Malignant lymphoma arising in angio‐immunoblastic lymphadenopathy
Malignant lymphoma arising in angio‐immunoblastic lymphadenopathy
复制标题
血管免疫母细胞性淋巴结病引起的恶性淋巴瘤
作者：
B. Nathwani;H. Rappaport;E. Moran;G. Pangalis;Hun Kim
这项研究基于 48 名患有血管免疫母细胞性淋巴结病的患者，以及 36 名患者，其淋巴结除了血管免疫母细胞性淋巴结病 (AILD) 外，在诊断性活检中还显示出组织学特征被解释为免疫母细胞型恶性淋巴瘤的患者。在进行后续活检或尸检的 23 名 AILD 患者中，有 35%（即 8 名）进展为免疫母细胞淋巴瘤 (IL)。多个紧密排列的大淋巴细胞簇或岛构成了 IL 的最初组织学证据。随后的组织检查揭示了疾病的进展，表现为肿瘤细胞增殖对淋巴结的弥漫性替代。 AILD 患者和淋巴结活检被解释为 AILD + IL 的患者之间在既往病史、临床或实验室检查结果上没有观察到显着差异。然而，这两组在泼尼松或化疗或两者联合治疗后的完全缓解率方面存在很大差异（AILD 为 63%，AILD + IL 为 26%；p = 0.01）；中位生存期（AILD 为 35 个月，AILD + IL 为 6 个月；p = 0.0004）；尸检时恶性淋巴瘤的发生率（AILD 为 20%，AILD + IL 为 82%；p < 0.005）；尸检时发现结外恶性淋巴瘤（AILD 为 10%，AILD + IL 为 64%；p < 0.025）。在AILD组中，泼尼松后完全缓解的患者的中位生存期显着长于部分缓解或无缓解的患者（p = 0.02），接受化疗的患者也是如此（p < 0.003）。在 AILD + IL 组中，接受化疗的患者中位生存期观察到类似的差异 (p < 0.007)，但接受泼尼松治疗的患者则没有观察到类似的差异 (p = 0.31)。
This study is based upon 48 patients with angio‐immunoblastic lymphadenopathy and 36 patients whose lymph nodes revealed, in addition to angio‐immunoblastic lymphadenopathy (AILD), histologic features interpreted as malignant lymphoma of the immunoblastic type in the diagnostic biopsy. Progression into immunoblastic lymphoma (IL) was observed in 35%, or eight, of the 23 patients with AILD in whom follow‐up biopsies or autopsy were performed. Multiple clusters or islands of compactly arranged large lymphoid cells constituted the initial histologic evidence of IL. Subsequent tissue examination revealed progression of the disease in the form of diffuse replacement of lymph nodes by the neoplastic cellular proliferation. No significant differences in the past history, clinical or laboratory findings were observed between the patients with AILD and those whose lymph node biopsies were interpreted as AILD + IL. These two groups differed greatly, however, with respect to rate of complete remission following either prednisone or chemotherapy, or both (63% for AILD vs. 26% for AILD + IL; p = 0.01); median survival (35 months for AILD vs. six months for AILD + IL; p = 0.0004); incidence of malignant lymphoma at autopsy (20% for AILD vs. 82% for AILD + IL; p < 0.005); and the finding of extranodal malignant lymphoma at autopsy (10% in AILD vs. 64% in AILD + IL; p < 0.025). In the AILD group, median survival of patients who had complete remission after prednisone was significantly longer than that of patients who had partial or no remissions (p = 0.02) and the same was true for patients who were given chemotherapy (p < 0.003). In the AILD + IL group, a similar difference in the median survival was observed in patients treated with chemotherapy (p < 0.007), but not in those treated with prednisone (p = 0.31).