The Study Of The Classification, Prognosis And Correlation With Epstein-Barr Virus In Primary Tonsillar Diffuse Large B Cell Lymphoma

Part one:The immune classification of primary tonsillar diffuse large B cell lymphomaObjective:According to Hans’s immune classification, this part aimed to classify the primary tonsillar diffuse large B cell lymphoma (DLBCL) and studied the correlation of classification with clinical pathology and prognosis. Compare the classification with the non-tonisllar DLBCL.Methods:81cases of formalin fixed paraffin embedding (FFPE) primary tonsillar DLBCL and42cases of FFPE primary non-tonsillar DLBCL were collected. CD10, Bcl-6, MUMI were detected to classify the primary tonsillar and non-tonsillar DLBCL into germinal center (GCB) and non-germinal center (non-GCB) by immunohistochemical (IHC) according to Hans algorithm. The SPSS19.0software was used to study the correlation of clinical pathology and prognosis with classification and compare the classification of tonsillar with the non-tonsillar ones.Results:There were14of the81cases of primary tonsillar DLBCL belonged to GCB type and67(63%) cases belonged to non-GCB. Eighteen cases of42cases non-tonsillar DLBCL belonged to GCB and24cases belonged to non-GCB type. Classification was correlated with patient’s sex (P=0.016), in non-GCB type, male was more common; in GCB type female was the priority among primary tonsil DLBCL. The classification of tonsillar DLBCL was significantly different from the non-tonsillar DLBCL, t=9.398, P=0.002<0.05.Conclusion:Non-GCB type was the majority type in primary tonsillar DLBCL; male was prevailed among non-GCB, while female was more common in GCB. The classification of tonsillar DLBCL was different from the non-tonsillar DLBCL. Part two The different infection rate of Epstein-Barr virus in primary tonsillar and non-tonsillar diffuse large B cell lymphoma and the comparison of two methodsObjective:To investigate if there is any difference between primary tonsillar and non-tonsillar diffuse large B cell lymphoma (DLBCL) in Epstein-Barr virus (EBV) infection. We also intend to determine which method of detection is more accurate in this assessment.Method:We collected81cases of primary tonsillar DLBCL,42cases of non-tonsillar DLBCL,20cases of tonsillar chronic inflammation. These tissues underwent EBERs in situ hybridization (ISH),31cases of primary tonsillar DLBCL went to latent membrance protein1(LMP1) gene polymerase chain reaction (PCR),and then compared the detection rate of EBERs ISH and LMP1PCR in primary tonsillar DLBCL using SPSS19.0statistical software, and chose P=0.05as inspection level.Results:Of the81cases of primary tonsillar DLBCL,20(24.7%) cases EBERs ISH were positive. There were18in31cases underwent PCR (58.06%) expressed LMP1. Three in42cases of non-tonsillar DLBCL were EBERs ISH positive; none of chronic inflammation was positive using the two methods. The result suggested that primary tonsillar DLBCL was significantly higher than non-tonsillar DLBCL in the infection of EBV, t=5.603, P=0.018<0.05. In primary tonsillar DLBCL, detection rate of LMP1PCR and EBERs ISH had significant difference, t=11.139, P=0.001<0.05.Conclusions:The infection rate of EBV between primary tonsillar and non-tonsillar DLBCL was significant difference. The detection rate of LMP1PCR significant higher than EBERs ISH. Part three Prognostic factors in primary tonsillar diffuse large B cell lymphomaObjective:Study the prognositic functions of diffuse large B cell lymphoma (DLBCL) classification, the expression of CD5, Ki-67, EBV and necrosis within tumor in primary tonsillar DLBCL.Methods:Follow-up these patients and got patients’information. Used the data of the first part in classification of the81cases of primary tonsillar DLBCL; immunohistochemical (IHC) of CD5, Ki-67were also done in these tissues; the detection rate of EBERs of ISH were used, and the HE sliced of81cases of tonsillar DLBCL were reviewed. All the datum were processed in SPSS19.0statistical software, and chose P=0.05as inspection level.Results:Non-GCB type was prevail in primary tonsillar DLBCLwith a better prognosis (P=0.042); CD5+cases did not significantly asscioated with prognosis(P>0.05); older onset age (P=0.041) and higher scores of Ki-67(P=0.039) indicated poor prognosis; EBERs is a good prognostic index (P=0.033). Necrosis within the tumor tissue predicted good outcome (P=0.016).Conclusion:Our result confirmed that immune classifications and EBERs, Ki-67, age and necrosis within tumor can be used as prognostic indicators in primary tonsillar DLBCL.