| Background and 0bjectivePrimary mediastinal?thymus?large B cell lymphoma?PMLBCL?is a special type of B cell lymphoma originating from the thymic medulla,with unique clinical,pathological and molecular genetics characteristics.The early clinical features of most patients are atypical,and the location of the disease is relatively insidious.The imaging examination is has no specificity.The clear diagnosis depends on the pathological examination,but the pathological tissue is difficult to obtain,the incidence is low,the diagnosis is difficult,and it is easy to cause misdiagnosis and missed diagnosis.The diagnosis of primary mediastinal?thymus?large B-cell lymphoma is more difficult to distinguish from systemic diffuse large B-cell lymphoma and classical Hodgkin's lymphoma nodular sclerosis by HE staining.In addition to the expression of whole B cells,the immunophenotype also expressed CD30,bcl-2,bcl-6 and CD10to varying degrees.Only HE histomorphology and existing immunohistochemical indicators may be misdiagnosed or missed.In recent years,studies have shown that CD23 has a higher positive rate in PMLBCL and a lower positive rate in DLBCL because of the different origin cells of PMLBCL.CD200 has a higher positive rate in PMLBCL,but does not express in DLBCL,and has better specificity and sensitivity.The CD23 molecular protein is a marker located on the surface of the B lymphocyte membrane,and has many functions such as mediating B lymphocyte activation and differentiation,processing and presenting antigen.Studies have reported that CD23 is elevated expression in peripheral blood lymphocytes of chronic B lymphocytic leukemia,allergic diseases,autoimmune diseases,etc.,and is positively correlated with the severity of the disease,the stronger the expression,the worse the survival prognosis of patients.CD200 is an immunoglobulin superfamily glycoprotein encoded by a gene located on chromosome 3q12.1.CD200 is expressed in many B-cell derived lymphoid hematopoietic diseases,such as chronic lymphocytic leukemia,acute myeloid leukemia,multiple myeloma,etc.,but is not substantially expressed in systemic diffuse large B-cell lymphoma.In view of the difference in expression of CD23 and CD200 in PMLBCL and DLBCL,it can be used as an important marker for identifying both,and CD200 has not been widely used at present.In this study,immunohistochemistry was used to detect and analyze the expression of CD23 and CD200 in PMLBCL and DLBCL,and to investigate the role of both in the diagnosis of PMLBCL and its differential diagnosis,and to find more specific immunohistochemical indicators to improve diagnosis rate of the disease,in order to provide a theoretical reference for the judgment of PMLBCL prognosis and standardized clinical individualized treatment.Methods1.A total of 33 large B-cell lymphomas diagnosed in the mediastinum were diagnosed by mediastinal biopsy or surgical excision for examination and immunohistochemistry at the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2017,mediastinal puncture was performed in 28 cases,mediastinal mass was surgically removed in 4 cases,and lymph node biopsy was performed in 1 case,among them,18 cases were diagnosed as primary mediastinal?thymus?large b-cell lymphoma and 15 cases as diffuse large b-cell lymphoma,and diffuse large B-cells occurred in non-collapsed lymphoma 50 cases of non-special type.2.The protein expression of CD23 and CD200 in the three groups was detected by immunohistochemical S-P method,and the above methods were compared and analyzed.Explore the possibility of assisted diagnosis of PMLBCL.3.Statistical analysis:The data were analyzed by SPSS20.0 statistical software.The analysis of qualitative data rate was compared by row×column chi-square test;the correlation analysis was performed by paired four table consistency test.The test level?=0.05.ResultsThe results of immunohistochemistry showed:1.The positive expression rates of CD23 in primary mediastinal?thymus?large B-cell lymphoma,diffuse large B-cell lymphoma with mediastinum,and diffuse large B-cell lymphoma with non-medialhernia were 77.78%and 40.00%,respectively8.0%,the difference between the three groups was significant,statistically significant(?2=32.45,P<0.05),and then compared between the two groups,there were statistical differences.2.The positive expression rates of CD200 in primary mediastinal large B-cell lymphoma,diffuse large B-cell lymphoma with mediastinum,and diffuse large B-cell lymphoma with non-medial fistula were 88.89%and 26.67%,respectively 14.00%,the difference between the three groups was statistically significant(?2=34.11,P<0.05),there was no significant difference in the expression rate between the two groups in the diffuse large B-cell lymphoma group and the non-mediastinal diffuse large B-cell lymphoma group.3.The positive rates of CD200 and CD23 in primary mediastinal?thymus?large B-cell lymphoma were 88.89%and 77.78%,respectively.The positive rates in diffuse large B-cell lymphoma were 8.00%and 14.00%,respectively.Co-expression of sexual mediastinal large B-cell lymphoma and diffuse large B-cell lymphoma was statistically significant?P<0.05?.ConclusionsCD23 protein and CD200 protein have high expression effect in primary mediastinal?thymus?large B-cell lymphoma,which can be used as an auxiliary diagnostic index.The expression of the two in PMLBCL/DLBCL has a certain correlation. |
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