伴MYC、BCL2、BCL6基因重排的DLBCL/HGBL临床病理学特征分析

魏晶, 何雅琪, 薛田, 柏乾明, 水若鸿, 陆洪芬, 李小秋, 于宝华

  1. 复旦大学附属肿瘤医院病理科,复旦大学上海医学院肿瘤学系,上海 200032
  • 收稿日期:2023-03-26 修回日期:2023-07-03 出版日期:2023-09-30 发布日期:2023-10-01
  • 通信作者: 于宝华
  • 作者简介:魏晶(ORCID: 0009-0008-9307-3255),学士。

摘要/Abstract

摘要:

背景与目的:MYCBCL2和BCL6基因重排的弥漫性大B细胞淋巴瘤/高级别B细胞淋巴瘤(diffuse large B-cell lymphoma/high-grade B-cell lymphoma,DLBCL/HGBL)又称三重打击淋巴瘤(triple-hit lymphoma,THL),其发病率低且文献报道较少,人们对其缺乏充分认识。本研究旨在探讨THL的临床病理学特征及患者预后。方法:收集复旦大学附属肿瘤医院病理科2016年6月—2021年12月诊断的THL病例10例,回顾性分析其临床特征,采用H-E染色观察其组织病理学特征,采用免疫组织化学法分析其免疫表型,采用荧光原位杂交(fluorescence in situ hybridization,FISH)法检测MYCBCL2和BCL6基因重排,采用EB病毒编码RNA(Epstein-Barr virus-encoded RNA,EBER)原位杂交法检测判断EB病毒的感染状态。结果:10例THL患者中,男性4例,女性6例。中位年龄54岁(43~80岁)。其中2例发生在淋巴结,6例发生在结外器官,其余2例结内外均受累。临床分期Ⅲ/Ⅳ期4例(40%),Ⅰ/Ⅱ期6例(60%)。40%(4/10)的患者国际预后指数(international prognostic index,IPI)评分≥3分。50%(4/8)的患者有骨髓侵犯。2例(20%)有B症状。40%(4/10)的患者有乙肝病毒既往感染史。显微镜下观察5例呈非特指DLBCL(DLBCL, not otherwise specified,DLBCL-NOS)形态,2例兼具DLBCL与伯基特淋巴瘤特征,1例呈母细胞样形态,其余2例因组织挤压严重无法准确分类。免疫组织化学染色显示,80%为生发中心B细胞(germinal center B-cell,GCB)型,20%为非GCB(non-GCB)型;78%(7/9)为MYC/BCL2双表达,BCL6阳性率为80%,Ki-67增殖指数均≥80%。FISH检测显示,10例均同时有MYCBCL2和BCL6基因重排。EBER原位杂交均呈阴性。除1例手术切除病灶后未化疗外,9例均接受系统治疗。10例患者的总生存期为2.0 ~ 55.5个月,中位总生存期为16.8个月。1年总生存率为68.6%,其中Ⅰ/Ⅱ期患者的1年总生存率100%,Ⅲ/Ⅳ期患者为25%。结论:THL好发于中老年人,以结外器官受累更常见,是一组形态学表现多样、以GCB型为主并常伴有MYC/BCL2双表达的侵袭性B细胞淋巴瘤。本研究患者中临床分期Ⅰ/Ⅱ期占多数且预后较好,因此及早甄别THL对于及时干预、改善预后具有重要临床意义。

关键词: 弥漫性大B细胞淋巴瘤/高级别B细胞淋巴瘤, 三重打击淋巴瘤, 基因重排, 临床病理学特征, 免疫表型, 生存

Abstract:

Background and purpose: Diffuse large B-cell lymphoma/high-grade B-cell lymphoma (DLBCL/HGBL) with gene rearrangement of MYC, BCL2 and BCL6, also known as triple-hit lymphoma (THL), has a low incidence and relevant literature is limited. Thus comprehensive and sufficient understanding is lacking. The purpose of this study was to explore the clinicopathological features and prognosis of this rare disease. Methods: Ten cases of THL diagnosed in Department of Pathology, Fudan University Shanghai Cancer Center from June 2016 to December 2021 were collected. Clinical features were analyzed retrospectively. Histopathological features were observed using H-E stain. Immunophenotype was analyzed by immunohistochemistry. The rearrangement of MYC, BCL2 and BCL6 genes was detected by fluorescence in situ hybridization (FISH), and Epstein-Barr virus (EBV) infection was detected by in situ hybridization using EBV-encoded RNA (EBER). Results: Of the 10 cases, 4 cases were male and 6 cases were female. The median age was 54 years (43-80 years). Two cases occurred in lymph nodes, 6 cases involved extranodal organs, and both lymph nodes and extranodal organs were involved in the other 2 cases. There were 4 cases (40%) with clinical stage Ⅲ/Ⅳ disease and 6 cases (60%) with clinical stage Ⅰ/Ⅱ disease. 40% (4/10) patients had international prognostic index (IPI) score ≥3. 50% (4/8) patients had bone marrow invasion. Two (20%) cases had B symptoms. 40% (4/10) patients had a history of hepatitis B virus infection. Five cases had the morphology of DLBCL, not otherwise specified (DLBCL-NOS); Two cases showed morphological features intermediate both DLBCL and Burkitt lymphoma; One case had a blastoid cytomorphology, and the other 2 cases failed to be classified accurately because of serious crushing artifacts of the tissue. Immunophenotypically, 80% of the cases were of germinal center B-cell (GCB) type and 20% were of non-GCB type. MYC/BCL2 double expression accounted for 78% (7/9), BCL6 positivity was found in 80% of the total cases, and the Ki-67 proliferation index was ≥80% in all cases. FISH showed that all 10 cases had MYC, BCL2 and BCL6 gene translocation rearrangement. EBV infection was consistently absent. All except one case received systemic treatment. The overall survival was 2.0-55.5 months (median, 16.8 months), and 1-year overall survival rate was 68.6%. The 1-year overall survival rates of patients with stage Ⅰ/Ⅱ disease and stage Ⅲ/Ⅳ disease were 100% and 25% respectively. Conclusion: THL mainly affects middle-aged and elderly patients, which occured more frequently in extranodal organs, and it is characterized by GCB immunophenotype and MYC/BCL2 double expression. A considerable number of patients have a clinical stage of Ⅰ/Ⅱ disease and a better prognosis in the current series, indicating that early identification of THL is of great importance for timely intervention and improving the prognosis.

Key words: Diffuse large B-cell lymphoma/high-grade B-cell lymphoma, Triple-hit lymphoma, Gene rearrangement, Clinicopathological features, Immunophenotype, Survive

中图分类号: 

相关文章

[1] 陈璐艳, 王丽雪, 傅佩芬. 新发Ⅳ期乳腺癌患者手术价值探讨[J]. 中国癌症杂志, 2023, 33(5): 431-436.
[2] 张岩, 王正, 陈彤箴, 柏乾明, 李小秋. 涎腺玻璃样变透明细胞癌8例临床病理学特征分析[J]. 中国癌症杂志, 2023, 33(2): 168-173.
[3] 刘燚铭, 范蕾, 莫淼, 邵志敏, 余科达. 卵巢功能抑制治疗雌激素受体阳性早期乳腺癌的短期效应和长期生存的影响因素分析[J]. 中国癌症杂志, 2022, 32(8): 705-711.
[4] 洪雅萍, 黄韵坚, 黄漳州, 陈胜佳, 钟巧凤, 曾洪福, 庄武. EGFR突变的晚期非小细胞肺癌患者接受一代TKI靶向治疗的效果及预后预测因子分析[J]. 中国癌症杂志, 2022, 32(7): 624-634.
[5] 齐萌芳, 田甜, 黄蕤. 不同年龄儿童及青少年分化型甲状腺癌患者的临床病理学特征与131I治疗分析[J]. 中国癌症杂志, 2022, 32(5): 404-409.
[6] 周长帅, 杨越超, 崔欢欢, 陈磊, 陈鑫, 郝斌, 童彤, 曹依群. 36例小脑转移瘤外科治疗及预后因素分析[J]. 中国癌症杂志, 2022, 32(4): 357-362.
[7] 王子茂, 曹原, 王琪影. 皮肤梭形细胞黑色素瘤患者生存预测模型的构建及验证[J]. 中国癌症杂志, 2022, 32(3): 234-242.
[8] 李婷, 徐宇, 贾东东, 廖智超, 孙伟, 吴海啸, 任志午, 赵军, 邢汝维, 滕胜, 杨蕴, 陈勇, 李涛, 杨吉龙. Ⅲ期恶性黑色素瘤患者术后辅助抗PD-1 vs 靶向治疗:中国多中心真实世界数据分析[J]. 中国癌症杂志, 2022, 32(12): 1147-1157.
[9] 林艺, 王策, 康勋, 康庄, 陈峰, 江波, 李文斌. 胶质母细胞瘤复发相关基因的筛选、表达和临床预后分析[J]. 中国癌症杂志, 2022, 32(1): 13-23.
[10] 王泽洲, 张 扬, 莫 淼, 袁 晶, 周昌明, 沈 洁, 冯小双, 吴浩旋, 李 航, 叶 挺, 胡 鸿, 陈海泉, 郑 莹 . 以医院登记为基础的初诊未转移肺癌患者的转移部位分布及生存分析[J]. 中国癌症杂志, 2021, 31(9): 775-782.
[11] 何晓顺, 焦伟娟, 郭凌川, 黄 山, 吴玉锦, 黄仁鹏 . 6例胚胎发育不良性神经上皮肿瘤患者的临床病理学分析[J]. 中国癌症杂志, 2021, 31(9): 822-827.
[12] 蔡树模, 汤 洁, 黄 啸, 黄晓炜, 刘素萍, 柯桂好, 郑 重, 程 玺, 唐美琴. 铂类药物敏感复发卵巢癌患者的三步化疗法附20例分析[J]. 中国癌症杂志, 2021, 31(4): 330-334.
[13] 武元元 , 王 军 , 刘勤江 , 张 明 . 甲状腺未分化癌的预后因素分析及治疗决策[J]. 中国癌症杂志, 2021, 31(3): 212-220.
[14] 田 华, 何小勇, 王道猛, 杨永国, 梅 霞, 钱 斌 . 腺苷酸激酶4在肺腺癌中的表达及其临床意义[J]. 中国癌症杂志, 2021, 31(2): 108-113.
[15] 丁平安, 张志栋, 杨沛刚, 林叶成, 田 园, 徐校胜, 吴 娟, 刘 颖, 郭洪海, 刘 洋, 王 冬, 檀碧波, 李 勇, 赵 群 . 胃癌脑膜转移的临床病理学特征及预后分析[J]. 中国癌症杂志, 2021, 31(2): 126-135.