Objective: To investigate the clinicopathological features of intestinal diffuse large B-cell lymphoma (DLBCL).
Methods: The clinical features, pathological morphology, immunophenotype, and EBER in situ hybridization of 136 DLBCL patients diagnosed in Jinan People's Hospital Affiliated to Shandong First Medical University from January 2007 to October 2014 were analyzed retrospectively. A total of 136 DLBCL samples were obtained, the DLBCL sites were categorized as: duodenum (n=23), ileocecal region (n=63), other small intestine (n=29), rectum (n=7), and other large intestine (n=14). Survival curves for the DLBCL patients were plotted using the Kaplan-Meier method and judged by the Log-rank test.
Results: Patients with DLBCL of the ileocecal region and other small intestine except duodenum were mainly male (P=0.042), and had a higher proportion of limited-stage tumors(P=0.015), and lower International Prognostic Index (IPI) (P=0.001). Patients with DLBCL of ileocecal region had higher incidence of lactate dehydrogenase elevation (P=0.007), and higher incidence of intestinal obstruction or perforation (P<0.001) than those with DLBCL of other regions. The 5-year overall survival and 5-year progression-free survival of patients with DLBCL in ileocecal and other small intestine sites were higher than those in other sites, but the differences were not statistically significant (P=0.135, 0.459). Fifty percent of intestinal DLBCL were germinal center B cell-like (GCB) subtypes. A low-grade B-cell lymphoma was found in 21% of 136 tumor samples. In ileocecal and other small intestinal specimens, the proportion of low-grade B-cell lymphoma was 29%, and the difference was statistically significant(P=0.025). About 16% of 136 DLBCL samples expressed follicular lymphoma while no mucosa-associated lymphoid tissue lymphoma . The Epstein-Barr virus-encoded RNA-1 (EBER1) positive rate of duodenal DLBCL was significantly higher than that of other sites (5/23, 22% vs 2/63, 3%, P=0.001).
Conclusion: The intestinal DLBCL is commonly observed in male, and ileocecal is the most primary site. Patients with DLBCL of the ileocecal region and small intestine except duodenum have low IPI, high proportion of limited-stage tumors, low level of lactate dehydrogenase, high incidence of intestinal obstruction or perforation, and low incidence of inert lymphoma. The EBER1 positive rate of DLBCL in duodenal is higher.
题目: 肠道弥漫性大B细胞淋巴瘤患者的临床病理特征分析.
目的: 探讨肠道弥漫性大B细胞淋巴瘤（DLBCL）的临床病理特征.
方法: 回顾性分析2007年1月至2014年10月在山东第一医科大学附属济南人民医院确诊的136例DLBCL患者的临床特点、病理形态、免疫表型及EBER原位杂交等资料。共获取136例肿瘤样本，根据肿瘤部位分为十二指肠23例，回盲部63例，其他小肠29例，直肠7例和其他大肠14例。采用Kaplan-Meier法绘制生存曲线并行Log-rank检验.
结果: 与肠道其他部位比较，回盲部和十二指肠以外的小肠部位的DLBCL患者主要为男性（P=0.042），国际预后指数较低（P=0.001），局限期肿瘤占比较高（P=0.015）；回盲部乳酸脱氢酶升高的发生率更高（P=0.007），肠梗阻或穿孔率更高（P<0.001）。回盲部及其他小肠部位的DLBCL患者的5年总生存率、5年无进展生存率高于其他部位，但比较差异无统计学意义（P=0.135，0.459）。50%肠道DLBCL为生发中心B细胞样亚型。136例肿瘤样本中低度恶性B细胞淋巴瘤占比为21%，回盲部及其他小肠标本均占低度恶性B细胞淋巴瘤的29%，与其他部分比较差异有统计学意义（P=0.025）。136例DLBCL肿瘤样本中约16%表达滤泡性淋巴瘤，无黏膜相关淋巴组织淋巴瘤表型表达。十二指肠DLBCL的EBER1阳性率明显高于其他部位（5/23，22% vs 2/63, 3%，P=0.001）.
结论: 肠道DLBCL以男性为主，回盲部为最常见的发病部位。回盲部和十二指肠以外的小肠DLBCL患者国际预后指数低，局限期肿瘤比例高，乳酸脱氢酶水平低，肠梗阻或穿孔的发生率高，惰性淋巴瘤发生率低。十二指肠DLBCL的EBER1阳性率较高.