發(fā)布時(shí)間：2018-06-13 03:11

  本文選題：Hans分型 + 扁桃體　； 參考：《復(fù)旦大學(xué)》2013年碩士論文

【摘要】：第一部分原發(fā)性扁桃體彌漫大B細(xì)胞淋巴瘤免疫分型的研究 目的：探討原發(fā)性扁桃體彌漫性大B細(xì)胞淋巴瘤(Diffuse Large B Cell Lymphoma, DLBCL)的Hans免疫分型、臨床病理、預(yù)后的相關(guān)性以及與非扁桃體原發(fā)DLBCL分型比較。 方法：收集福爾馬林固定石蠟包埋(Formalin-fixed paraffin-embedded, FFPE)原發(fā)性扁桃體DLBCL標(biāo)本81例,原發(fā)性非扁桃體DLBCL42例。免疫組織化學(xué)(Immunohistochemistry, IHC)技術(shù)檢測(cè)CD10、Bcl-6、MUMI,根據(jù)Hans分類方法將原發(fā)性扁桃體與原發(fā)性非扁桃體DLBCL分為GCB(Germinal center DLBCL)與non-GCB(Non-germinal center DLBCL)兩個(gè)亞型,用SPSS19.0軟件分析原發(fā)性扁桃體與非扁桃體原發(fā)DLBCL之間分型的差異性,以及病人臨床病理資料、預(yù)后的相關(guān)性。 結(jié)果：81例原發(fā)性扁桃體DLBCL中,14(17%)例為GCB型,67(63%)例為non-GCB型。在原發(fā)性扁桃體DLBCL中,分型與病人的性別相關(guān)性(P=0.016)有統(tǒng)計(jì)學(xué)意義,non-GCB中男性所占比率較高,GCB中女性所占比率較高。42例原發(fā)性非扁桃體DLBCL中,18(42.8%)為GCB型,24(57.2%)例為non-GCB型,原發(fā)性扁桃體DLBCL與非扁桃體DLBCL相比,各型所占比率不同,差異有統(tǒng)計(jì)學(xué)意義,t=9.398,P＝0.0020.05。 結(jié)論：原發(fā)性扁桃體DLBCL中,以non-GCB型為主；non-GCB中男性所占比率較高, GCB中女性所占比率較高；與非扁桃體原發(fā)DLBCL分型相比,各型所占比率不同。 第二部分原發(fā)性扁桃體彌漫大B細(xì)胞淋巴瘤與其他部位彌漫大B細(xì)胞淋巴瘤EB病毒感染的差異性研究 目的探討EB病毒(Epstein-Barr Virus, EBV)在原發(fā)性扁桃體彌漫性大B細(xì)胞淋巴瘤(Diffuse Large B Cell Lymphoma, DLBCL)與其他部位的感染率的差異性,同時(shí)比較兩種EBV檢測(cè)方法。 方法收集81例原發(fā)性扁桃體DLBCL、42例原發(fā)性非扁桃體DLBCL,20例扁桃體慢性炎,10例鼻腔NK/T淋巴瘤福爾馬林固定石蠟包埋(Formalin-fixed paraffin-embedded, FFPE)組織。以上組織標(biāo)本均行原位雜交(In situ hybridization, ISH)實(shí)驗(yàn)；其中31例扁桃體DLBCL標(biāo)本行聚合酶鏈?zhǔn)椒磻?yīng)(Polymerase chain reaction, PCR)。用SPSS19.0軟件比較兩種EBV檢測(cè)方法；探討EBV在扁桃體DLBCL與其他部位DLBCL中的存在有無(wú)差異。 結(jié)果81例原發(fā)性扁桃體DLBCL進(jìn)行EBERs ISH檢測(cè),有20例陽(yáng)性；31例原發(fā)性扁桃體DLBCL行LMP1PCR擴(kuò)增,18例陽(yáng)性；42例原發(fā)性非扁桃體DLBCL行EBERs ISH,3例EBERs ISH陽(yáng)性；兩種方法在扁桃體慢性炎中均未檢測(cè)出EBV存在。原發(fā)性扁桃體DLBCL在EBV檢出率與原發(fā)性非扁桃體DLBCL相比較,t=5.603,P=0.0180.05,差異有統(tǒng)計(jì)學(xué)意義�？ǚ綑z驗(yàn)原發(fā)性扁桃體DLBCL中LMP1PCR和EBERs ISH兩種方法的檢測(cè)陽(yáng)性率,t=11.139,P=0.0010.05,差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論原發(fā)性扁桃體DLBCL在EBV存在率上顯著高于原發(fā)性非扁桃體DLBCL。原發(fā)性扁桃體DLBCL組織中檢測(cè)EBV, LMP1PCR方法敏感性統(tǒng)計(jì)學(xué)上顯著優(yōu)于EBERs ISH。 第三部分：原發(fā)性扁桃體彌漫大B細(xì)胞淋巴瘤預(yù)后相關(guān)因素的研究 目的：探討原發(fā)性扁桃體彌漫大B細(xì)胞淋巴瘤(Diffuse Large B Cell Lymphoma, DLBCL)的Hans分型,CD5, Ki-67, EBV的表達(dá)及腫瘤內(nèi)壞死情況與預(yù)后的相關(guān)性。 方法：隨訪病人,獲取病人資料。利用第一部分扁桃體DLBCL的分型數(shù)據(jù)；CD5,Ki-67免疫組化(IHC)；第二部分原位雜交(ISH)數(shù)據(jù)及復(fù)習(xí)HE切片,探討與扁桃體DLBCL預(yù)后相關(guān)因素。所有數(shù)據(jù)經(jīng)SPSS19.0運(yùn)算,P=0.05為檢驗(yàn)水準(zhǔn)。 結(jié)果：原發(fā)性扁桃體DLBCL中,non-GCB型有較好的結(jié)局(P=0.042)；CD5表達(dá)與病人生存期及結(jié)局相關(guān)性(P0.05)沒(méi)有統(tǒng)計(jì)學(xué)意義；較高的發(fā)病年齡(P=0.041)及較高的Ki-67評(píng)分(P=0.039)與預(yù)后負(fù)相關(guān)；EBERs陽(yáng)性與預(yù)后正相關(guān)(P＝0.033),腫瘤組織內(nèi)壞死的出現(xiàn)與預(yù)后(P=0.016)正相關(guān)。 結(jié)論：Hans分型、EBV、Ki-67、發(fā)病年齡及腫瘤內(nèi)組織壞死情況均可提示原發(fā)性扁桃體DLBCL的預(yù)后。
[Abstract]:Part one immunological classification of primary tonsillar diffuse large B cell lymphoma
Objective: To investigate the Hans immunophenotyping of primary tonsillar diffuse large B cell lymphoma (Diffuse Cell Lymphoma, DLBCL), the correlation of clinicopathology, prognosis and the comparison with the non tonsillar primary DLBCL typing of the primary tonsillar B Lymphoma Lymphoma (DLBCL).
Methods: 81 cases of primary tonsil DLBCL specimens from formalin fixed paraffin (Formalin-fixed paraffin-embedded, FFPE) and primary non tonsil DLBCL42 were collected. CD10, Bcl-6, MUMI were detected by immunohistochemistry (Immunohistochemistry, IHC) technique. The primary tonsil and primary non tonsil DLBCL were carried out according to the Hans classification method. It is divided into two subtypes of GCB (Germinal center DLBCL) and non-GCB (Non-germinal center DLBCL). The difference between the typing of primary tonsil and non tonsillar primary DLBCL, as well as the correlation between the clinicopathological data and the prognosis of the patients are analyzed by SPSS19.0 software.
Results: in 81 cases of primary tonsillar DLBCL, 14 (17%) were GCB and 67 (63%) was non-GCB. In primary tonsillar DLBCL, the sex correlation (P=0.016) of the patients was statistically significant, the ratio of male to non-GCB was higher, and the ratio of women in GCB was higher in.42 case primary non tonsillar DLBCL, 18 (42.8%) was GCB, 24 (42.8%). 57.2%) of the cases were non-GCB type, and the ratio of DLBCL in primary tonsil was different from that in non tonsil DLBCL. The difference was statistically significant, t=9.398, P = 0.0020.05.
Conclusion: in primary tonsillar DLBCL, non-GCB type is the main type, the ratio of male in non-GCB is higher, and the ratio of women in GCB is higher. Compared with non tonsillar primary DLBCL typing, the proportion of each type is different.
The second part is the difference of EB virus infection between primary tonsillar diffuse large B cell lymphoma and other diffuse large B cell lymphoma.
Objective to investigate the difference in the infection rate of EB virus (Epstein-Barr Virus, EBV) in primary tonsillar diffuse large B cell lymphoma (Diffuse Large B Cell Lymphoma, DLBCL) and the other two types of EBV detection methods.
Methods 81 cases of primary tonsil DLBCL, 42 cases of primary non tonsil DLBCL, 20 cases of tonsillar chronic inflammation, 10 cases of NK/T lymphoma of nasal cavity and formalin fixed paraffin embedded (Formalin-fixed paraffin-embedded, FFPE) tissue. All of the above tissue specimens were in situ hybridization (In situ hybridization, ISH); 31 of them were tonsillar DLBCL. Polymerase chain reaction (PCR). Compare two EBV detection methods with SPSS19.0 software, and discuss the existence of EBV in the presence of DLBCL in the tonsil DLBCL and other parts.
Results 81 cases of primary tonsil DLBCL were detected by EBERs ISH, 20 cases were positive, 31 cases of primary tonsil DLBCL were amplified by LMP1PCR and 18 were positive; 42 cases of primary non tonsil DLBCL were EBERs ISH and 3 cases of EBERs ISH were positive; the two methods were not detected EBV in tonsil chronic inflammation. Compared with primary non tonsillar DLBCL, t=5.603, P=0.0180.05, the difference was statistically significant. The positive rate of two methods of LMP1PCR and EBERs ISH in primary tonsil DLBCL, t=11.139, P=0.0010.05, were statistically significant.
Conclusion the incidence of primary tonsil DLBCL in EBV is significantly higher than that of primary non tonsillar DLBCL. primary tonsillar DLBCL tissue to detect EBV. The sensitivity of LMP1PCR method is significantly better than that of EBERs ISH..
The third part: prognostic factors of primary tonsillar diffuse large B cell lymphoma.
Objective: To investigate the Hans typing of primary tonsil diffuse large B cell lymphoma (Diffuse Large B Cell Lymphoma, DLBCL), the expression of CD5, Ki-67, EBV, and the correlation between the tumor necrosis and the prognosis of the tumor.
Methods: follow up the patients and obtain the patient's data. Using the type data of the tonsil DLBCL in the first part, CD5, Ki-67 immunohistochemistry (IHC), the second part of the in situ hybridization (ISH) data and the review of the HE section, the prognosis related factors of the tonsil DLBCL were discussed. All the data were calculated by SPSS19.0, P=0.05 was the test level.
Results: in primary tonsillar DLBCL, non-GCB had a better outcome (P=0.042); the expression of CD5 was not statistically significant to the patient's survival and outcome (P0.05); higher onset age (P=0.041) and higher Ki-67 score (P=0.039) were negatively correlated with prognosis; EBERs positive was positively correlated with prognosis (P = 0.033), and necrosis in tumor tissues. There is a positive correlation between the appearance and prognosis (P=0.016).
Conclusion: Hans typing, EBV, Ki-67, age of onset and necrosis of tumor tissue all suggest the prognosis of DLBCL of primary tonsil.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R739.64

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 宗永生,吳秋良,林素暇,何潔華,張昌卿;EB病毒相關(guān)性疾病病理學(xué)研究的進(jìn)展[J];中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版);2005年05期

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本文編號(hào)：2012431