A Clinicopathological Study Of EB Virus-positive Diffuse Large B Cell Lymphoma

Objective: Research has showed that among the hematopoietic and lymphoidtissue tumors, EB-virus (EBV) was primarily associated with Hodgkin lymphoma,Burkitt lymphoma, extranodal NK/T cell lymphoma, but its relationship with othertypes of lymphomas was still unclear. Diffuse large B-cell lymphoma (DLBCL) is themost common and heterogeneous type in the hematopoietic and lymphoid tumors, andthe evolution of its classification system is very complicated. The occurrence,progression, and prognosis of DLBCL were related to many factors，but the studiesabout the relationship between EBV and DLBCL were rare. In order to understand therelationship between EBV and DLBCL and its impact on the incidence of clinicalpathology,153cases of DLBCL were retrospectively collected and analyzed byimmunohistochemistry and in situ hybridization (ISH) of EBV. The purpose is toexplore the relationship between EBV infection and DLBCL, the clinicopathologicalfeatures and prognosis of the characteristics of EBV-positive DLBCL, and DLBCLcases of EBV-positive of the elderly and non-senile EBV-positive non-comparativeanalysis, to understand both the clinical and pathological features prognosis isdifferent.Methods: in this study,153cases of DLBCL were selected from the files of Department of Pathology, Sichuan Provincial People’s Hospital between2007and2013. The clinical information and follow-up data of all the cases were collected andsummarized. The pathological diagnosis was based on the2008WHO classificationof hematopoietic and lymphoid neoplasms. Immunohistochemical staining wasperformed for (CD3,CD20,CD79α,CD10,Mum-1,CD5,CD15,CD30,CyclinD1,CD21,Bcl-6,CD23,ALK-1,Ki-67). Hans classification was performed on the basis ofimmunohistochemical type. ISH of EBV was carried out to detected EBV infection.IgH gene rearrangements were ananlysed in the uncertain cases.Results:1.There were21/153cases（13.7%）of EBV-positive DLBCL.2. Theclinicalpathologic characteristics of EBV-positive DLBCL:(1) There were6males(28.6%)and15females(71.4%), male to female ratio of1:3.8. The median age was59years.(2) The localization of tumors were17cases (81%)in lymph nodes,4cases(19%) of in extra nodal，Small intestine, face, external iliac, stomach each onecase.(3)The LDH level was raised in17(81%) cases.（4）Ann Arbor clinical stage:4(19%) cases were in stage Ⅰ~Ⅱ,17(81%)cases were in stage Ⅲ~Ⅳ.(5)7cases（33%）of patients had B symptoms（.6）IPI score:5（23.8%）case of0-2,16（76.2%）cases of3to5.（7）Histological type：central blastic cell type in18（87.5%） cases,immuno blastic cell type3（14.3%） cases（.8）Immunohistochemistry: CD5positivein3cases (14.3%), CD10positive in4cases (19%), Bcl-6positive in9cases (42.9%),Mum-1positive in11cases (52.4%), Ki-67medianis proliferation index(PI) was60%，≥60%in11cases,<60%in10cases.(9)Hans type:16（76.2%）cases ofnon-GCB subtype,5（23.8%）cases of GCB subtype, non-GCB and GCB ratio of1:0.3.(10) Treatment:12（57.1%） cases accepted surgery alone, while surgery incombination with was in9(42.9%) cases.（11）Prognosis: The median survival timeof21cases was10±4.4months, the average survival time was15.3±3months. Theoverall survival was19.0%.3. The results of EBV-positive DLBCL elderly:（1）Thepositive rate:15cases of EBV-positive DLBCL elderly and accounting for9.8%of allcases in this group.(2) Gender:3(20%)males and12(80%) females, the gender ratio of1:4.(3) locations:12(80%) cases in lymph nodes,3(20%) cases of extranodal,Small intestine, face, external iliac each one case.(4) Ann Arbor clinical stage:80%(12/15)for a period of Ⅲ~Ⅳ.(5) Prognosis: the median survival time was7±1.9months, and the average survival time was11.7±3.3months. The overall survivalrate was6.7%of the EBV-positive elderly group.Conclusion:(1)Compared with EBV-negative DLBCL, EBV-positive casespreferred to occur in female patients and in lymph nodes with a higher LDH levels,IPI score and more advanced clinical stage (mostly Ⅲ~Ⅳ). Ki67PI were lower (PP＜0.05) in EBV-positive DLBCLs.(2) EBV-positive DLBCL of the elderlypatients compared with EBV-negative cases, better hair in women and more commonin the lymph nodes, Ki-67PI low and higher stages, the difference was statisticallysignificant (P <0.05).(3) There were no significant difference between theEBV-positive DLBCL of the elderly patients with EBV-positive DLBCL of thenon-senile, except older onset age (P>0.05).(4) EBV can be used as an independentprognostic indicator of DLBCL.(5)The prognosis of EBV-positive DLBCL of theelderly patients were poorer than EBV-negative patients.