Cool C D, Bitter M A
Department of Pathology, University of Colorado Health Sciences Center, Denver 80262, USA.
Hum Pathol. 1997 Sep;28(9):1026-33. doi: 10.1016/s0046-8177(97)90055-1.
Recent information is limited regarding pathological features of the malignant lymphomas of Africa, other than Burkitt's lymphoma. In this study, we apply modern techniques and nomenclature to classify 73 lymphomas from a central histopathology laboratory serving 40 mission hospitals in Kenya. We were particularly interested in the frequency of recently recognized lymphomas and the incidence of Epstein-Barr virus in various lymphoma subtypes. Malignant lymphomas accounted for 12% of all surgical pathology specimens processed in the laboratory over the 21-month period included in the study. Patient age ranged from 4 to 97 years (median, 35 years). The male-to-female ratio was 2.5:1. Sixty lymphomas (82%) were non-Hodgkin's, and 13 (18%) were Hodgkin's disease. Of the non-Hodgkin's lymphomas (NHLs), 52 (87%) were B-lineage, including 21 (35% of NHLs) Burkitt's lymphomas (only one from the jaw), 11 (18%) diffuse large B cell lymphomas; nine (15%) small lymphocytic lymphomas, six (10%) Burkitt's-like lymphomas, two (3%) follicular lymphomas (two of two expressed bcl-2 protein; one of two showed bcl-2 major breakpoint region rearrangement), two (3%) mantle cell lymphomas, and one extranodal marginal zone lymphoma. Of the eight T cell lymphomas, six were precursor T-cell type, and the remaining two were peripheral T cell lymphomas, unspecified. The median age of the 13 patients (18% of lymphomas) with Hodgkin's disease was 23 years (range, 9 to 97 years). Six were nodular sclerosis, four were mixed cellularity, one case each was lymphocyte depletion, lymphocyte predominance, and unclassified Hodgkin's disease. Hodgkin's cells in 6 of the 12 nonlymphocyte predominance cases were positive for CD20, and in three of the six for CD45 as well. Epstein-Barr virus was identified using in situ hybridization for EBER 1 in the malignant cells of 22 of 39 informative lymphomas, including each of 17 Burkitt's lymphomas, and three of seven diffuse large B cell lymphomas. Of note, none of five Burkitt's-like lymphomas expressed EBER 1. One of two informative cases of peripheral T cell lymphoma, and four of nine cases of Hodgkin's disease were EBER 1 positive. In summary, T cell lymphomas and recently recognized B-lineage non-Hodgkin's lymphoma subtypes do not appear to be particularly common in East Africa.
除伯基特淋巴瘤外，关于非洲恶性淋巴瘤病理特征的最新信息有限。在本研究中，我们应用现代技术和命名法对肯尼亚一家为40家教会医院服务的中央组织病理学实验室的73例淋巴瘤进行分类。我们特别关注最近确认的淋巴瘤的发生率以及爱泼斯坦-巴尔病毒在各种淋巴瘤亚型中的发生率。在该研究纳入的21个月期间，恶性淋巴瘤占该实验室处理的所有外科病理标本的12%。患者年龄范围为4至97岁（中位数为35岁）。男女比例为2.5:1。60例淋巴瘤（82%）为非霍奇金淋巴瘤，13例（18%）为霍奇金病。在非霍奇金淋巴瘤（NHL）中，52例（87%）为B细胞系，包括21例（占NHL的35%）伯基特淋巴瘤（仅1例来自颌部）、11例（18%）弥漫性大B细胞淋巴瘤；9例（15%）小淋巴细胞淋巴瘤、6例（10%）伯基特样淋巴瘤、2例（3%）滤泡性淋巴瘤（2例均表达bcl-2蛋白；2例中的1例显示bcl-2主要断裂区重排）、2例（3%）套细胞淋巴瘤和1例结外边缘区淋巴瘤。在8例T细胞淋巴瘤中，6例为前体T细胞型，其余2例为未特定的外周T细胞淋巴瘤。13例霍奇金病患者（占淋巴瘤的18%）的中位年龄为23岁（范围为9至97岁）。6例为结节硬化型，4例为混合细胞型，淋巴细胞消减型、淋巴细胞为主型和未分类霍奇金病各1例。在12例非淋巴细胞为主型病例中的6例中，霍奇金细胞CD20呈阳性，其中6例中的3例CD45也呈阳性。使用原位杂交检测EBER 1，在39例可提供信息的淋巴瘤中的22例的恶性细胞中检测到爱泼斯坦-巴尔病毒，包括17例伯基特淋巴瘤中的每一例，以及7例弥漫性大B细胞淋巴瘤中的3例。值得注意的是，5例伯基特样淋巴瘤中无一例表达EBER 1。2例可提供信息的外周T细胞淋巴瘤病例中的1例，以及9例霍奇金病病例中的4例EBER 1呈阳性。总之，T细胞淋巴瘤和最近确认的B细胞系非霍奇金淋巴瘤亚型在东非似乎并不特别常见。
