Perforation predicts poor prognosis in patients with primary intestinal diffuse large B-cell lymphoma S-S Chuang, H Ye, 1 S-F Yang, 2 W-T Huang, 3 H-K Chen, 3 P-P Hsieh, 4 W-S Hwang, 5 K-Y Chang, 6 C-L Lu 7 & M-Q Du 1 Department of Pathology, Chi-Mei Medical Centre, Tainan and Taipei Medical University, Taipei, Taiwan, 1 Department of Pathology, University of Cambridge, Cambridge, UK, 2 Department of Pathology, Kaohsiung Medical University Hospital and Kaohsiung Medical University, 3 Department of Pathology, Chang Gung Memorial Hospital–Kaohsiung Medical Centre and Chang Gung University College of Medicine, and 4 Department of Pathology, Veterans General Hospital–Kaohsiung, Kaohsiung, and Centre for General Education, Yuh-Ing Junior College of Health Care and Management, Kaohsiung, 5 Division of Haemato-oncology, Department of Internal Medicine, Chi-Mei Medical Centre, 6 Institute of Cancer Research, National Health Research Institutes, Tainan, Division of Haematology and Oncology, Department of Internal Medicine, National Cheng-Kung University Hospital and College of Medicine, National Cheng-Kung University, and 7 Department of Medical Research, Chi-Mei Medical Centre, Tainan, Taiwan Date of submission 26 October 2007 Accepted for publication 6 May 2008 Chuang S-S, Ye H, Yang S-F, Huang W-T, Chen H-K, Hsieh P-P, Hwang W-S, Chang K-Y, Lu C-L & Du M-Q (2008) Histopathology 53, 432–440 Perforation predicts poor prognosis in patients with primary intestinal diffuse large B-cell lymphoma Aims: To elucidate the clinicopathological features and prognostic factors of primary intestinal diffuse large B-cell lymphoma (PI-DLBL). Methods and results: Archival tissues from 30 tumours were used for tissue microarray construction, immuno- histochemistry and interphase fluorescence in situ hybridization for chromosomal translocation. The M:F ratio was 1.7:1, with a median age of 60 years. The ileum and ileocaecum were most frequently involved (40% each). Fourteen (47%) were at stage I E disease, 15 (50%) at stage II E . Five (17%) tumours were perforated at presentation. The tumours expressed Bcl-6 (73%), MUM1 (70%), Bcl-2 (67%) and CD10 (23%). Nine (30%) were classified as germinal centre B-cell (GCB) phenotype and 21 non-GCB. Eight of 30 (27%), 7 ⁄ 30 (23%) and 2 ⁄ 29 (7%) cases were positive for rearrangements involving IGH, BCL6, and C-MYC loci, respectively, whereas all cases were negative for BCL2 and CCND1 translocation. Perforation was a poor prognostic indicator, with a hazard ratio of tumour-related death at 8.75 (P = 0.001). The differ- entiation antigens, GCB versus non-GCB phenotype, or lymphoma-associated translocations were of no prog- nostic significance. Conclusions: We found a higher rate of perforation and lower frequency of GCB phenotype in PI-DLBL in Taiwan compared with other geographical areas; perforation is a poor prognostic indicator. Keywords: diffuse large B-cell lymphoma, FISH, immunophenotype, intestine, perforation, Taiwan Abbreviations: ABC, activated B cell; DLBL, diffuse large B-cell lymphoma; FISH, fluorescence in situ hybridization; GCB, germinal centre B; H&E, haematoxylin and eosin; HR, hazard ratio; MALT, mucosa-associated lymphoid tissue; NHL, non-Hodgkin’s lymphoma; PI-DLBL, primary intestinal diffuse large B-cell lymphoma; TMA, tissue microarray Introduction The gastrointestinal tract is the most common site of primary extranodal non-Hodgkin’s lymphoma (NHL). 1 Most primary gastrointestinal lymphomas occur in the stomach and, less commonly, in the intestine, 2–5 with mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBL) as the most Address for correspondence: S-S Chuang, Department of Pathology, Chi-Mei Medical Centre, 901 Chung-Hwa Road, Yung-Kang City, Tainan County 710, Taiwan. e-mail: cmh5301@mail.chimei.org.tw Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing Limited. Histopathology 2008, 53, 432–440. DOI: 10.1111/j.1365-2559.2008.03140.x