具有11号染色体长臂异常的Burkitt样淋巴瘤的临床病理及分子遗传学特征

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目的:探讨具有11号染色体长臂异常的Burkitt样淋巴瘤(Burkitt-like lymphoma with 11q aberration,BLL-11q)的临床病理、分子遗传学特征及治疗和预后。方法:收集郑州大学第一附属医院2016年1月至2020年1月诊断的6例BLL-11q,进行HE染色、免疫组织化学、EBER原位杂交及荧光原位杂交检测,观察其组织学形态、免疫表型及分子遗传学特征,分析临床信息并进行随访。结果:6例BLL-11q患者免疫功能均正常,男性5例,女性1例,年龄20~38岁,中位年龄29岁。6例均发生于淋巴结,且均位于头颈部。Ann Arbor分期5例为Ⅰ~Ⅱ期,1例为Ⅳ期。淋巴结结构大部分或全部破坏,肿瘤细胞弥漫性增生浸润,其中4例类似Burkitt淋巴瘤,2例形态介于Burkitt淋巴瘤和弥漫性大B细胞淋巴瘤之间不能分类,核分裂象多见,凋亡及坏死明显,5例可见“星空”现象。肿瘤细胞均弥漫性强表达CD20、CD10及bcl-6,Ki-67阳性指数均>95%,1例CD21染色可见滤泡树突状细胞(FDC)网。不同程度的表达C-MYC。CD3、bcl-2、MUM1、CD30、末端脱氧核苷酸转移酶(TdT)均为阴性。EBER原位杂交检测均为阴性。荧光原位杂交(FISH)检测C-MYC、bcl-2、bcl-6分离均为阴性,11q23.3获得伴11q24.3丢失均为阳性,其中1例出现11q23.3的扩增。同时,本组病例进行了IgH及IRF4基因分离探针的检测,6例病例均为阴性。随访时间4~19个月,均无病生存。结论:BLL-11q是一种少见的淋巴瘤,形态及免疫表型类似Burkitt淋巴瘤,但缺乏MYC基因重排,存在特征性的11q异常,应提高对该病变的认识,避免误诊和漏诊。“,”Objective:To investigate the clinicopathological features, molecular genetics, treatment and prognosis of Burkitt-like lymphoma with 11q aberration (BLL-11q).Methods:Six cases of BLL-11q diagnosed at the First Affiliated Hospital of Zhengzhou University, from January 2016 to January 2020 were reviewed and analyzed using hematoxylin-eosin staining, immunohistochemistry, EBER in situ hybridization and fluorescence in situ hybridization. Clinical information including follow-up data was collected and analyzed.Results:The median age of the six immunocompetent patients was 29 years (range 20-38 years) and the male to female ratio was 5∶1. All patients had nodal disease in the head and neck region. Five patients had Ann Arbor stage Ⅰ-Ⅱ disease, while one patient had stage Ⅳ disease. Lymph nodes showed partial or total architectural effacement by a diffuse proliferation of monomorphic lymphocytes. Four cases were morphologically similar to Burkitt lymphoma, and two cases were unclassified with histological features between Burkitt lymphoma and diffuse large B-cell lymphoma. Mitotic figures, apoptosis and necrosis were conspicuous. Five cases exhibited the“starry sky”pattern. CD20, CD10 and bcl-6 were diffusely and strongly positive. The Ki-67 index was more than 95%. The follicular-dendritic-cell meshwork was noted in one case using CD21 stain. C-MYC was expressed variably. CD3, bcl-2, MUM-1, CD30 and TDT were negative in all cases. EBER in situ hybridization was also all negative. FISH analyses using C-MYC, bcl-2 and bcl-6 break-apart probes were all negative. All cases had the 11q23.3 gain/11q24.3 loss pattern, and 11q23.3 amplification was found in one case. IgH and IRF4 break-apart probes analysis was also negative. All patients were alive with no disease after a follow-up of 4 to 19 months.Conclusion:BLL-11q is a rare lymphoma that resembles Burkitt lymphoma morphologically and phenotypically, but lacks C-MYC gene rearrangements. Instead, it has a chromosome-11q alteration characterized by proximal gains and telomeric losses. It′s necessary to improve our understanding of BLL-11q to avoid misdiagnosis and missed diagnosis.
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