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目的探讨套细胞淋巴瘤(MCL)的临床病理特征及预后因素。方法对102例经形态学及免疫表型检测确定的 MCL 进行分析,组织病理制片和链霉素抗生物素蛋白过氧化物酶法或EnVision 法染色,并进行了随访。结果 102例患者中位年龄59岁(30～79岁),男女之比约2.92:1。淋巴结是最常受累的部位(98/98,100%),结外常受累的部位:骨髓(29/45,64.4%)、脾脏(36/57,63.2%)、咽淋巴环(15/48,31.3%)、外周血(15/51,29.4%)、肝脏(12/53,22.6%)及胃肠道(15/102,14.7%);87.7%(71/81)初次就诊时处于临床Ⅲ～Ⅳ期,45.5%(25/55)患者有 B 症状;48.7%(19/39)患者血清乳酸脱氢酶升高。除7例(6.9%)因组织取材小无法区分病变模式外,余95例中12例(11.76%)为套区增生型,41例(40.2%)结节型,42例(41.2%)弥漫型。75.5%(77)经典型,24.5%(25例)瘤细胞呈母细胞样变型。102例均表达 B 细胞标记而不表达 T 细胞标记,96例(94.1%)肿瘤细胞表达细胞周期蛋白 D1,70例(71.4%)CD5弱阳性。68例获得随访,中位生存时间10个月(0～89个月)。套区增生型+结节型、经典型的核分裂象≤15/10 HPF,增殖指数≤15%;骨髓无受累,提示患者预后好,而其他临床病理因素对患者生存未见影响。结论国内 MCL 患者病征与国外患者基本一致,其病变模式、细胞变型、核分裂象、增殖指数、骨髓是否受累及受累程度与预后有关。
Objective To investigate the clinicopathological features and prognostic factors of mantle cell lymphoma (MCL). Methods 102 cases of MCL determined by morphological and immunophenotypic tests were analyzed, histopathology and streptavidin peroxidase or EnVision staining were performed and followed up. Results The median age of 102 patients was 59 years (30-79 years), and the ratio of men to women was 2.92: 1. Lymph nodes were the most frequently affected sites (98/98, 100%). The most common sites of extranodal involvement were bone marrow (29/45, 64.4%), spleen (36/57, 63.2%), pharyngeal lymph node (15/48, 31.3 (15/51, 29.4%), liver (12 / 53,22.6%) and gastrointestinal tract (15 / 102,14.7%); 87.7% (71/81) were in clinical stage Ⅲ ~ Ⅳ, 45.5% (25/55) patients with B symptoms; 48.7% (19/39) patients with elevated serum lactate dehydrogenase. Except for 7 cases (6.9%), there were 12 cases (11.76%) with neoplasia, 41 cases (40.2%) nodular and 42 cases (41.2%) diffused type. 75.5% (77) of the classic, 24.5% (25 cases) tumor cells showed a mother-like variant. Totally, 96 cases (94.1%) of tumor cells expressed cyclin D1, and 70 cases (71.4%) of CD5 were weakly positive. 68 patients were followed up, the median survival time of 10 months (0 ~ 89 months). Set of hyperplastic nodules, classic schizophrenia ≤ 15/10 HPF, proliferation index ≤ 15%; bone marrow without involvement, suggesting that patients with good prognosis, and other clinical and pathological factors had no effect on the survival of patients. Conclusions The symptoms of MCL patients in China are basically the same as those in other countries. The pathological changes, cell variant, mitosis, proliferation index, bone marrow involvement and prognosis are all related.