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, L'expression de P63 et l'index de prolifération Ki67, élevé dans les 2 entités, n'étaient pas des marqueurs discriminants contrairement à ce qui est décrit dans la littérature pour P63 et rapporté pour les lymphomes ganglionnaires pour Ki67

. Le-statut-gc/non-gc, aide au diagnostic des LBPC-GC Nous avons testé 5 algorithmes sur les 64 cas LBPC-GC

, La valeur diagnostique du statut GC/non-GC était optimale avec ces 3 algorithmes : sensibilité =100%, spécificité =100%, valeur prédictive positive = 100% et valeur prédictive négative = 100%. Sachant que l'algorithme de Hans modifié ne repose que sur 2 anticorps (le CD10 et le MUM1), ces 2 anticorps suffiraient à distinguer les LBTJ et les LBCF, ce qui est intéressant d'un, Muris avaient les mêmes résultats : les 25 LBCF-GC étaient bien de statut GC et le 32 LBTJ étaient bien de statut non-GC

, La mutation MYD88 : critère diagnostique des LBPC-GC Nous n'avons pas mis en évidence de mutation MYD88 dans les LBCF sur l'ensemble de la série des 64 cas (ARTICLE 1 et 2). Dans l'ARTICLE 2, la mutation MYD88 était retrouvée dans 19 des 25 cas de LBTJ (76%). Dans l'ARTICLE 1 (18 cas supplémentaires par rapport à l'ARTICLE 2), la mutation MYD88

, sur 32 cas de LBTJ (69%) et 3 sur 7 cas de LBPC-GC inclassés (41%), aucun des cas classés en LBCF-GC n'était muté, p.22

, De nouveaux critères pronostiques dans les LBPC-GC

I. De-façon, nous avons mis en évidence que dans le sous-groupe LBTJ, l'expression de MYC était significativement associée à un risque de récidive cutanée

. Le-statut-gc/non-gc, les cas non-GC, classés selon les algorithmes Hans, Hans modifié et Muris avaient une moins bonne survie globale et spécifique que les cas GC, valeur pronostique dans les LBPC-GC Dans la série de 64 cas de LBPC-GC (ARTICLE 1)

, nous avons montré que le statut double hit était un événement très rare dans les LBPC-GC : un seul cas (5%) avec un réarrangement de MYC et BCL6. Ce cas correspondait à un LBCF-GC et le patient au bout de 29 mois de suivi était en vie en rémission complète, Au contraire des LBDGC ganglionnaires, la recherche du statut double hit ne semble donc pas pertinente dans les LBPC-GC

, Il était significativement associé au diagnostic de LBTJ : 19 sur 23 cas (89%). L'expression de BCL2 seul, MYC seul et la double expression MYC et BCL2 étaient associées à une moins bonne survie dans les LBPC-GC (respectivement p=0.018, p=0.016 et p=0.03). Et nous avons montré qu'également dans le sous-groupe des LBTJ, les patients avec un profil double expresseur avaient une maladie plus agressive (p=0.001). La recherche phénotypique de double expression MYC et BCL2 est donc, nous avons montré que le profil double expresseur était en revanche fréquent : 25 (57%), p.85

. Discussion and . Perspectives, Classification WHO 2017 de LBPC : intérêt de l'entité « autres » Nous avons montré que la classification WHO 2017 de LBPC était applicable dans la très grande majorité des cas avec seulement 7 cas non classables entre LBTJ et LBCF-GC

, Lymphome primitif cutané B diffus à grandes cellules, autres » de la précédente classification WHO/EORTC 2005. Ce sous-groupe « autre » a été rapporté dans plusieurs publications concernant les LBPC avec des pourcentages variables et sans définition précise des cas classés dans cette catégorie, Ces rares cas de LBPC-GC inclassés pourraient correspondre à l'ancien sous-groupe, vol.9, pp.47-50

, Ces 7 cas avaient dans notre étude un pronostic intermédiaire reflétant probablement leur hétérogénéité. En analysant les différentes caractéristiques (cliniques, morphologiques, phénotypiques et moléculaire avec la mutation MYD88) de ces 7 cas inclassés avec leur REFERENCES

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. Serment-d'hippocrate,

, Au moment d'être admis à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité

, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux

, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte

, Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences

, Je donnerai mes soins à l'indigent et à quiconque me les demandera. Je ne me laisserai pas influencer par la soif du gain ou la recherche de la gloire

, Admis dans l'intimité des personnes, je tairai les secrets qui me seront confiés. Reçu à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs

, Je ferai tout pour soulager les souffrances. Je ne prolongerai pas abusivement les agonies. Je ne provoquerai jamais la mort délibérément

, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés

, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité

, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses

, que je sois déshonoré et méprisé si j'y manque