Abstract
Among Epstein-Barr virus (EBV)-positive cytotoxic T/NK-cell lymphoma, there are only a few reports on the clinicopathologic features of patients with primary nodal presentation (nodal EBV cytotoxic T-cell lymphoma [CTL]). Here, we compared the clinicopathologic profiles of 39 patients with nodal EBV CTL with those of 27 cases of "extranasal" NK/T-cell lymphoma of nasal type (ENKTL), especially addressing their T-cell receptor (TCR) phenotype. Histologically, 22 of 39 nodal EBV CTL cases (56%) were unique in having centroblastoid appearance, which was contrasted with the lower incidence of this feature in ENKTL (15%, P=0.001). In contrast, pleomorphic appearance was more frequently seen in ENKTL than in nodal EBV CTL (67% vs. 23%, P=0.001). Thirty-three of 39 nodal EBV CTL cases (85%) were of T-cell lineage on the basis of TCR expression and/or TCRγ gene rearrangement; in detail, 18 cases (46%) were TCRβ positive (αβ T), 5 (13%) were TCRγ and/or δ positive (γδ T), and 10 (26%) were TCR-silent type with clonal TCRγ gene rearrangement but no expression of TCRβ, γ, or δ. These results were clearly contrasted by a lower incidence of T-cell lineage in ENKTL (7 cases, 26%, P<0.001). Notably, the survival time of the 5 nodal lymphoma patients with γδ T-cell phenotype was within 3 months, which was inferior to those of αβ T and TCR-silent types (P=0.003), and 3 of those with available clinical information were all found to be associated with autoimmune diseases. These data suggest that nodal EBV CTL is distinct from ENKTL.
摘要
在EBV阳性细胞毒性NK/T细胞淋巴瘤中,关于淋巴结内原发病例(EBVCTL)的临床病理特征报道很少。
这里我们分析了39例淋巴结EBVCTL的临床病理特征,并且与27例鼻外的鼻型NK/T细胞淋巴瘤(ENKTL)进行比较,尤其是他们的T细胞受体表型。
组织学上,39例淋巴结EBVCTL中有22例(56%)有特征性的中心母细胞形态,这一特征在ENKTL中出现的几率较低(15%,P=0.001)。与此相反,多形性特征在ENKTL中比在淋巴结EBVCTL中更经常见到(67%vs.23%,P=0.001)。39例淋巴结EBVCTL中有33例(85%)具有T细胞谱系的T细胞受体表达和/或TCRγ基因重排,具体地说,18例(46%)TCRβ阳性(αβT),5例(13%)TCRγ和/或δ阳性(γδT),10例(26%)是TCR沉默型、即存在克隆性的TCRγ基因重排但不表达TCRβ、γ或δ。这些结果在ENKTL的T细胞谱系中出现的比例较低(7例,26%,P<0.001)。值得注意的是5例具有γδT细胞表型的结内淋巴瘤患者生存期在3个月以内,明显差于αβT细胞型和TCR沉默型(P=0.003),其中有3例存在与自身免疫性疾病相关的临床信息。这些数据表明淋巴结EBVCTL有别于ENKTL。
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