Folliküler lenfoma derece 3B diffüz büyük B hücreli lenfomanın bir varyantı mı?
Küçük Resim Yok
Tarih
2014
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Folliküler lenfoma (FL) diffüz büyük B hücreli lenfomadan (DBBHL) sonra en sık görülen ikinci lenfomadır. FL derece 1-2 ve 3 (3A ve 3B) olarak derecelendirilmiştir. Derece 3B'de neoplastik folliküller santroblastlardan oluşmakta ve DBBHL'yı anımsatmaktadır. İmmünohistokimyasal incelemede FL hücreleri CD10, BCL-6 ve BCL-2 ile pozitif boyanırlar. Ancak derece 3 olgularda CD10 ve BCL-2 diğer derecelere oranla daha az pozitiftir. CD10 ve BCL-2 negatif olguların bir kısmında MUM-1/IRF-4 pozitiftir. MUM-1 pozitif olguların çoğunda diffüz paterni görülmektedir. Bu fenotip non-germinal merkez tipi DBBHL'yi anımsatmaktadır. Çalışmamıza 88 FL ve 39 DBBHL tanılı vaka dâhil edilmiştir. FL olgularında derece artışına paralel olarak folliküler paternin azaldığı izlenmiştir (P=0,011). Derece 3B olguların %40'ında, DBBHL ile birliktelik gösteren derece 3A olguların %50'sinde CD10 negatiftir. CD10 ile tanılar karşılaştırıldığında, derece ve diffüz patern arttıkça CD10'da negatifleşme görülmüştür (P<0,001). CD10 negatif olan iki derece 3B olgusundan biri BCL-2 fokal pozitif, BCL-6 negatif, MUM- %2 ve Kİ67 %20 pozitif, diğeri BCL-2 negatif, BCL-6 fokal pozitif, MUM-1 ve Ki67 %80 pozitif immunfenotipindedir. Derece arttıkça MUM-1 ve Ki67 yoğunluğu artmaktadır (sırasıyla P=0,003 ve P=0,001). FL ve DBBHL tanı grupları arasında belirgin prognostik bir fark bulunmamıştır. FLIPI2 ile yapılan değerlendirmede derece 3 olgularda prognoz bir miktar daha kötü görünmektedir. Sonuç olarak FL derece 3B olgularının bir kısmında diğer FL derecelerinden farklı bir immunfenotip ortaya çıkmaktadır ve bu fenotip DBBHL ile benzerlik göstermektedir. Ancak derece 3B tanılı olguların arşivimizde çok az sayıda bulunması sebebiyle, bu farklılık çok anlamlı görülmemiştir. Çalışmamızın sonucunda daha geniş serilerde derece 3B vakaları incelenebilirse, FL derece 3B, FL sınıflamasından çıkarılarak, DBBHL bir varyantı olarak kabul edilebileceği kanısına varılmıştır
Follicular lymphoma (FL) is the second most common lymphoma following diffuse large B cell lymphoma (DLBCL). FL was graded as grade 1-2 and 3 (3A and 3B). In grade 3B neoplastic follicles consist of centroblasts and resemble DLBCL. On immunohistochemical staining, cells of FL are positive for CD10, BCL-6 and BCL-2. But CD10 and BCL-2 are less common in grade 3 cases, compared to the other grades. Some of the cases negative for CD10 and BCL-2 are positive for MUM-1/IRF-4. MUM-1 positive cases usually express diffuse pattern and this phenotype resembles non-germinal center type DLBCL. Eighty eight cases of FL and 39 cases of DLBCL are included in the study. A decrease of follicular pattern was identified parallel to an increase in grade (P=0,011). CD10 was negative in 40% of grade 3B cases and 50% of those cases of grade 3A coexpressing DLBCL. Correlation of CD10 and diagnoses revealed negativity of CD10 with an increase in the grade and diffuse pattern (P<0,001). Of the two grade 3B cases negative for CD10, one was BCL-2 focally positive, BCL-6 negative, MUM- 2% and Kİ67 20% positive, and the other one was BCL-2 negative, BCL-6 focally positive, MUM-1 and Ki67 80% positive. As the grade got higher, the MUM-1 and Ki67 staining was more intense (P=0,003 and P=0,001, respectively). There was no prognostic difference between the groups of patients diagnosed as FL and DBBHL. On evaluation by FLIPI2 grade 3 cases presented worse prognoses. As a result, some cases of FL grade 3B express a different immunophenotype compared to other grades and this phenotype presents some similarities to DLBCL. But this difference of grade 3B was not significant due to the low number of cases in our series. Our study reveals that if larger series of grade 3B were evaluated, FL grade 3B may no longer be classified under FL, but may be accepted as a variant of DLBCL.
Follicular lymphoma (FL) is the second most common lymphoma following diffuse large B cell lymphoma (DLBCL). FL was graded as grade 1-2 and 3 (3A and 3B). In grade 3B neoplastic follicles consist of centroblasts and resemble DLBCL. On immunohistochemical staining, cells of FL are positive for CD10, BCL-6 and BCL-2. But CD10 and BCL-2 are less common in grade 3 cases, compared to the other grades. Some of the cases negative for CD10 and BCL-2 are positive for MUM-1/IRF-4. MUM-1 positive cases usually express diffuse pattern and this phenotype resembles non-germinal center type DLBCL. Eighty eight cases of FL and 39 cases of DLBCL are included in the study. A decrease of follicular pattern was identified parallel to an increase in grade (P=0,011). CD10 was negative in 40% of grade 3B cases and 50% of those cases of grade 3A coexpressing DLBCL. Correlation of CD10 and diagnoses revealed negativity of CD10 with an increase in the grade and diffuse pattern (P<0,001). Of the two grade 3B cases negative for CD10, one was BCL-2 focally positive, BCL-6 negative, MUM- 2% and Kİ67 20% positive, and the other one was BCL-2 negative, BCL-6 focally positive, MUM-1 and Ki67 80% positive. As the grade got higher, the MUM-1 and Ki67 staining was more intense (P=0,003 and P=0,001, respectively). There was no prognostic difference between the groups of patients diagnosed as FL and DBBHL. On evaluation by FLIPI2 grade 3 cases presented worse prognoses. As a result, some cases of FL grade 3B express a different immunophenotype compared to other grades and this phenotype presents some similarities to DLBCL. But this difference of grade 3B was not significant due to the low number of cases in our series. Our study reveals that if larger series of grade 3B were evaluated, FL grade 3B may no longer be classified under FL, but may be accepted as a variant of DLBCL.
Açıklama
Anahtar Kelimeler
Patoloji, Pathology, Folikül, Follicles, Genler, Genes, Lenfoma, Lymphoma, Lenfoma-B hücreli, Lymphoma-B cell, Lenfoma-folliküler, Lymphoma-follicular, Lenfoma-non Hodgkin, Lymphoma-non Hodgkin, Neoplazmlar, Neoplasms
