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目的观察人类免疫缺陷病毒(HIV)感染相关弥漫性大B细胞淋巴瘤的临床和病理学特点。方法收集华中科技大学同济医学院附属协和医院病理科2009—2013年间2例HIV相关弥漫性大B细胞淋巴瘤进行临床、病理形态观察、免疫表型检测、原位杂交技术检测EB病毒(EBV)及荧光原位杂交(FISH)检测c-MYC基因状态,并结合文献复习此类淋巴瘤的临床病理特点。结果 2例患者年龄分别为30岁及48岁,均为HIV感染者。例1患者血清CD4+T细胞计数462×106个/L,例2患者血清CD4+T细胞计数410×106个/L,病变均发生在结外器官。形态学上例1以中心母细胞为主、混杂有一定数量的免疫母细胞,可见星空现象,例2肿瘤细胞中等大小,伴纤细的纤维化间质。免疫组化:2例B细胞抗原标记物(CD20/PAX5)均(+),例1中CD10、bcl-6、MUM1均(+),例2中仅bcl-6(+)。Ki-67检测细胞增殖指数分别为80%和90%。原位杂交检测EBV显示例1存在EB病毒感染。2例均未检测到c-MYC基因易位。结论 HIV相关弥漫性大B细胞淋巴瘤较少见,可发生于HIV感染具有免疫能力的患者,大多数患者为中青年,病变常发生于结外器官;其正确诊断需结合临床与实验室的检查。
Objective To observe the clinical and pathological features of diffuse large B cell lymphoma associated with human immunodeficiency virus (HIV) infection. Methods Two cases of HIV-associated diffuse large B-cell lymphoma from 2009 to 2013 were collected from Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The clinical and pathological features, immunophenotypes and in situ hybridization (EBV) And fluorescence in situ hybridization (FISH) c-MYC gene status, combined with the literature review of this type of lymphoma clinicopathological features. Results The two patients were 30 and 48 years old, both of whom were HIV-infected. Example 1 The patient’s serum CD4 + T cell count 462 × 106 / L, 2 patients with serum CD4 + T cell count 410 × 106 / L, the lesions occurred in the extranodal organs. Morphology example 1 center centroblasts, mixed with a certain number of immune cells, the visible sky, Example 2 tumor cells of medium size, with slender fibrosis interstitial. Immunohistochemistry: CD20 / PAX5 was positive in 2 cases (+). CD10, bcl-6 and MUM1 were all positive in case 1, and only bcl-6 (+) in case 2. Ki-67 detection of cell proliferation index were 80% and 90%. EBV detection by in situ hybridization shows that EB virus infection exists. No c-MYC gene translocation was detected in 2 cases. Conclusions HIV-associated diffuse large B-cell lymphoma is uncommon and can occur in HIV-infected patients with immunocompetence. Most patients are young and middle-aged, and the lesions often occur in the extranodal organ. The correct diagnosis should be based on both clinical and laboratory an examination.