vol. 36, pp. 405 - marianna uigakukai.marianna-u.ac.jp/idaishi/www/365/05-36-3yo kato.pdf · vol....

11
臘腶腺腦腽腲膅膐臨膗膻膿 Vol. 36, pp. 405415, 2008 3q27BCL6 腔腌腅腗腀腉腑腇腈腆腏腂腜腐腘腛腋腓 腁腄腃腙腎腍腚腊腕腋腓腖腒 腖腄 腣腄 1 腏腃腖腄 腐腎腉 1 腈腧 腎腄腛腃 1 膆臍 腃腘腄腅 腘腄 腠腒腢腉 1 腖腄 腜腏腢腉 1 腐腚 腞腎腍 1 腒腓 膠臠 腣腐腘腥 1 腒腊 腐腍 1 腦腃 腝腕 1 腒腓 腔腇 1 腈腟腃 1 膲膤 腔腇腙腐 臗臭 腜腏腖腟 1 腃腌 臋臈 腑腡腨腉 2 臯臢 腗腇腞腤 腗腆 3 腄腤 1 : 20 9 26 臛臐臤臵膶腘腠腣膀臕腺腽腴臆腙腎腥腙膏臕腥臭腣腐腜腘3q27BCL6 臵膶腥臁腓 膀臕腺腽腴臆臃膬 10 腕膹膦臦腋腠臜臏臞膋膦臅腖臛臐臤膄臶膽膃臎腥膓臙腍膯膇膽腖腙膙腥膯膾致腘膪臹腍腐腺腽腴臆膹腙膦臦腚膕腇膌膦腗腂腍膌膦腕 1 2 膮腙膕臌臤腥臁腑臅腘腚腰腢腥臁腐腗腂臯臑膑膹centroblast腕腁腒腐膭膦臅腚 CD3CD19CD20CD56CD34腇膣臲腕CD5 CD10 腘腚腖膈臕腇腁腒腐腋腠臜臏臞腚 DLBCL 9 FL 1 腕腁腒腐3q27 BCL6 臛臐臤臵膶腥臯臑腕膖臺腎腣腇膋臜臏膍膗腘腠腣 Hans 腙腦腻腫腺腭腷腥腂腣 GCB germinal center B-cell6 non-GCB 4 腇膚腛腤腏腍腝 GCB 膥腕 腚腗腆腒腐臡腸腰腻腕腁腣 IPI international prognostic index腙至腆腡膲腛腕臣腕腁腒腐腖臜臏臞腚臀腍腔腂腐腋腖腆腡臛臐臤膄臶膽臵膶腘腠腢膥腥腎腥腎腣 腋腖腚膏腕腁腣腇臡腍臂腥臝膍腎腣腋腖腚膵腕腁腣腖膱腄腡腤腣ῐῌ῏ 膀臕腺腽腴臆BCL63q27 臵膶膯膇膽臟膨膛臆腕腚臣腉腙臄膘腁腣腂腚膥腘臻膃 致腗臛臐臤臵膶腇膳腌腤腔腂腣2001 腇腊 腌腤腐 WHO 腎腥臻臰致腗臛臐臤臵膶腥臁腓 膴臓臕腥臼腍腐膥腖腎腣腙腘臥腍腺腽 腴臆腚臉臲腢腋腠臜臏臞腕腎腥腍腔腂腣 12腺腽腴臆腚 BTNK 臕腘腊腡腤臖臊 B 腙腟腎腣腫腔臕腺腽腴臆 FLt14;18῍ῌq 32;q21.3腳腀腨腯腱腺腽腴臆腙 t8;14῍ῌq24;q32腶腽腱腻膹腺腽腴臆 MCLt11;14῍ῌq13;q32腇臧致臛臐臤臵膶腕腁腣B 腺腽腴臆腚臓腘腅腊腣膋腪腼腵腺腽 Ig膄臶膽腙 VDJ 膰臖腖臯臑腕腙腩腹腬腬腧腯腮膷膰臖腙膺腘臐臤臵膶腥膖臺腎腣 34t14;18t11;14腚膴臓3q27BCL6 臵膶腖 t8;14臯臑腕膟腈腣腋腖腇 腋腤腛腕腙膫膢腘腠腢腡腆腘腌腤腔腂腣腋腙臵 膶腘腠腣 BCL6 臅腚臯臑腕膭腍 B 1 臘腶腺腦腽腲膅膐臨膗 膐膗 膨膊腬腀2 臘腶腺腦腽腲膅膐臨膗 臒臫腋腠3 臷膔臨膗 膅膗膗膧腋腠臒臫膗 405 19

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Page 1: Vol. 36, pp. 405 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/365/05-36-3Yo Kato.pdf · Vol. 36, pp. 405 415, 2008 ... ˆRS/T3 ˇ 2U 60 V WX$Y III IV performance status PS 2

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� �9:;<=>?@AB��CDE�F��EG�BH+@�I>( 3q27�BCL6 <=HJKAB��CDLM 10�NO�PQ���RST��UPVW9:;�XY!Z[H\]�(�^_!WE`�H^�ab>cd��) ��CDO�EPQe( fghPij��hPN 1�2kEf�;HJl( O�V>e��HJ�ij.mnO� �centroblast� Nop�) �U�qPVe CD3�( CD19( CD20( CD56�( CD34� grsN( CD5 W CD10 >e�B�WtB�gop�) ��RSTeDLBCL �9��W FL �1��Nop�) D�O�e( 3q27�BCL6 9:;<=H .mNuv�@g( �URSw>?@ Hans E�xy�z{H!j@WGCB �germinal center B-cell�F �6��W non-GCBF �4��g|}~( "���GCBFNei�p�) �^����xNo@ IPI �international prognostic index� E���(}N�#Nop�) O�WRSTe����j��W��( 9:;�XY!<=>?��FH���@�WeG�No@g( �^����$H�%w�@�We�&No@W���~@)

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���D�Ne( ��E��o@je�F>�Zbi9:;<=g'��~�j@) 2001 �>(��~� WHO ��e( ��bi9:;<=HJK��B)��H�*���FW�@E>��( ��CDe�+s���RSTN����j@1� 2�)

��CDe B�T�NKO�B>���~( �� BO�>,+�@-�B��CD �FL� E t�14;18��q32;q21.3�(  ¡¢£¤��CDE t�8;14��q24;q32�(��¤xO���CD �MCL� E t�11;14��q13;q32�g¥�b9:;<=No@) BO���CDe( ��>¦�@�U§¨©�� �Ig� XY!E V�D�J ª«�W .mNE¬­®®¯£°ª«�E±>( 9:;<=Huv�@3� 4�) t�14;18�W t�11;14�e��(3q27�BCL6 <=W t�8;14� e .mN²#@�Wg�~}NE³´>?�.��>�~�j@) �E<=>?@ BCL6 µ)Ve( .mN(q� BO�

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19

Page 2: Vol. 36, pp. 405 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/365/05-36-3Yo Kato.pdf · Vol. 36, pp. 405 415, 2008 ... ˆRS/T3 ˇ 2U 60 V WX$Y III IV performance status PS 2

����������������� ��3q27�BCL6 ���� ����� Ig ���������������� ����� B ��� ����������!� �"#$%&%'�(��)!*+,-���� B &%'� �di#use large B cell lymphoma: DLBCL� ����&%'�!�./01� 2��������1�)��2����/3��4.� �������� !�"5#6����������$! 3q27�BCL6 ���7�&%'�%&�8'9� (:;��<)�=> 10*+!:,?-�@.94�

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/0�� 20061 9A3/ 20081 8A�2B&C%DEF�GHI��34F!56�J79� 3q27�BCL6 ������@89�4 10*+!*�564.�9@94&%':!;K<=�L�9� MNO �Giemsa� ���''PQRS �Papani-colaou� ��!�����TU94� MNO���� L>94;K<=�VWXYZ!? 30@[A94� B 1ml �/9 1�1.5CMNO��I�D\9� E>94��I�FGH�]� 15�30 ���:� BI9^_J:TU945�� ''PQRS��� 95�`WXYZ! 30�[A9� 95�50�`WXYZaK�8L:� BI9� b���cBd$e&%��I! 3���94� 0.5�fgBMI!N�:BI9� 50�95�`WXYZaK!OB9� ������ OG100��I� EA100��I! 2���:� �P� QR� SL9^TU94���� !�� 9@hT�'�ij%UV9WX<=�L>9� hematoxylin & eosin �HE���!TU94� "5� ����k CD3� CD5� CD20�CD10k� �ventana��k BCL6k� �Novocastra��kMUM1k� �ABCAM��Yl� iRYm�dVd&Y�� nZ�GVoj`%�pqr[��s\t�u�d&Y!vw04�����'��x]1yz<^-_{�Yl

46�� 9@�1|�4&%':}`�abI�!c~-��X9��deI��4� RPMI1640 abI�Sef�Hg �FCS� � 15��z1y�D\9� de��� 37�C� 5�CO2 �%$��YWY! 24�48��ab94� abhi 2��j�� QZ���hkl� 0.02mg�ml �z1y�\��

���m��.4� �/� 2��ab:�� 1200�� 5��:�ng��^� 0.075M KCl �1|��� 15��opN��94� 1200�� 5��:�ng��^� qj�L�94�ZXC �Car-noy� [AI �VWXYZ 3 :rg 1�![A94� s�_Jt!<=�L>9� ����d&�e%N�: G �%�t�Yl4� ���uA�b)���� ���?�������b)��t �interna-tional system for human cytogenetic nomenclature:

ISCN�7� �v�4�Fluorescent in situ hybridization �FISH� ���

������1|e�DZ���&�d� BCL6�BCL2�IgH �RY� �LSI Dual Color, BreakApart Rearrangement Probe� �Yl48�� <-�z��� DNA � 70�C 70�"ZNC���2xSSC ! 2 ��w���]� xy�z!�RY�DNA � 37�C ! 16�18 �����{����]4�  ¡<¢94�RY���� ¡£|¤�!TU9� �����}c�@.94� <-�z���DNA��� ����'�Yl4�ZXC[A���Yl4� �ZXC[A94���~��0^lz3�4���� ��56�Yl4'�ij%[A<=�Yl4� 60�C ¥��!'�ij%�M894� $e¦%�`WXYZ!O'�ij%N�9� 0.2NHCl! 20��N�:� �R§CY¨K ! 37�C 10�20 �N�9� 10���"ZB&%©l!`WXYZ![A94� �_:��ZXC[A���u�� FISH 94�=ª«���¬­r�� ��®� 1395®���

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¯�@.94 3q27�BCL6 ��� �&%'� 10*+��@°��� Table 1 �±94� 1��42�71 ²!� LDH ��^��230IU�l� � 3 +��$�³! 7 +�n�9^l4� PS �Performancestatus�� 0� 5+ �*+ 1�2�3�7�8�� 1� 3+ �*+4�5�10�� 2 � 1 + �*+ 9�� 3 � 1 + �*+ 6�!*�4� :´���� �*+ 2�� � �*+ 5�� ���*+ 1�� µ� �*+ 6�!�./0 2+ �*+ 5�7�������^l4� J7�� �¶��~40^lz3�4*+ 6 �·�¸� <^-�G7t!*�R-�CHOP 7t�¹v94�J7j�(:�(�!�0¸� J7t����

\� � nº»¼� /406

20

Page 3: Vol. 36, pp. 405 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/365/05-36-3Yo Kato.pdf · Vol. 36, pp. 405 415, 2008 ... ˆRS/T3 ˇ 2U 60 V WX$Y III IV performance status PS 2

���������� �� ����������������� �������� !"��#$%&'(�)�Working Formulation �WF��*+� REAL ,-� ./�01# WHO ,-�2001 2� ��+3��+� 0145���67�+3��+���89:;# IPI �interna-tional prognostic index�9� �� ��# WF �<=>?@ABCDEFEGH �NHL�I� CHOPJK+# CHOP -LMCNE�OJ�/�PQ�RS/�T3��� 2U ��60V��WX$Y �III�IV��performance status �PS� �2�4��Z[ LDH

��\]��^_$`� ��2�� 5����a)"���3�����Iab� low risk �0�1�� low-intermediate �2�� high-intermediate �3�� high risk�4�5� � 4cI,-��� ���89:;I IPI��+d� Low � 1 Q �PQ 8��Low-Inter-mediate �LI� � 4 Q �PQ 1�3�5�7��High-Inter-mediate �HI� � 4Q �PQ 2�4�9�10��High �H� �1Q �PQ 6��b�� e2� DNf(g CD20 gh� Rituximab �FiDjE���WXIkl���OJmn�o�/�� .�p�qr#shtu?v

wxy �CDC� zghtu?vw{1?vwxy�ADCC� d���+� FiDjE�klIa)FEGH�|}~OJ#� �� �� CHOP JK�3 R-CHOP JK�d`������� ���89:;I�`���!I"b�� R-CHOP JK�OJ/�PQ����a7���d/� R-IPI������+10�� R-IPI �#� Very good �0��Good �1�2�� Poor �3�4�5� � 3 cI,-���R-IPI ��+d very good � 1Q �PQ 8��good� 4Q �PQ 1�3�5�7��poor � 5Q �PQ 2�4�6�9�10��b�� �>?@FEGHI,-�� FL�# HI d H �PQ� 10�15�d�"7� IPI �#�,IOJ������"�b�� .��� FLI�/ FLIPI �follicular lymphoma internationalprognostic index�11� ������� ��#� 2U�61�����WX$Y �Ann Arbor ,- III�a�IVY���9���E �12 g�dl ����$`FEG^��� �5������LDH �\]������� 5��������+����89:;��DLBCL d FL �PQ��� 3q27�BCL6  ¡QI FLIPI��+d� Low �L�� 1Q �PQ 7��

Table 1. Clinical Features of B-cell Lymphoma Patients Associated with 3q27�BCL6 Translocations

3q27�BCL6  ¡�¢�>?FEGH 407

21

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Intermediate �I�� 3� ��� 1�3�5��High �H�� 6� ��� 2�4�6�7�9�10������ �� 7�� IPI R-IPI ���� ������������FLIPI ������������� ����� R-CHOP ��� !"#�$%�&'!�FLIPI ! IPI�R-IPI �(�)*���+�

&��,�-.%���/012�� 3�45����45�� 67�389�:;<=>12 �centroblast� �Lennert� !�!12�� 12?��@A��B��� CCDEFGHI�3JK� LMNHI�12?�OP�Q�&'!� RSC/12�OP��TU�V��WX�

Fig. 1. Morphology of lymphoma cells.

Large sized lymphoid cells, twice larger than neutrophils, are seen. The

lymphoid cells have a round or irregular shaped nucleus with thick

membrane and condensed chromatin.

�a� Papanicolaous stain. �400�b� Giemsa stain. �400

Fig. 2. Histology of 3q27�BCL6 translocation.A di#use proliferation of medium to large-sized cells with vesicular chromatin

and prominent nucleolus is seen. The lymphoma cells are positive for BCL-6

�c� and MUM-1 �d�, but negative for CD10 �d� by immunohistochemistry. Eachof BCL-6 and MUN-1 exhibits unclear positive staining in some lymphoma

cells. a �400; b,c,d �200

YZ [ \]^_` %408

22

Page 5: Vol. 36, pp. 405 - Marianna Uigakukai.marianna-u.ac.jp/idaishi/www/365/05-36-3Yo Kato.pdf · Vol. 36, pp. 405 415, 2008 ... ˆRS/T3 ˇ 2U 60 V WX$Y III IV performance status PS 2

��� �Fig. 1�� ����� DLBCL 9 ��FL 1� ���� �Table 1������������ �FCM� �� CD3��CD

19��CD20��CD56��CD34� ���������� CD10 � 5 �� 2�5�7�9�10��� � 5 �� 1�3�4�6�8��! ����� "#$%&'�� CD10 � �� 7 ( 1 )(*+�,�- BCL6 � ����� Hans (./0�1213, 14�)3�45� GCB 6 6� 7 GCB 6 4���� �Fig. 3, Table 2�� FL�8-9:;�18q21.3�BCL2 <=)>?@A� BCL2 BC� ��4(�D�� 3q27�BCL6 <=(EF�"#GH�I4 BCL6 BCJ(� KLM��� N(N5�� OPQRS)�-� DNA�RNA�TUB

C(�,�)VW��M�IXYZ[S5��(\]�^UP4_` )ab���4�CD5 � 6( 1�� ����� CD5 � T@A�� 5c4� de B @Afg�-h �ij Ck��li�/@A�ijf�de novoCD5�DLBCL �� 5c41� 2�� de novo CD5�

DLBCL (mnopq�� ;r�s tu�vwx�B �y�LDH (z{�|}�~)pq5��IPI �;���415�18�� ����i(���IX R-CHOP ����o��5cX� N� ��������(U�'oYZ[S��^c�cX� ��� CD5 (�U�'oYZ��[S5������4�GH������ 1 �� 10��������

Table 2. Immunohistochemistry of B-cell Lymphoma Patients with 3q27�BCL6Translocations

Fig. 3. Decision tree for TMA classification of DLBCL by Hans.

3q27�BCL6 <=)>?� �ijf 409

23

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�� 1 � ��� 1�������� �� ������ �� 6 ���� 35�57 ������near-diploidy� �� ��� �� 6 ������87��������� !� �Table 3�� ISCN�� "#�����$%&'�()*+,-� ./012)345�6'78)9:�;<=- 6�� >?>� @ABC���$%&')�DEFG��H!� IJ�� ISCN )K<LMNOA��PQH! 1RS��3 Table 3 )�T� I-=������UV �Spectral karyotyping: SKY�8�

� FISHUV�WX> YZ>� �Fig. 5�� 3� ��� 2�3�9�� t�3;14��q27;q32�� 14q32�IgH� 1� ��� 5�� t�3;22��q27;q11.2� � 22q11�IgL �� ��[\ ��� 7�8�� Ig ]^_`a�bc�� t�3;3��q27;q29� � t�3;5��q27;q13� �� �� 1� ��� 7��� 3q27�BCL6 );<� FL )de�H 18q21.3�BCL2 bc3f(� �Table 3�����GV);<ghijklRS�BmnoApqrs�X!� FISH)7\�t 10��� 3q27�BCL6 bc�uvJ��wf>�� ���GV�f(=-� 18q21.3�BCL2 bc 1 � ��� 7��

FISH �3xbc�uvJ��wf>y�� FISH�� 5� ��� 2�3�4�7�9�� 14q32�IgHbc�f(=-� z 5� ��� 1�5�6�8�10�� 14q32�IgH `a�bc�� �� 3q27�BCL6 bc{|�}~�����N�@A�� z�I-`a����'J��wf,-�19�25��

� �

3q27�BCL6bc�� FL 15�� DLBCL 20�30��f(=-'�������\� B RS@ABC)��'�� �40��2���' DLBCL H?��3����!1� 2��@ABC���&'RS�� �����?=���RS���RS����RS �immunoblast� )��,-'5� 12�� ���RS����������\� �)������-��=-'� MN��A��R���� ��� !�¡¢�� �������1 H!>�£f(=->L>L��)¤> !'�RS¥�¦§¨/�� ©)ªS�=-'� ��RS�� ����)��-�uvRS��'� ���«����� ��¬­®�MN��A�¯!°±�

Table 3. Molecular Cytogenetic Analysis of B-cell Lymphoma Patients Associated with 3q27�BCL6 Translocations

;² ³ ´µ¶·¸ =410

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���������� ��� � 1�2������������� ��������� !"#$%�� 3q27�BCL6 &'#()*�� +,��-.����#()�/0��12� DLBCL�� FL �34����/��#567892:;<� WHO =>��� FL �?@AB�CD��/��E�/0���FG� grading#HI� �J���/0��� 0�5# Grade 1� 6�15# Grade

2� 16KL# Grade 3E%�� Grade 3a ��/���M6%�NG�� �/���O��29NG#3b �=>%�� PQ���,R���/0���;<<4� 3q27�BCL6 &'#()?@���Grade 3 ��SE�TUV�<�� S�W*�Grade 1 �;<� ��XEABY�Z[7<\]�� ��X�^��_�#`a729��b7� ABcd��_�#ef7I�<4Egh��<� S�W*�� ij�=k�lm���no�pqr?���s2:;<SE:�� ?@"��/0���t.�u?@"��/���56789<vw"xgh����

W* 7� 3q27�BCL6�yh� 18q21.3�BCL2&'xz;89<� 18q21.3�BCL2 &'�{|�CD�V�D�J }~�� 3q27�BCL6 &'���/�CD��������}~�������SE����89�1�4�� �;8� 18q21.3�BCL2 #()pqr?���=�7� ��/�CD��������}~����V�� 3q27�BCL6 &'#��7<x�EZ�V��26� 27�� �ij������m�?@���,R��9��#��78x� -.��m#��%�E����������87�ISE�TUV��� WHO=>��ij�&'� �98 "{|"¡¢£#=>%�� ¡¢£�?@���{|�ij��m#��7{|�¤y%���b7� {|�ij�&'#��7<pqr?���� ��/�V��¥�¦�&'#��7I�SE�§¨V���S��� {|"¡¢£E�2©E)�DNA���ªij�&'# «�pqr?�£�#¬­%�SE#§789�� ,REij�������E�®¯�� °±V��t.*�^²789�³´���

Fig. 4. Representative G-banded karyotype of t�3;5��q27;q13� and t�14;18��q32;q11.2�.The arrows indicate abnormal chromosomes. BCL 6, BCL 2, and IGH are located on

chromosome 3q27, 18q21.3 and 14q32, respectively.

3q27�BCL6 &'#()µ"pqr? 411

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�������� IPI�R-IPI�FLIPI ��� ������ �������������������� ����� !�"#$%&'(��������)� *+�,-������./�012*�� 3��45 6789:6;7 2<=>�sIL-2R��p53�BCL2 ?@�BCL6 AB�CDE*�FG�� HI� IPI �JK���� DLBCLL��� cDNA M6N:OP6�QR�ST B�GCB� U�V W B-like �ABC� U�XYZ �type3� �[�*��13�� XYZ�\]�^_�`���ABCU�a.�� 3�bcd+GCBU� ABCU�ef���g�h�0ij*��� .d.�cDNA M6N:OP6�k[�� RNA �l����mn�obp>Cq��hR� .d�rs�hRt3�uv��w_x�yz�{|���d}�� QR~���$w_�����30C�����(�{|���C12*�� Tissue microar-ray �TMA� 0�����.� CD10�BCL6�MUM1 �Q� Hans �O�����C��*��14�� GCB U� CD10� 0 CD10��BCL6��

MUM1� � Non-GCB U� CD10��BCL6��MUM1� 0 CD10��BCL6��MUM1� C��� ������ST� 3q27�BCL6 ����l����� Hans �O���������)� �fFGCB U0��30C��*��� .d.� GCBU� 6 ��� GCB UC 4 ��F��� 3��� cDNA M6N:OP60 TMA �QR[�*�� GCB U0� GCB U�� ��������������������4� Ch�� ���������C�:9 6¡¢¡�9�ef£�4� �h�C� ���¤¥�7¦���C[W��§¤.�STd+¨�[W����AB��©¦897C GCB Ud+� GCB Uª0«W.�4� C¬z+���

� �

��>���­®.���¯Q°��±²��³.F��C� �����]´�h}�� ���,-�������� 3q27�BCL6 ���¤¥L��µW.������¶���q�ChR� �����

Fig. 5. FISH results of splitting probes of BCL6 and BCL2.

�a� Split signals of BCL6. Arrows indicate splitted signals of BCL6 probe. Arrow head isnormal BCL6.

�b� Interface cell showed fusion signals of IGH-BCL2. Arrows indicate normal BCL2 andIGH. Arrow heads indicate fusion signals of IGH-BCL2.

�c� Fusion signals show BCL2 BCL6. Split signal of red �IGH� and green �BCL2�.

·¸ � Y¹º»¼ +412

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Abstract

Clinicopathological Features of Lymphoma Associated with 3q27�BCL6Translocations Based on Cytology, Histology, Immunology,

and Molecular Cytogenetics

Yo Kato1, Tasuku Saito1, Kohei Ogawa1, Yasuyuki Inoue1, Masayuki Kato1,

Yasushi Shibuya1, Yoshinori Suzuki1, Shigeki Kosugi1, Michiko Irei1,

Takao Suzuki1, Aki Kyo1, Masatomo Takahashi1, Junki Koike2,

Naoya Nakamura3, and Ikuo Miura1

Ten lymphoma patients associated with 3q27�BCL6 translocations were investigated retrospectively bycytology, histology, cytogenetics, and fluorescence in situ hybridization �FISH�, to explore a possibleclassification by chromosomal translocations. Common cytological features were centroblasts without

cytoplasmic granules. Typical immunological phenotype by flow cytometry and immunohistochemistry

was CD3��CD19��CD20��CD56��CD34� with variable CD5 and CD10 positivity. Pathological diag-noses were nine of di#use large B cell lymphoma �DLBCL� and one of follicular lymphoma �FL�.Immunohistochemistry disclosed germinal center B-cell like �GCB� subtype �6 cases� and non-GCB subtype�4 cases� according to algorithm by Hans. Risk groups by IPI �international prognostic index� were variousand it was assumed to be caused by additional chromosomal changes to 3q27�BCL6 translocations. Themalignalt lymphoma may be classified into subtype having various prognoses by chromosome transloca-

tions.

1 Division of Hematology and Oncology, Department of Internal Medicine, St. Marianna University School ofMedicine

2 Department of Diagnostic Pathology, St. Marianna University School of Medicine3 Department of Pathology, Tokai university School of Medicine

3q27�BCL6 ��������� 415

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