffuse large cell lymphoma, but transformation to lymphomas classified using the Working Formulation as diffuse mixed, large cell immunoblastic, or small noncleaved cell also have been reported. Evidence of transformation may be found over time in sequential biopsy specimens, or may coexist in the same biopsy specimen. Here, we describe six cases of follicular lymphoma, large cell in five cases and mixed in one case, that transformed into a diffuse or sinusoidal CD30 antigen-positive large cell lymphoma with anaplastic cytologic features. Both the follicular and diffuse/sinusoidal components were of B-cell lineage, positive for the CD20 antigen and negative for the CD3 and CD43 antigens. The neoplastic cells expressed monotypic immunoglobulin light chain in five cases, three kappa and two lambda. BCL-2 protein was positive in four tumors, in both the follicular and diffuse/sinusoidal components in three cases, and only in the latter component in one case. Using the polymerase chain reaction (PCR), three of six cases had monoclonal immunoglobulin heavy chain gene rearrangements. The t(14;18) was not amplified in any case. Using reverse transcriptase (RT)-PCR, the t(2;5) was amplified in one of four tumors. This report highlights the heterogeneity of B-lineage anaplastic large cell lymphomas and indicates the need to consider antecedent follicular lymphoma in any B-cell lymphoma with anaplastic cytologic features.
滤泡性淋巴瘤的自然病程是累积大细胞并转变为弥漫性，从而进展/转化为高级别淋巴瘤。组织学转化发生在约60%的患者中。最常见的是，滤泡性淋巴瘤转化为弥漫性大细胞淋巴瘤，但也有报道转化为工作分类法归类为弥漫性混合、大细胞免疫母细胞性或小无裂细胞性淋巴瘤。随着时间推移，在连续活检标本中可能发现转化证据，也可能在同一活检标本中共存。在此，我们描述6例滤泡性淋巴瘤，其中5例为大细胞型，1例为混合型，它们转化为具有间变性细胞学特征的弥漫性或窦状CD30抗原阳性大细胞淋巴瘤。滤泡性和弥漫性/窦状成分均为B细胞谱系，CD20抗原阳性，CD3和CD43抗原阴性。肿瘤细胞在5例中表达单克隆免疫球蛋白轻链，3例为κ链，2例为λ链。4例肿瘤中BCL-2蛋白阳性，3例在滤泡性和弥漫性/窦状成分中均阳性，1例仅在后者成分中阳性。使用聚合酶链反应（PCR），6例中有3例存在单克隆免疫球蛋白重链基因重排。任何病例中均未扩增出t(14;18)。使用逆转录酶（RT）-PCR，4例肿瘤中有1例扩增出t(2;5)。本报告强调了B细胞谱系间变性大细胞淋巴瘤的异质性，并表明在任何具有间变性细胞学特征的B细胞淋巴瘤中都需要考虑先前存在的滤泡性淋巴瘤。
