Investigation Of Protein Expression In Follicular Lymphoma And Diffuse Large B-cell Lymphoma

Objective:Diffuse large B-cell lymphoma(DLBCL) and Follicular lymphoma(FL) are the common two types of non-Hodgkin's lymphomas (NHL) , the indolent FL can transition to highly aggressive DLBCL. FL and a part of DLBCL have the common cell origin,so they have the biological and immunological characteristics of germinal center B-cell derived lymphoma. The morphological features,immune phenotypes,genetics and clinical characteristics of DLBCL are different,that may be not a separate disease. Scholars at home and abroad by different methods divided DLBCL into two subtypes according to the different cell origin,that is germinal center B-cell derived DLBCL(GCB-DLBCL) and Non-germinal center B-cell derived DLBCL(Non GCB-DLBCL). The two subtypes of DLBCL are different in cell origin,so that also is different in biological characteristics and the prognosis.Sometimes DLBCL is difficult to identify poorly differentiated carcinoma, when the polymorphologic DLBCL and the worse quality of HE slide, particularly in the extra-nodal DLBCL. FL and follicles reactive hyperplasia in lymph node are a common problem in the differential diagnosis. Lymphoma is a tumor of the immune system,which is to make the diagnosis on the basis of morphologic characteristics combining monoclonal antibody immunohistochemical markers. CD10 and Bcl-6 are the markers of the germinal center,which are also expression in the germinal-center derived lymphomas, such as FL,GCB-DLBCL and BL. MUM-1 is non germinal-center marker, different expressions in the circumstances by using CD10,Bcl-6 and MUM-1,DLBCL can be divided into GCB-DLBCL and Non GCB-DLBCL. Ki-67 and Bcl-2 are the commonly prognostic markers,Ki-67 in the expression rate of aggressive lymphoma is higher than inert lymphoma. We can make the differential dignosis of FL and follicles reactive hyperplasia in lymph node,according to BcL-2 expression in different sites. At the same time,Bcl-2 is a resistance gene, which may affect the effect of treatment.This study examined the immune phenotype characteristics of FL and DLBCL at the protein level,discussion the cell origin and prognostic significance,providing the reference for the clinical treatment and the prognosis.Methods:The experiment collected clinicopathological datas of 44 cases FL and 22 cases DLBCL,18 cases in the lymph nodes,48 cases of extra-nodes(46 cases of tonsil, one case of mediastinal,one case of the small intestine),observed the histopathologic charcteristics and the immunohistochemical staining by SP two-step,using CD10,Bcl-6,MUM-1,Ki-67 and Bcl-2 monoclonal antibodys.Results:1.The expression rates of CD10,Bcl-6 in FL are 36.36%,77.27%,the co-expression rate of both in FL is 31.81%;the expression rate of CD10 betwen the lymph nodes and extra-nodes of FL is no significant difference(P <0.05). The expression rates of Bcl-6 in the lymph nodes and extra-nodes of FL are 28.57%,86.48%, and there is significant difference (P> 0.05), the expression of Bcl-6 is higher in extra-nodes than that in the lymph nodes.2. The expression rates of CD10,Bcl-6 and MUM-1 in DLBCL are 22.72%,63.63%and 77.27%, three expressions in the lymph nodes of DLBCL and the extra-nodes of DLBCL are no significant differences (P <0.05). 3.According to CD10,Bcl-6 and MUM-1 expressions in the 22 cases of DLBCL,we can divide DLBCl into groups: CD10 is positive(GCB-DLBCL),five cases;CD10 and Bcl-6 are both negative (Non GCB-DLBCL),8 Cases;CD10 is negative,Bcl-6 is positive and MUM-1 is positive (Non GCB-DLBCL),seven cases;CD10 is negative,Bcl-6 is positive and MUM-1 is negative(GCB-DLBCL),two cases. DLBCL can be divided into GCB-DLBCL and Non GCB-DLBCL ,7 cases of GCB-DLBCL (2 cases of lymph nodes,5 cases of extra-nodes),15 cases of the Non GCB-DLBCL (9 cases of lymph nodes,6 cases of extra-nodes).The proportion of GCB-DLBCL is lower than Non GCB-DLBCL.4. The expression rates of Ki-67 betwen FL and DLBCL are 33.33% and 72.72%,and there is significant differences(P> 0.05),the expression rate of Ki-67 in the DLBCL is higher than in the FL. The expression rate of Bcl-2 betwen FL and DLBCL is no significant difference(P <0.05).The expression rates of Ki-67 and Bcl-2 betwen GCB-DLBCL and Non GCB-DLBCL are no significant differences(P <0.05).Conclusions:1.Follicular lymphoma may transformation to diffuse large B-cell lymphoma,that is the indolent changes to the invasive,at the same time lymph nodes and the extra-nodes,the characteristics is in coexistence.2.Combination the three markers of CD10,Bcl-6 and MUM-1,diffuse large B-cell lymphoma is divided into two subtypes of germinal center origin and the non- germinal origin.3.In the region,non-germinal origin of diffuse large B-cell lymphoma is in the majority,they there are a adverse prognosis.This study from the perspective of clinical pathology concluded the features of follicular lymphoma and diffuse large B-cell lymphoma, observing CD10,Bcl-6,MUM-1,Ki-67 and Bcl-2 etc. defined the diagnosis and the identification of two most common types of lymphoma the germinal center derived B cell lymphoma and non-germinal center derived DLBCL,so that make the clinical treatment options and prognosis judgement more objective. At the same time it clears that follicular lymphoma transformations to diffuse large B-cell lymphoma that is the inert changes to the invasive. Further it reveals a fact, non germinal center derived diffuse large B-cell lymphoma is in the majority in the region.