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Abstract
The present study was conducted upon 50 patients diagnosed as DLBCL at the Pathology Lab of Suez Canal University Teaching Hospital between 1994 and 2005. It included 30 male and 20 female patients. The age of the patients ranged from 14 to 84 years with median age of 50 years and mean age of 46.3± 13.28.
Nodal tumors constituted 35 cases (70%) of studied DLBCL, while extranodal tumors represented 15 cases (30%). Among the nodal tumors, the commonest site was cervical lymph nodes (43%), followed by axillary lymph nodes (29%), inguinal lymph nodes (20%) and mesenteric lymph nodes (8%). The commonest extranodal site involved was stomach (40%), followed by colon (27%), spleen (13%), CNS (13%) and liver (7%).
30 tumors (60%) were at stage I and 20 tumors (40%) were at stage II. There was a lack of representative cases for more advanced stages III-IV.
Among the 50 studied tumors the frequency of morphological variants were 28 (56%) centroblastic variant, 14 (28%) immunoblastic variant, 5 (10%) anaplastic variant and 3 (6%) T cell/Histiocyte rich variant.
In the current study, CD10 expression was found in 15 tumors (30%) of the whole series using IHC staining. A high CD10 expression was detected among young aged patients, however, the difference was statistically insignificant. Extranodal tumors were associated with a slight higher percentage of CD10 expression than nodal ones, but a statistical significant difference was not achieved. Among morphological variants, more CD10 expression was associated with centroblastic and THR/DLBCL variants. No CD10 expression was detected among immunoblastic variant. The difference was statistically significant. In addition, a statistical significant relation between CD10 expression and tumor stage, with a higher CD10 expression was detected in stage I than stage II.
Out of the 50 studied DLBCL, IHC bcl6 positivity was detected in 33 cases (66%). A higher bcl6 expression was detected among young aged patients, however, the difference was statistically insignificant. The relation between bcl6 expression and tumor location was statistically insignificant although slight higher percentage of bcl6 expression was among nodal tumors. As regards the morphological variants, a high bcl6 expression were associated with centroblastic variant, but the difference did not achieve the statistical significant value. A statistical significant relation between bcl6 expression and tumor stage, with more bcl6 expression was detected among stage I than stage II.
Using the concomitant expression of bcl6 & CD10 as marker for GC-phenotype, the current study revealed that 13 cases (26%) of the fifty studied cases had GC phenotype and 37 cases (74%) had non-GC phenotype. A high percentage of GC phenotype was detected among young aged patients, however, the difference was statistically insignificant. More GC phenotype association was detected among nodal tumors compared with extranodal ones. However, the difference did not achieve the statistical significant value. All tumors of immunoblastic variant were of non-GC-phenotype. On the other hand, most of THR/DLBCL and centroblastic variants were of GC-phenotype. The difference was statistically significant. A higher percentage of stage I tumor showed GC-phenotype compared with stage II. The difference was statistically significant.
In the current study 21 tumors (42%) showed cyclin B1 expression. An increased cyclin B1 expression was noted among old aged patients compared with young aged patients. The difference was statistically significant. Extranodal tumors showed more cyclin B1 expression than nodal ones. But no statistical significant difference has been achieved. High percentage of anaplastic and THR/DLBCL variants were associated with cyclin B1 expression. On the other hand, less percentage of centroblastic and immunoblastic variants expressed cyclin B1. However the difference was statistically insignificant. A significant relation between cyclin B1 expression and tumor stage was achieved in our study, with high cyclin B1 expression among stage II tumors.
Out of the 50 studied DLBCL tumors, 28 tumors (56%) showed p53 expression. More p53 expression was detected among old aged patients than young aged ones. The difference was statistically insignificant. Nodal tumors showed more p53 expression more than extranodal ones. A statistical significant difference between them was detected. Most of centroblastic and THR/DLBCL variants expressed p53 compared with immunoblastic and anaplastic variants. However, the difference was statistical insignificant. No significant difference was achieved between tumor stages as regards p53 expression, in spite for more p53 expression among stage I tumors.
The current study revealed that most tumors expressed bcl6 also expressed cyclin B1. This positive relation was statistically significant. While, a higher percentage of tumors expressed bcl6 did not express p53. However, that relation was statistically insignificant.
A higher percentage of tumors that expressed CD10 also expressed cyclin B1, with a statistical significant relation. A statistical significant relation was additionally detected between CD10 expression and p53 expression, with most cases expressed CD10 also expressed p53.
More GC-phenotype tumors expressed cyclin B1 compared with non-GC-phenotype ones. A statistical significant relation was achieved between them. No significant relation between differentiation phenotype and p53 expression was detected, although, a high percentage of GC-phenotype tumors expressed p53.
In conclusion, CD10, bcl6 expression and GC-phenotype were associated with some good prognostic parameters such as young age, nodal cases and stage I tumor. This indicates that these markers could be good prognostic factor in DLBCL. Furthermore, extended studies will needed to confirm our results.
The association between cyclin B1 expression and some adverse prognostic factors (including old age, extranodal tumors, anaplastic variant and stage II), suggested an adverse role of cyclin B1 expression among DLBCL series.
As CD10 and bcl6 expression is significantly associated with cyclin B1, which has a role in cell proliferation, these markers could be used as new target agent in DLBCL therapy.