乳腺弥漫大B细胞淋巴瘤9例临床病理特征分析(1)
[摘要]目的 探讨乳腺弥漫大B细胞淋巴瘤(PBDLBCL)的临床病理特征、鉴别诊断及预后。方法 回顾性分析2013年3月～2017年8月我院收治的9例乳腺弥漫大B细胞淋巴瘤的临床病理特征、免疫表型，并复习文献。结果 9例乳腺弥漫大B细胞淋巴瘤均为女性，年龄22～80岁，中位年龄52岁；5例为右侧，3例为左侧，1例为双侧。8例确诊为原发，1例为继发。免疫表型：9例乳腺弥漫大B细胞淋巴瘤LCA、CD20、CD79a均阳性表达，CD3、CD5、CK均阴性；Ki-67指数70%～95%，中位数90%。结论 乳腺淋巴瘤少见，患者多为女性，好发于单侧乳腺，原发性多见，病理类型主要为弥漫大B细胞型。病理光镜及免疫组化结果有助于诊断及鉴别诊断。
[关键词]乳腺肿瘤；弥漫大B细胞淋巴瘤；临床病理；免疫组织化学
[中图分类号] R737.9 [文献标识码] A [文章编号] 1674-4721(2018)2(c)-0102-03
[Abstract]Objective To investigate the clinicopathological features，differential diagnosis and prognosis of diffuse large B cell lymphoma of the breast (PBDLBCL).Methods 9 cases of patients with diffuse large B cell lymphoma of breast treated in our hospital from March 2013 to August 2017 were selected，and the clinicopathological features and immunophenotype were analyzed retrospectively.The literatures were reviewed.Results 9 cases of diffuse large B cell lymphoma of the breast were female，aged 22-80 years，median age of 52 years.5 cases were right，3 cases were left and 1 cases were bilateral.8 cases were diagnosed as primary and 1 were secondary.Immunophenotype：9 cases of diffuse large B cell lymphoma of breast were positive expression of LCA，CD20 and CD79a，CD3，CD5 and CK were negative，Ki-67 index was 70%-95%，median 90%.Conclusion Breast lymphoma is rare，and most of the patients are female.It is very common in unilateral mammary gland.The main pathological type is diffuse large B cell type.Pathological，light and immunohistochemical findings are helpful in the diagnosis and differential diagnosis.
[Key words]Breast cancer；Diffuse large B cell lymphoma；Clinical Pathology；Immunohistochemistry
乳腺淋巴瘤是少見的结外淋巴瘤，通常分为原发和继发两种，主要病理类型为弥漫大B细胞淋巴瘤，原发和继发淋巴瘤具有基本相同的组织结构和细胞形态，目前无法通过病理检查进行有效区分。现回顾性研究本院收治9例乳腺弥漫大B细胞淋巴瘤的临床病理学特征、免疫表型，并复习相关文献，以探讨该病特点，旨在提高对乳腺淋巴瘤的认识水平，为今后临床诊疗工作提供有益的参考。
1资料与方法
1.1 一般资料
选取2013年3月～2017年8月南昌市第三医院收治的9例乳腺弥漫大B细胞淋巴瘤患者，患者均为女性，年龄22～80岁，中位年龄52岁。9例均以乳腺肿块为首发症状，5例为右乳，3例为左乳，1例为双乳，有同侧腋窝淋巴结受累者3例，纵膈和腹膜后淋巴结受累者1例。9例乳腺弥漫大B细胞淋巴瘤患者均以发现乳腺肿块就诊。7例乳腺外观正常、无乳头溢液及内陷， 2例伴低热、乏力、出汗等淋巴瘤b症状，1例乳腺皮肤红肿。本研究均已获得患者知情同意，并已经过我院医学伦理委员会批准。
1.2 方法
1.2.1组织病理学检查 患者肿瘤标本来源为彩超空芯针穿刺活检3例，手术切除肿块活检4例和手术肿块切除冰冻检查2例，所有肿瘤标本均经过10%中性福尔马林浸泡固定、脱水、包埋、切片和HE染色，显微镜观察程序。组织学诊断按照WHO关于淋巴造血组织肿瘤分类(2008版)[1]标准。
1.2.2免疫组化检测 免疫组化采用En Vison 两步法染色，DAB显色。免疫组化选用的抗体包括CD3、CD5、CD20、CD79a、LCA、Ki-67、CKpan和EMA。En Vison 试剂盒和抗体从福建迈新公司和北京中杉金桥公司采购。严格按照公司产品说明书操作，根据抗体类型选择相应的抗原修复方法，已知阳性淋巴瘤切片和正常淋巴结组织作为阳性对照，PBS替代一抗作为阴性对照。参考Colomo等[2]提出的标准，免疫组化标记结果，>25%肿瘤细胞着色为阳性；≤25%肿瘤细胞着色为阴性。Ki-67指数判读：以肿瘤细胞核着棕黄色为阳性，高倍镜(400倍)下选取有代表性10个视野进行统计，增殖指数=(阳性肿瘤细胞数/肿瘤细胞总数)×100%。, 百拇医药(涂剑宏 瞿伟)
[关键词]乳腺肿瘤；弥漫大B细胞淋巴瘤；临床病理；免疫组织化学
[中图分类号] R737.9 [文献标识码] A [文章编号] 1674-4721(2018)2(c)-0102-03
[Abstract]Objective To investigate the clinicopathological features，differential diagnosis and prognosis of diffuse large B cell lymphoma of the breast (PBDLBCL).Methods 9 cases of patients with diffuse large B cell lymphoma of breast treated in our hospital from March 2013 to August 2017 were selected，and the clinicopathological features and immunophenotype were analyzed retrospectively.The literatures were reviewed.Results 9 cases of diffuse large B cell lymphoma of the breast were female，aged 22-80 years，median age of 52 years.5 cases were right，3 cases were left and 1 cases were bilateral.8 cases were diagnosed as primary and 1 were secondary.Immunophenotype：9 cases of diffuse large B cell lymphoma of breast were positive expression of LCA，CD20 and CD79a，CD3，CD5 and CK were negative，Ki-67 index was 70%-95%，median 90%.Conclusion Breast lymphoma is rare，and most of the patients are female.It is very common in unilateral mammary gland.The main pathological type is diffuse large B cell type.Pathological，light and immunohistochemical findings are helpful in the diagnosis and differential diagnosis.
[Key words]Breast cancer；Diffuse large B cell lymphoma；Clinical Pathology；Immunohistochemistry
乳腺淋巴瘤是少見的结外淋巴瘤，通常分为原发和继发两种，主要病理类型为弥漫大B细胞淋巴瘤，原发和继发淋巴瘤具有基本相同的组织结构和细胞形态，目前无法通过病理检查进行有效区分。现回顾性研究本院收治9例乳腺弥漫大B细胞淋巴瘤的临床病理学特征、免疫表型，并复习相关文献，以探讨该病特点，旨在提高对乳腺淋巴瘤的认识水平，为今后临床诊疗工作提供有益的参考。
1资料与方法
1.1 一般资料
选取2013年3月～2017年8月南昌市第三医院收治的9例乳腺弥漫大B细胞淋巴瘤患者，患者均为女性，年龄22～80岁，中位年龄52岁。9例均以乳腺肿块为首发症状，5例为右乳，3例为左乳，1例为双乳，有同侧腋窝淋巴结受累者3例，纵膈和腹膜后淋巴结受累者1例。9例乳腺弥漫大B细胞淋巴瘤患者均以发现乳腺肿块就诊。7例乳腺外观正常、无乳头溢液及内陷， 2例伴低热、乏力、出汗等淋巴瘤b症状，1例乳腺皮肤红肿。本研究均已获得患者知情同意，并已经过我院医学伦理委员会批准。
1.2 方法
1.2.1组织病理学检查 患者肿瘤标本来源为彩超空芯针穿刺活检3例，手术切除肿块活检4例和手术肿块切除冰冻检查2例，所有肿瘤标本均经过10%中性福尔马林浸泡固定、脱水、包埋、切片和HE染色，显微镜观察程序。组织学诊断按照WHO关于淋巴造血组织肿瘤分类(2008版)[1]标准。
1.2.2免疫组化检测 免疫组化采用En Vison 两步法染色，DAB显色。免疫组化选用的抗体包括CD3、CD5、CD20、CD79a、LCA、Ki-67、CKpan和EMA。En Vison 试剂盒和抗体从福建迈新公司和北京中杉金桥公司采购。严格按照公司产品说明书操作，根据抗体类型选择相应的抗原修复方法，已知阳性淋巴瘤切片和正常淋巴结组织作为阳性对照，PBS替代一抗作为阴性对照。参考Colomo等[2]提出的标准，免疫组化标记结果，>25%肿瘤细胞着色为阳性；≤25%肿瘤细胞着色为阴性。Ki-67指数判读：以肿瘤细胞核着棕黄色为阳性，高倍镜(400倍)下选取有代表性10个视野进行统计，增殖指数=(阳性肿瘤细胞数/肿瘤细胞总数)×100%。, 百拇医药(涂剑宏 瞿伟)