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目的观察乳腺原发性弥漫性大B细胞性淋巴瘤(DLBCL)的临床病理特征、免疫表型,探讨乳腺DLBCL的诊断、鉴别诊断、治疗及预后。方法按WHO(2008)淋巴瘤分类标准,收集22例乳腺原发性DLBCL,分析其临床病理特征、免疫分型并随访。结果 22例DLBCL均为女性,年龄29～74岁,中位年龄50岁。其中左乳10例,右乳11例,双乳1例。Ann Arbor分期1例为Ⅲ期,1例为Ⅳ期,其余均为Ⅰ期或Ⅱ期。单侧乳腺肿块是最常见的首发症状。镜下多表现为中等大小或较大的肿瘤性淋巴细胞弥漫浸润,部分呈“列兵样”排列,可残存乳腺结构,部分可见淋巴上皮病变,有/无坏死。可行免疫分型的病例均为非生发中心B细胞(GCB)型。11例获得随访资料,其中7例存活,存活时间为18～80个月;4例死亡,生存时间为5～15个月。结论乳腺原发性DLBCL少见,表型多为非GCB型,免疫组化标记有助于确诊,治疗以手术治疗辅助联合化、放疗等方案为宜。
Objective To observe the clinicopathological features and immunophenotype of breast primary diffuse large B-cell lymphoma (DLBCL) and to investigate the diagnosis, differential diagnosis, treatment and prognosis of breast DLBCL. Methods According to WHO (2008) classification of lymphoma, 22 cases of breast primary DLBCL were collected and analyzed for clinicopathological features, immunophenotype and follow-up. Results All the 22 cases of DLBCL were female, aged 29-74 years with a median age of 50 years. Of which 10 cases of left breast, right breast in 11 cases, 1 case of breast milk. Ann Arbor staging 1 case of stage Ⅲ, 1 case of stage Ⅳ, the rest are stage Ⅰ or Ⅱ. Unilateral breast lumps are the most common first symptom. Microscopic performance of medium size or larger diffuse infiltration of tumor-bearing lymphocytes, some were “soldier-like” arrangement, the residual structure of the breast, part of the lymphatic epithelial lesions, with / without necrosis. Feasible immunophenotyping cases are non-germinal center B cells (GCB) type. Eleven patients were followed up, of which seven cases survived, the survival time was 18 to 80 months; 4 patients died and the survival time was 5 to 15 months. Conclusions Breast primary DLBCL is rare, phenotype is mostly non-GCB type, and immunohistochemical markers are helpful for the diagnosis. Surgical adjuvant chemotherapy and radiotherapy are the best options.