目的:MNDA(髓样核分化抗原)被认为是边缘区淋巴瘤(MZL)的潜在诊断标志物,但其在区分MZL与其他B细胞非霍奇金淋巴瘤(B-NHL)方面的效用及其在弥漫性大B细胞淋巴瘤(DLBCL)中的临床病理相关性尚不明确.我们全面研究了一系列B-NHL中MNDA的表达,并评估了其诊断价值。
方法:采用免疫组织化学方法检测1293例B-NHL和338例反应性淋巴增生(RLH)中MNDA的表达,并在不同类型的B-NHL中进行比较。研究了MNDA在DLBCL中的临床病理相关性。
结果:MNDA在MZL中高表达(437/663,65.9%),与RLH边缘区B细胞的局限染色相比;而浆细胞分化的肿瘤细胞丢失了MNDA表达。MNDA在套细胞淋巴瘤中表达显著增高(MCL,79.6%,p=0.006),而在慢性淋巴细胞白血病/小淋巴细胞淋巴瘤中较低(CLL/SLL,44.8%,p=0.001)和淋巴浆细胞性淋巴瘤(LPL,25%,p=0.016),在滤泡性淋巴瘤中显著降低(FL,5.2%,p<0.001),与MZL相比。29.6%(63/213)的DLBCL为MNDA阳性。非GCB组的MNDA阳性率(39.8%)高于GCB组(16.3%)(p<0.001),在具有BCL2/MYC双表达(50%)的DLBCL中比没有BCL2/MYC双表达(24.8%)的DLBCL中更频繁地观察到MNDA染色(p=0.001)。此外,MNDA和CD5在DLBCL中的表达之间存在显着相关性(p=0.036)。
结论:MNDA在MZL中高表达,在MZL和RLH以及FL的鉴别诊断中具有潜在的应用价值。而它在区分MZL和MCL方面的价值,CLL/SLL是有限的。此外,MNDA在DLBCL中的表达更常见于非GCB组和BCL2/MYC双表达组,并证明与CD5有相关性,值得进一步研究。MNDA的临床相关性及其与这些淋巴瘤预后的相关性也需要充分阐明。
OBJECTIVE: MNDA (myeloid nuclear differentiation antigen) has been considered as a potential diagnostic marker for marginal zone lymphoma (MZL), but its utility in distinguishing MZL from other B-cell non-Hodgkin lymphomas (B-NHLs) and its clinicopathologic relevance in diffuse large B-cell lymphoma (DLBCL) are ambiguous. We comprehensively investigated
MNDA expression in a large series of B-NHLs and evaluated its diagnostic value.
METHODS: MNDA expression in a cohort of 1293 cases of B-NHLs and 338 cases of reactive lymphoid hyperplasia (RLH) was determined using immunohistochemistry and compared among different types of B-NHL. The clinicopathologic relevance of
MNDA in DLBCL was investigated.
RESULTS: MNDA was highly expressed in MZLs (437/663, 65.9%), compared with the confined staining in marginal zone B-cells in RLH; whereas neoplastic cells with plasmacytic differentiation lost
MNDA expression. MNDA expression was significantly higher in mantle cell lymphoma (MCL, 79.6%, p = 0.006), whereas lower in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL, 44.8%, p = 0.001) and lymphoplasmacytic lymphoma (LPL, 25%, p = 0.016), and dramatically lower in follicular lymphoma (FL, 5.2%, p < 0.001), compared with MZL. 29.6% (63/213) of DLBCLs were positive for MNDA. The cases in non-GCB group exhibited a higher rate of MNDA positivity (39.8%) compared to those in GCB group (16.3%) (p < 0.001), and MNDA staining was more frequently observed in DLBCLs with BCL2/MYC double-expression (50%) than those without BCL2/MYC double-expression (24.8%) (p = 0.001). Furthermore, there was a significant correlation between
MNDA and CD5 expression in DLBCL (p = 0.036).
CONCLUSIONS: MNDA was highly expressed in MZL with a potential utility in differential diagnosis between MZL and RLH as well as FL, whereas its value in distinguishing MZL from MCL, CLL/SLL is limited. In addition, MNDA expression in DLBCL was more frequently seen in the non-GCB group and the BCL2/MYC double-expression group, and demonstrated a correlation with CD5, which deserves further investigation. The clinical relevance of MNDA and its correlation with the prognosis of these lymphomas also warrant to be fully elucidated.