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目的探讨EB病毒阳性的老年人弥漫性大B细胞性淋巴瘤(DLBCL)的组织形态特征、免疫组化、诊断与鉴别诊断,观察治疗及预后情况。方法对2例老年人EBV阳性的DLBCL行HE和免疫组化染色观察,收集临床资料并随访。结果患者年龄分别为58岁和72岁,无免疫缺陷及淋巴瘤病史。病理改变主要为大小差别较大的异型淋巴细胞弥漫浸润,散在少数R-S样细胞,可见广泛的地图样肿瘤性坏死及血管中心性浸润。免疫组化显示异型肿瘤细胞CD20弥漫强(+),80%～90%肿瘤细胞胞核EBV原位杂交呈中～强(+)。随访3～6个月,1例死亡。结论老年人EBV阳性的DLBCL罕见,是最近正在被逐渐认识的新淋巴瘤类型,其临床和病理特征独特,诊断需与淋巴瘤样肉芽肿和EBV阳性的霍奇金淋巴瘤鉴别。
Objective To investigate the histopathological features, immunohistochemistry, diagnosis and differential diagnosis of DLBCL in elderly patients with Epstein-Barr virus (EBV) and to observe the treatment and prognosis of DLBCL. Methods Two cases of EBV-positive DLBCL in the elderly were examined by HE and immunohistochemistry. The clinical data were collected and followed up. Results The patients were 58 and 72 years old, respectively, with no history of immunodeficiency and lymphoma. The major pathological changes were diffuse infiltration of atypical lymphocytes of large and small size, scattered in a small number of R-S-like cells, showing extensive map-like tumor necrosis and central vascular invasion. Immunohistochemistry showed that CD20 was diffusely diffuse (+) in allogeneic tumor cells, and mid-to-strong (+) EBV in situ hybridization in 80% -90% tumor cells. A follow-up of 3 to 6 months, 1 patient died. Conclusion The rare EBV-positive DLBCL in the elderly is a new type of lymphoma that is being gradually recognized recently. The clinical and pathological features of DLBCL are unique. The diagnosis of lymphoma-like granulomas and EBV-positive Hodgkin’s lymphoma should be differentiated.