The tumor cells express B cell markers (CD20 and/or CD79a) and harbor EBV gene [latent membrane protein-1 (LMP1) and/or EBV nuclear antigen-2 (EBNA2)]. Additionally,
variations in CD30 and CD10 expression have been observed in comparison to EBV-negative DLBCL. CD30 is seen in about 75% of age-related EBV-positive DLBCL compared to 13% in EBV-negative DLBCL, while CD10 expression is decreased (18% and 38%, respectively) (48). Molecular abnormalities Molecular studies will typically detect the clonality of immunoglobulin genes and EBV genomes (50). Prognosis Typically the prognosis for EBV-positive Inhibitors,research,lifescience,medical B-cell lymphomas in the elderly is significantly learn more poorer than that of EBV-negative tumors, with a mean survival of about 2 Inhibitors,research,lifescience,medical years. Advanced age (>70 years) and presence of B symptoms such as fever, weight loss, lymphadenopathy confers worse prognosis (48,49). The general performance status of elderly patients also plays a role in the clinical course of the disease; inasmuch as many of these patients may not be able undergo intensive therapies. As such, EBV-positive DLBCL of
the elderly warrants separate consideration due to the diagnostic and therapeutic challenges they pose (48-50). Follicular lymphoma (FL) FL is the second most common type of lymphoma among adults in western countries, typically occurring in lymph Inhibitors,research,lifescience,medical nodes with splenic, hepatic and bone marrow involvement. Primary extranodal FL is uncommon, constituting less than 7% of GI tract lymphomas (51). FL of the GI tract most frequently occurs in middle-aged adults with a slight female predominance (2:1). The tumor typically arises in the duodenum followed by the ileum and colon (52). Pathogenesis The translocation (14;18) places the anti-apoptotic or proto-oncogene BCL2 locus located Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical on chromosome 18,
under the control of the IgH locus which is situated on chromosome 14, resulting in over expression of anti-apoptotic proteins and immortalization of tumor cells (52,53). Morphology and immunophenotype Histologically, FL of the GI tract consists of relatively uniform, medium Suplatast tosilate sized neoplastic follicles which involve the mucosa. These nodules are composed of small, monotonous lymphoid cells with characteristic cleaved nuclei (centrocytes) admixed with variable numbers of centroblasts which are larger lymphoid cells with vesicular chromatin, presence of nucleoli, with fair amount of cytoplasm. Deeper infiltration into the muscularis mucosae or submucosa can also be seen, as can superficial involvement of surface epithelium with or without ulceration (51). Immunohistochemically, BCL2 and CD20 are nearly uniformly positive, with most cases negative for CD3, CD5, CD23, CD43, and cyclin D1. CD10 positivity generally highlights both neoplastic follicles and interfollicular tumor cells in cases with a follicular, as well as mixed follicular and diffuse growth patterns (53).
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