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目的探讨 bcl-10蛋白表达对黏膜相关淋巴组织结外边缘区 B 细胞淋巴瘤(MALT 淋巴瘤)的诊断价值。方法收集140例不同部位的 MALT 淋巴瘤,包括胃38例、眼眶35例、肠16例、皮肤15例、涎腺15例、肺14例、甲状腺3例、其他部位4例。对照:10例扁桃体反应性滤泡增生(RFH)、5例眼眶的淋巴组织增生和143例非 MALT 淋巴瘤、不同类型的非霍奇金淋巴瘤(NHL),包括20例 NK/T 细胞淋巴瘤、20例滤泡性淋巴瘤(FL)、20例间变性大细胞淋巴瘤(ALCL)、20例淋巴结内弥漫大 B 细胞淋巴瘤(DLBCL)、10例原发胃 DLBCL、13例淋巴结边缘区淋巴瘤(NMZL)、12例套细胞淋巴瘤(MCL)、11例脾脏边缘区淋巴瘤(SMZL)、6例血管免疫母细胞性 T 细胞淋巴瘤(AITL)、6例外周 T 细胞淋巴瘤(PTCL)、3例 B-小淋巴细胞淋巴瘤(B-SLL)、1例淋巴浆细胞性淋巴瘤(LPL)和1例浆细胞瘤。免疫组织化学 EnVision 法检测 bcl-10蛋白;免疫组织化学双标记法检测CD20与 bcl-10的共表达。结果在扁桃体 RFH 中,bcl-10蛋白呈中等强度表达于生发中心 B 细胞质中,套细胞不表达,边缘区细胞和副皮质区 T 细胞呈弱表达。在眼眶淋巴组织增生中,2例 bcl-10阴性,3例主要呈淋巴滤泡生发中心 B 细胞质阳性,与扁桃体 RFH 的表达类似。在非 MALT 淋巴瘤的其他类型 NHL 中,除3例(3/10)原发胃 DLBCL 呈胞核阳性外,其余均未见胞核表达;在不同 NHL中的胞质阳性分别为:结内(12/20)和胃(7/10)DLBCL、FL 和 ALCL(16/20)、PTCL(5/6)、AILT(6/6)、NMZL(13/13)、SMZL(11/11)、B-SLL(3/3)和浆细胞瘤(1/1),11例 MCL 呈胞质可疑阳性,20例 NK/T 细胞淋巴瘤和1例 LPL 阴性;在部分淋巴瘤中可见肿瘤性细胞表达而反应性小淋巴细胞不表达:MALT 淋巴瘤之 bcl-10的总表达率为92.1%(129/140),其中54.3%(76/140)胞质阳性,37.9%(53/140)胞核阳性;但不同部位之胞核阳性率有所不同。在 MALT 淋巴瘤中,bcl-10蛋白核强表达最常见于眼眶(25.7%,9/35);除出现异常 bcl-10胞核表达外,约20%有反应性滤泡的病例呈生发中心失表达。双标记显示 bcl-10阳性细胞为 CD20阳性细胞,但 CD20阳性细胞多于 bcl-10阳性细胞。结论 (1)淋巴细胞增生性病变中 bcl-10蛋白普遍表达,细胞质表达可出现在多数 NHL 和反应性增生中,但在淋巴瘤中呈肿瘤细胞表达而反应性细胞不表达,提示 bcl-10异常可能与部分淋巴瘤的形成有关;(2)细胞核内 bcl-10异常表达主要见于 MALT 淋巴瘤;眼眶、肺等部位的胞核强阳性和生发中心阴性的特殊模式,对 MALT 淋巴瘤的诊断及其与反应性病变的鉴别诊断有一定辅助意义。
Objective To investigate the diagnostic value of bcl-10 protein expression in mucosa-associated lymphoid tissue extranodal marginal zone B-cell lymphoma (MALT lymphoma). Methods Totally 140 MALT lymphomas of different sites were collected, including 38 cases of stomach, 35 cases of orbital, 16 cases of intestine, 15 cases of skin, 15 cases of salivary gland, 14 cases of lung, 3 cases of thyroid gland and 4 cases of other parts. Control: 10 cases of tonsillar reactive follicular hyperplasia (RFH), 5 cases of orbital lymphoid hyperplasia and 143 cases of non-MALT lymphoma, different types of non-Hodgkin’s lymphoma (NHL), including 20 cases of NK / T cell lymph 20 cases of follicular lymphoma (FL), 20 cases of anaplastic large cell lymphoma (ALCL), 20 cases of diffuse large B cell lymphoma (DLBCL) in lymph nodes, 10 cases of primary gastric DLBCL, 13 cases of lymph node margin Regional lymphoma (NMZL), 12 cases of mantle cell lymphoma (MCL), 11 cases of splenic marginal zone lymphoma (SMZL), 6 cases of angioimmunoblastic T cell lymphoma (AITL), 6 cases of peripheral T cell lymphoma (PTCL), 3 cases of B-small lymphocytic lymphoma (B-SLL), 1 case of lymphoplasmacytic lymphoma (LPL) and 1 case of plasmacytoma. Immunohistochemistry EnVision assay bcl-10 protein; immunohistochemical double-labeled method to detect CD20 and bcl-10 co-expression. Results In tonsil RFH, the bcl-10 protein was moderately expressed in the cytoplasm of germinal center B, but not in the mantle cells. The T cells in the marginal zone and the paracortex were weakly expressed. In orbital lymphoid hyperplasia, two cases of bcl-10 negative, three cases were mainly lymphoid follicular germinal center B cytoplasm positive, similar to the expression of RFH in tonsils. Among the other NHLs of non-MALT lymphoma, no nuclear expression was found in 3 of 3 (3/10) primary gastric DLBCLs, with no cytoplasmic expression in other NHLs; the cytoplasmic positives in different NHLs were: (12/20) and gastric (7/10) DLBCL, FL and ALCL (16/20), PTCL (5/6), AILT (6/6), NMZL (13/13), SMZL , B-SLL (3/3) and plasmacytoma (1/1). Eleven cases of MCL showed cytoplasmic suspicious positive, 20 cases of NK / T cell lymphoma and 1 case of LPL negative. In some lymphoma, Cell Expression and Reactivity Small Lymphocytes Not Express: The overall expression rate of bcl-10 in MALT lymphoma was 92.1% (129/140), of which 54.3% (76/140) were cytoplasmic positive, 37.9% (53/140) Nucleus positive; but different parts of the nucleus positive rate is different. In MALT lymphomas, the strong expression of bcl-10 protein was the most common in the orbit (25.7%, 9/35). In addition to the abnormal expression of bcl-10, about 20% of the patients with reactive follicles showed germinal centers Loss of expression. Double labeling showed that the bcl-10 positive cells were CD20 positive cells but more CD20 positive cells than bcl-10 positive cells. Conclusions (1) The expression of bcl-10 protein is generally expressed in lymphoproliferative lesions. The expression of cytoplasm can occur in most of NHL and reactive hyperplasia, but is expressed in lymphoma but not in reactive cells, suggesting that bcl-10 Abnormalities may be related to the formation of some lymphomas. (2) Abnormal expression of bcl-10 in the nucleus is mainly found in MALT lymphomas; special patterns of strong nuclei and negative germinal center in orbit and lung, And its differential diagnosis of reactive lesions have some auxiliary meaning.