肌细胞增强因子2B和其他生发中心相关抗原在B细胞非霍奇金淋巴瘤鉴别诊断中的意义比较

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  ——本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。

  在正常生发中心(germinal center,GC) B细胞中,肌细胞增强结合因子2B (myocyte enhancer binding factor 2B,MEF2B)是原癌基因BCL6的转录激活因子。还不清楚其在B细胞淋巴瘤中的表达情况及与其他生发中心相关抗原有何区别。MEF2B在B细胞淋巴瘤,特别是滤泡型淋巴瘤(follicular lymphoma,FL)和边缘区淋巴瘤(marginal zone lymphoma,MZL) 鉴别诊断中的意义仍待探讨。我们对比了MEF2B与其他生发中心标志物、LIM结构域特有转录因子2(LlM domain-only transcription factor 2,LM02)以及人类生发中心相关淋巴瘤(human GC-associated lymphoma,HGAL)蛋白在多种B细胞淋巴瘤中的表达情况,重点关注了它们在FL和MZL鉴别诊断中的意义。在所有FL和Burkitt淋巴瘤、8/9的套细胞淋巴瘤、2/24的脾脏MZL、1/10的慢性淋巴细胞性白血病/小淋巴细胞性白血病和38/44的弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)中,MEF2B为阳性表达;但在所有黏膜相关淋巴样组织的结外MZL、淋巴结MZL和B淋巴母细胞淋巴瘤中, MEF2B均为阴性表达。聚焦低级别FLvs.MZL,MEF2B在FL中的敏感性为100%,特异性为95%,这一结果与BCL6相似,但优于LM02 (敏感性87%,特异性86%)和HGAL (敏感性97%,特异性86%)。值得注意的是,在4例浆细胞样分化的FL中,MEF2B均为阳性,而CD10为阴性,BCL6仅为弱阳性,其中1例LM02和HGAL表达同时缺失。MEF2B在22/25 (88%)例GC型DLBCL中为阳性表达,但是在非GC型DLBCL中也有16/19 (84%)的病例为阳性表达。在FL和MZL的鉴别诊断中,MEF2B的敏感性和特异性均优于LM02和HGAL,特别是在与MZL形态学和免疫学表型上非常相似的浆细胞样分化的FL中价值更为突出。然而,MEF2B在多数套细胞淋巴瘤和许多非GC型DLBCL中也呈明显阳性表达,其对GC来源的B细胞淋巴瘤特异性很差。
Am J Surg Pathol 2018;42:342-350
美国外科病理学杂志中文版2018年第三期摘要No.6
庄翔 翻译 石毓君 审校
  The American Journal of Surgical Pathology中文版声明:
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