The Clinical Pathological Significances Of C-MYC, BCL2Translocation And EBV, CD5, CD30Expression In Diffuse Large B Cell Lymphoma

ObjectiveBy large sample test and retrospective analysis to explore the clinical pathological and prognosis characters of Diffuse large B cell lymphoma with C MYC gene translocation, BCL2/IgH gene translocation and EBV, CD5, CD30expression, and verify these tags can provide guidance for further classification of DLBCL.MethodsWe selected232cases from423DLBCL according to the WHO classification of tumors of hematopoietic and lymphoid tissues (2008), Tissue microarray was constructed. we collected all cases clinical information and pathological information and make a Retrospective studies. Then Fluorescence in situ hybridization(FISH) for C-MYC and BCL2/IgH, IN situ hybridization for EBER-1/2mRNA and immunohistochemical study for CD5、CD30、CD10、BCL-6、MUM-1was performed. according to the expression of CD10、BCL-6、MUM-1, cases were subclassified into germinal center B cell like(GCB) and non-germinal center B cell like (NON-GCB) subtypes, they were followed up by telephone and letters.Results1.15cases of C-MYC rearrangement was detected in the232DLBCL cases,accounting for6.5%of DLBCL (15/232); BCL2/IgH gene translocation in19cases, accounting for8.2%(19/232);C-MYC/BCL2double hit lymphoma4cases, accounting for1.7%(4/232);the positive rate of EBER was9.1%(21/232); the expression rate of CD30was8.2%(19/232); the expression rate of CD5was9.5%(22/232).2.In232cases there are50GCB subtype and164NON-GCB subtype DLBCL with18cases immune classification data missing.GCB subtype accounted for27.6%(4/15) in C-MYC rearrangement cases with2cases immune classification data missing,26.3%(5/19) in BCL2/IgH translocation cases with1cases immune classification data missing. While GCB subtype accounted for17.4%(4/23) in EBER(+) cases,13.6%(3/22) in CD5(+) cases and15.8%(3/19) in CD30(+) cases.3.CD5positive DLBCL occurs more in women (15/21) than men, The difference statistically significant with "the non-specific type"(P=0.046). CD30positive DLBCL prone to B symptoms (6/19) is higher than "the non-specific type", difference has statistical significance (P=0.034).4.The survival curve of C-MYC gene rearrangement DLBCL and CD30-positive DLBCL was significantly worse than non special type of diffuse large B cell lymphoma (P=0.001,P=0.042). The survival curve difference of EBER-positive and the NON-special type of DLBCL lymphoma was not statistically significant (P=0.085),but among them the EBV-positive DLBCL of the elderly has worse prognosis in patients compare with "the non-specific type" DLBCL (P=0.0027).5.1n232cases of DLBCL tissue pathological morphology observation, found that patterns of necrosis in EBER positive cases are more than in "the non-specific type" DLBCL (P=0.000).6.Four cases C-MYC/BCL2double hit lymphoma all revealed aggressive clinical courses with poor prognosis, the median survival time was five months. Conclusion1.The C-MYC gene rearrangement and expression of CD30are independent prognostic factors for IPI score in diffuse large B cell lymphoma. The C-MYC gene rearrangement DLBCL and CD30-positive DLBCL patients was significantly had bad prognosis, and CD30-positive DLBCL easier to B symptoms, is expected to become new subtype of DLBCL.2.CD5positive DLBCL most occurs in older women, but did not find their prognosis different from "the non-specific type". EBV positive DLBCL of the elderly have poorer prognosis, is prone to have pattern necrosis in morphology.