检查点分子抑制治疗对复发的原发性皮肤弥漫性大B细胞淋巴瘤-腿型（primary cutaneous diffuse large B-cell lymphoma, leg-type, PCDLBCL-LT)有效，我们在本研究中检测了29例PCDLBCL-LT病例的程序性死亡配体（programmed death ligands, PD-L) 1和PD-L2的表达情况。我们对肿瘤细胞进行了PD-L1/PD-L2与PAX5免疫组化双染；对浸润的巨噬细胞进行了 PD-L1/PD-L2与CD168或CD163免疫组化双染。我们还通过对CD3 (肿瘤浸润淋巴细胞）、FOXP3 (调节性T细胞）、细胞程序性死亡蛋白-1 (PD-L1) CD33 (髓源抑制性细胞）的免疫染色对PCDLBCL-LT的微环境进行表征。采用荧光原位杂交检测PD-L1/PD-L2的编码基因9p24.1。所有纳入病例中均有PD-L1的表达，可见大量PD-L1阳性的M2型巨噬细胞（CD68+CD163+）浸润，但仅有1例为肿瘤细胞阳性（PAX5+PD-L1+）。进行荧光原位杂交检测的26例病例中，21例结果正常。3例 (11.5%)为低度多体状态，其中就包括肿瘤细胞PD-L1阳性病例。有趣的是，2例（7.7%)表现为PD-L1/PD-L2位点分离模式，肿瘤细胞为PD-L2阳性。无9p24.1重排的24例病例中均未见PD-L2阳性肿瘤细胞。免疫检查点抑制剂治疗PCDLBCL-LT的复发患者可能间接通过免疫细胞来发挥作用，但对罕见的因9p24.1重排而肿瘤细胞表达PD-L2的病例无效。在以M2型巨噬细胞为主要免疫细胞的某些淋巴瘤亚型中，结合肿瘤相关巨噬细胞重编程的抗肿瘤策略值得密切关注。
庄翔 翻译 石毓君 审校
美国外科病理学杂志中文版2018年第三期摘要No.5
Am J Surg Pathol 2018;42:326-334
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