扁桃体弥漫大B细胞淋巴瘤的分型、预后及其与EB病毒的相关性研究

发布时间：2018-06-13 03:11

本文选题：Hans分型 + 扁桃体　；参考：《复旦大学》2013年硕士论文

【摘要】：第一部分原发性扁桃体弥漫大B细胞淋巴瘤免疫分型的研究目的：探讨原发性扁桃体弥漫性大B细胞淋巴瘤(Diffuse Large B Cell Lymphoma, DLBCL)的Hans免疫分型、临床病理、预后的相关性以及与非扁桃体原发DLBCL分型比较。方法：收集福尔马林固定石蜡包埋(Formalin-fixed paraffin-embedded, FFPE)原发性扁桃体DLBCL标本81例,原发性非扁桃体DLBCL42例。免疫组织化学(Immunohistochemistry, IHC)技术检测CD10、Bcl-6、MUMI,根据Hans分类方法将原发性扁桃体与原发性非扁桃体DLBCL分为GCB(Germinal center DLBCL)与non-GCB(Non-germinal center DLBCL)两个亚型,用SPSS19.0软件分析原发性扁桃体与非扁桃体原发DLBCL之间分型的差异性,以及病人临床病理资料、预后的相关性。结果：81例原发性扁桃体DLBCL中,14(17%)例为GCB型,67(63%)例为non-GCB型。在原发性扁桃体DLBCL中,分型与病人的性别相关性(P=0.016)有统计学意义,non-GCB中男性所占比率较高,GCB中女性所占比率较高。42例原发性非扁桃体DLBCL中,18(42.8%)为GCB型,24(57.2%)例为non-GCB型,原发性扁桃体DLBCL与非扁桃体DLBCL相比,各型所占比率不同,差异有统计学意义,t=9.398,P＝0.0020.05。结论：原发性扁桃体DLBCL中,以non-GCB型为主；non-GCB中男性所占比率较高, GCB中女性所占比率较高；与非扁桃体原发DLBCL分型相比,各型所占比率不同。第二部分原发性扁桃体弥漫大B细胞淋巴瘤与其他部位弥漫大B细胞淋巴瘤EB病毒感染的差异性研究目的探讨EB病毒(Epstein-Barr Virus, EBV)在原发性扁桃体弥漫性大B细胞淋巴瘤(Diffuse Large B Cell Lymphoma, DLBCL)与其他部位的感染率的差异性,同时比较两种EBV检测方法。方法收集81例原发性扁桃体DLBCL、42例原发性非扁桃体DLBCL,20例扁桃体慢性炎,10例鼻腔NK/T淋巴瘤福尔马林固定石蜡包埋(Formalin-fixed paraffin-embedded, FFPE)组织。以上组织标本均行原位杂交(In situ hybridization, ISH)实验；其中31例扁桃体DLBCL标本行聚合酶链式反应(Polymerase chain reaction, PCR)。用SPSS19.0软件比较两种EBV检测方法；探讨EBV在扁桃体DLBCL与其他部位DLBCL中的存在有无差异。结果81例原发性扁桃体DLBCL进行EBERs ISH检测,有20例阳性；31例原发性扁桃体DLBCL行LMP1PCR扩增,18例阳性；42例原发性非扁桃体DLBCL行EBERs ISH,3例EBERs ISH阳性；两种方法在扁桃体慢性炎中均未检测出EBV存在。原发性扁桃体DLBCL在EBV检出率与原发性非扁桃体DLBCL相比较,t=5.603,P=0.0180.05,差异有统计学意义。卡方检验原发性扁桃体DLBCL中LMP1PCR和EBERs ISH两种方法的检测阳性率,t=11.139,P=0.0010.05,差异有统计学意义。结论原发性扁桃体DLBCL在EBV存在率上显著高于原发性非扁桃体DLBCL。原发性扁桃体DLBCL组织中检测EBV, LMP1PCR方法敏感性统计学上显著优于EBERs ISH。第三部分：原发性扁桃体弥漫大B细胞淋巴瘤预后相关因素的研究目的：探讨原发性扁桃体弥漫大B细胞淋巴瘤(Diffuse Large B Cell Lymphoma, DLBCL)的Hans分型,CD5, Ki-67, EBV的表达及肿瘤内坏死情况与预后的相关性。方法：随访病人,获取病人资料。利用第一部分扁桃体DLBCL的分型数据；CD5,Ki-67免疫组化(IHC)；第二部分原位杂交(ISH)数据及复习HE切片,探讨与扁桃体DLBCL预后相关因素。所有数据经SPSS19.0运算,P=0.05为检验水准。结果：原发性扁桃体DLBCL中,non-GCB型有较好的结局(P=0.042)；CD5表达与病人生存期及结局相关性(P0.05)没有统计学意义；较高的发病年龄(P=0.041)及较高的Ki-67评分(P=0.039)与预后负相关；EBERs阳性与预后正相关(P＝0.033),肿瘤组织内坏死的出现与预后(P=0.016)正相关。结论：Hans分型、EBV、Ki-67、发病年龄及肿瘤内组织坏死情况均可提示原发性扁桃体DLBCL的预后。
[Abstract]:Part one immunological classification of primary tonsillar diffuse large B cell lymphoma
Objective: To investigate the Hans immunophenotyping of primary tonsillar diffuse large B cell lymphoma (Diffuse Cell Lymphoma, DLBCL), the correlation of clinicopathology, prognosis and the comparison with the non tonsillar primary DLBCL typing of the primary tonsillar B Lymphoma Lymphoma (DLBCL).
Methods: 81 cases of primary tonsil DLBCL specimens from formalin fixed paraffin (Formalin-fixed paraffin-embedded, FFPE) and primary non tonsil DLBCL42 were collected. CD10, Bcl-6, MUMI were detected by immunohistochemistry (Immunohistochemistry, IHC) technique. The primary tonsil and primary non tonsil DLBCL were carried out according to the Hans classification method. It is divided into two subtypes of GCB (Germinal center DLBCL) and non-GCB (Non-germinal center DLBCL). The difference between the typing of primary tonsil and non tonsillar primary DLBCL, as well as the correlation between the clinicopathological data and the prognosis of the patients are analyzed by SPSS19.0 software.
Results: in 81 cases of primary tonsillar DLBCL, 14 (17%) were GCB and 67 (63%) was non-GCB. In primary tonsillar DLBCL, the sex correlation (P=0.016) of the patients was statistically significant, the ratio of male to non-GCB was higher, and the ratio of women in GCB was higher in.42 case primary non tonsillar DLBCL, 18 (42.8%) was GCB, 24 (42.8%). 57.2%) of the cases were non-GCB type, and the ratio of DLBCL in primary tonsil was different from that in non tonsil DLBCL. The difference was statistically significant, t=9.398, P = 0.0020.05.
Conclusion: in primary tonsillar DLBCL, non-GCB type is the main type, the ratio of male in non-GCB is higher, and the ratio of women in GCB is higher. Compared with non tonsillar primary DLBCL typing, the proportion of each type is different.
The second part is the difference of EB virus infection between primary tonsillar diffuse large B cell lymphoma and other diffuse large B cell lymphoma.
Objective to investigate the difference in the infection rate of EB virus (Epstein-Barr Virus, EBV) in primary tonsillar diffuse large B cell lymphoma (Diffuse Large B Cell Lymphoma, DLBCL) and the other two types of EBV detection methods.
Methods 81 cases of primary tonsil DLBCL, 42 cases of primary non tonsil DLBCL, 20 cases of tonsillar chronic inflammation, 10 cases of NK/T lymphoma of nasal cavity and formalin fixed paraffin embedded (Formalin-fixed paraffin-embedded, FFPE) tissue. All of the above tissue specimens were in situ hybridization (In situ hybridization, ISH); 31 of them were tonsillar DLBCL. Polymerase chain reaction (PCR). Compare two EBV detection methods with SPSS19.0 software, and discuss the existence of EBV in the presence of DLBCL in the tonsil DLBCL and other parts.
Results 81 cases of primary tonsil DLBCL were detected by EBERs ISH, 20 cases were positive, 31 cases of primary tonsil DLBCL were amplified by LMP1PCR and 18 were positive; 42 cases of primary non tonsil DLBCL were EBERs ISH and 3 cases of EBERs ISH were positive; the two methods were not detected EBV in tonsil chronic inflammation. Compared with primary non tonsillar DLBCL, t=5.603, P=0.0180.05, the difference was statistically significant. The positive rate of two methods of LMP1PCR and EBERs ISH in primary tonsil DLBCL, t=11.139, P=0.0010.05, were statistically significant.
Conclusion the incidence of primary tonsil DLBCL in EBV is significantly higher than that of primary non tonsillar DLBCL. primary tonsillar DLBCL tissue to detect EBV. The sensitivity of LMP1PCR method is significantly better than that of EBERs ISH..
The third part: prognostic factors of primary tonsillar diffuse large B cell lymphoma.
Objective: To investigate the Hans typing of primary tonsil diffuse large B cell lymphoma (Diffuse Large B Cell Lymphoma, DLBCL), the expression of CD5, Ki-67, EBV, and the correlation between the tumor necrosis and the prognosis of the tumor.
Methods: follow up the patients and obtain the patient's data. Using the type data of the tonsil DLBCL in the first part, CD5, Ki-67 immunohistochemistry (IHC), the second part of the in situ hybridization (ISH) data and the review of the HE section, the prognosis related factors of the tonsil DLBCL were discussed. All the data were calculated by SPSS19.0, P=0.05 was the test level.
Results: in primary tonsillar DLBCL, non-GCB had a better outcome (P=0.042); the expression of CD5 was not statistically significant to the patient's survival and outcome (P0.05); higher onset age (P=0.041) and higher Ki-67 score (P=0.039) were negatively correlated with prognosis; EBERs positive was positively correlated with prognosis (P = 0.033), and necrosis in tumor tissues. There is a positive correlation between the appearance and prognosis (P=0.016).
Conclusion: Hans typing, EBV, Ki-67, age of onset and necrosis of tumor tissue all suggest the prognosis of DLBCL of primary tonsil.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R739.64

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