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病例报告:在具有MYC重组的侵袭性B细胞淋巴瘤和白血病中,免疫类型多样化的不成熟模式,包括可变的TdT表达,具有MYC重组

Daishi Kato^1,2, Takahiro Fujino¹, Reiko Isa¹

¹Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Frontiers in oncology

|October 27, 2025

概括

在侵略性的B细胞淋巴瘤中,MYC重组可能会导致不成熟的免疫表型,模仿白血病并创造诊断挑战. 这一发现强调了使用形态学,免疫类型和遗传学进行综合分类的必要性.

科学领域:

血液学血液学血液学
在瘤学瘤学.
分子病理学分子病理学

背景情况:

具有MYC重组的侵略性B细胞淋巴瘤可以表现出免疫表型不成熟.
这种不成熟,包括TdT表达和弱CD20,可以模仿B-淋巴细胞白血病/淋巴瘤 (B-ALL/LBL),导致诊断模两可.
诸如扩散性大B细胞淋巴瘤 (DLBCL) 或高度B细胞淋巴瘤 (HGBCL) 这样的分类可能无法完全捕捉到这些复杂的病例.

研究的目的:

分析具有MYC重组和不成熟免疫表型的侵袭性B细胞淋巴瘤.
调查这些淋巴瘤和B-ALL/LBL之间的诊断重叠.
强调MYC重组在赋予不成熟的免疫表型特征中的作用.

主要方法:

一系列病例 (4名患者) 的回顾性分析.
对89名额外患有MYC重组成熟B细胞淋巴瘤的患者的文献综述.
免疫表型分析包括TdT,CD20,表面膜免疫球蛋白 (smIg) 和轻链表达.
整合形态学,免疫类型和遗传数据 (MYC重新排列).

主要成果:

四例MYC重组的HGBCL-MYC/BCL2或B-ALL病例显示TdT表达,弱/负CD20,没有smIg/轻链.
在MYC重组的病例中,在成熟的B细胞新生体和淋巴细胞白血病之间观察到重叠的免疫类型.
在淋巴瘤和白血病中,MYC重组与不成熟的免疫表型特征密切相关.

结论:

在B细胞淋巴瘤和白血病中,MYC重组有助于不成熟的免疫表型特征.
诊断的模两可是由于免疫类型的重叠造成的,需要仔细评估.
完善的分类整合形态学,免疫类型和遗传学对于准确的诊断和管理至关重要.

关键词:

在B细胞淋巴瘤.CD20 CD20 是一个CD20 CD20 是一个CD20.在MYC的重组中,MYC的重组.免疫类型的不成熟性表面膜免疫球蛋白表面膜免疫球蛋白终端脱氧核乙烯转移酶.

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