22例胃粘膜相关淋巴瘤临床病理及免疫表型分析

探讨胃粘膜相关淋巴瘤的临床病理特点。方法：收集２２例胃原发性恶性淋巴瘤，应用ＭＡＬＴ概念进行形态学及免疫组化分析。结果：本组资料显示临床以中年人多见，男女性别之比为１．４：１．病变好发于胃窦，体部。２２例经免疫组化证实均为Ｂ细胞性淋巴瘤。其中６例病理形态学呈典型ＭＡＬ淋巴瘤，１３例呈不典型ＭＡＬＴ淋巴瘤。     

胃原发性MALT淋巴瘤临床病理分析

目的：探讨我区胃原发性黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤(下称MALT淋巴瘤)的临床病理特点。方法：对14例胃原发性MALT淋巴瘤临床病理资料进行回顾性分析，并用免疫组化S-P法作下列抗体染色：HP、LCA、CD3、CD5、CDIO、CD20、cyclinD1、lgM、κ、λ及BCL-2等。结果：男性5例，女性9例，中位年龄56岁。7例位于胃窦部，7例位于胃体。临床分期为：Ⅰ期8例(57％)．Ⅱ期6例。14例均表现为溃疡型病灶，病灶周围黏膜呈息肉样增生。组织学特点为：肿瘤细胞以边缘区B细胞为主．混有少量母化的细胞及浆细胞，可见淋巴上皮病变及反应性淋巴滤泡，7例(50％)可见向弥漫性大B细胞淋巴瘤转化区。免疫组化染色：HP阳性7例(50％)，肿瘤细胞表达LCA、CD20、IgM；表达单一的轻链κ阳性5例、λ阳性9例；CD3、CD5、CD10、cyclinD1均阴性，中小肿瘤细胞BCL-2阳性，大细胞BCL-2阴性。结论：胃MALT淋巴瘤好发于中老年女性．易向弥漫性大B细胞淋巴瘤转化。     

胃MALT型淋巴瘤12例临床病理分析

目的：探讨胃MALT型淋巴瘤的临床病理特点,为诊断和治疗提供依据。方法：分析12例胃MALT型淋巴瘤的临床、病理形态学特点和免疫组化表达。结果：患者男女比例为1．40：1,中位年龄56岁。结论：胃MALT型淋巴瘤是结外最常见的一种低度恶性B细胞淋巴瘤,好发于老年人。     

胃黏膜相关淋巴组织型淋巴瘤临床病理分析

目的；研究胃黏膜相关淋巴组织（MALT）型淋巴瘤的形态特征。方法：应用HE染色及免疫组化Eivison二步法观察胃MALT型淋巴瘤。结果：17例胃MALT型淋巴瘤为B细胞表达。Kappa( )6例，Lambda( )8例。瘤细胞以CCL细胞型为主，淋巴上皮病变13例，滤泡克隆化8例，反应性滤泡增生11例。结论：淋巴上皮病变，滤泡克隆化，反应性滤泡增生及B细胞单克隆性是胃MALT型淋巴瘤的主要特征。有别于胃良性病变引起的淋巴组织反应性增生。     

膀胱原发恶性淋巴瘤的临床病理特点、免疫表型和预后

目的 探讨膀胱原发恶性淋巴瘤的临床、病理组织学特点和免疫表型。方法 回顾性总结7例膀胱恶性淋巴瘤的临床和病理组织学资料，免疫组织化学染色确定免疫表型。结果 6例原发性，1例继发性。7例均为老年患者，女性5例，男性2例；6例原发性结外MALT型边缘区B细胞淋巴瘤4例，弥漫性大B细胞淋巴瘤2例，1例继发是弥漫性大B细胞淋巴瘤。结论 膀胱恶性淋巴瘤好发于60岁左右的老年人，常见的临床表现是血尿和膀胱肿块。常见病理类型是弥漫性大B细胞淋巴瘤和结外MALT型边缘区B细胞淋巴瘤。     

原发性子宫体恶性淋巴瘤临床病理分析

目的 分析原发性子宫体恶性淋巴瘤临床病理特点。方法对2例原发性子宫体恶性淋巴瘤进行常规病理检查和免疫组化观察并结合文献进行分析。结果 子宫体原发性恶性淋巴瘤临床表现无特殊性，结合文献镜下见子宫黏膜和(或)肌层内淋巴样细胞弥漫增生，可出现滤泡结构，免疫组化显示B细胞标记。子宫颈卵巢输卵管可见肿瘤累及。结论 原发性子宫体恶性淋巴瘤以弥漫大B细胞型多见，侵袭性较高。     

胃原发性MALT淋巴瘤临床病理分析

目的:探讨我区胃原发性黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤(下称MALT淋巴瘤)的临床病理特点.方法:对14例胃原发性MALT淋巴瘤临床病理资料进行回顾性分析,并用免疫组化S-P法作下列抗体染色:HP、LCA、CD3、CD5、CD10、CD20、cyclinD1、1gM、κ、λ及BCL-2等.结果:男性5例,女性9例,中位年龄56岁.7例位于胃窦部,7例位于胃体.临床分期为:Ⅰ期8例(57%),Ⅱ期6例.l4例均表现为溃疡型病灶,病灶周围黏膜呈息肉样增生.组织学特点为:肿瘤细胞以边缘区B细胞为主,混有少量母化的细胞及浆细胞,可见淋巴上皮病变及反应性淋巴滤泡,7例(50%)可见向弥漫性大B细胞淋巴瘤转化区.免疫组化染色:HP阳性7例(50%),肿瘤细胞表达LCA、CD20、IgM;表达单一的轻链κ阳性5例、λ阳性9例;CD3、CD5、CD10、cyclinD1均阴性,中小肿瘤细胞BCL-2阳性,大细胞BCL-2阴性.结论:胃MALT淋巴瘤好发于中老年女性,易向弥漫性大B细胞淋巴瘤转化.     

胃MALT型淋巴瘤12例临床病理分析

目的:探讨胃MALT型淋巴瘤的临床病理特点,为诊断和治疗提供依据. 方法:分析12例胃MALT型淋巴瘤的临床、病理形态学特点和免疫组化表达.结果:患者男女比例为1.40∶1,中位年龄56岁.结论:胃MALT型淋巴瘤是结外最常见的一种低度恶性B细胞淋巴瘤,好发于老年人.     

原发性胃肠道恶性淋巴瘤42例临床病理分析

目的探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphomas,PGIL)的诊治方法。方法回顾性分析42例PGIL的临床病理资料,并进行CD20、CD30、CD3及CD45RO等抗体标记。结果本组42例PGIL中,男女之比约为2∶1,发病中位年龄47.5岁,胃及结肠最多见。免疫组化表型:CD20阳性率95.2%,CD3及CD45RO阳性率均为4.8%,CD30无阳性表达。组织学分型:T细胞来源的非霍奇金淋巴瘤仅2例,而B细胞来源的非霍奇金淋巴瘤40例,其中29例为黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)型淋巴瘤。低度、高度恶性者5年生存率分别为65.5%和20.0%。本组病例术前误诊率为33.3%。结论本病易误诊,MALT淋巴瘤是PGIL最常见的病理类型,恶性程度是PGIL重要的预后因素。     

乳腺原发性恶性淋巴瘤四例

乳腺原发性恶性淋巴瘤属于结外型恶性淋巴瘤，临床相当少见。现将我们所遇4例报道如下。临床资料见表。病理变化本组4例，肿瘤均位于乳腺组织内，呈结节状或分叶状，边界清楚者3例，不清楚1例。切面均为灰白色均质、鱼肉状，其中例2肿瘤切面伴灶性出血。镜下见瘤细胞弥漫性浸润乳腺小叶及周围脂肪组织和结缔组织，未累及皮肤。送检腋窝淋巴结2例，1例见瘤细胞侵犯，另1例淋巴结显示反应性增生。本组4例按成都会议分类，弥漫性无裂细胞性3例，淋巴母细胞性1例。免疫组化染色，3例L26阳性、1例L26阴性。讨论乳腺原发性恶性淋巴瘤占乳腺恶性肿…     

综合影像学、组织学和免疫组织化学特点诊断肺MALT淋巴瘤

背景与目的:肺的黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)是原发性肺恶性肿瘤中的少见类型,但在全身各部位所有的MALT淋巴瘤中,肺MALT淋巴瘤并不罕见。由于肺MALT淋巴瘤的临床表现和影像学特点不典型,常与炎症或肺上皮性恶性肿瘤不易鉴别。本研究综合肺MALT淋巴瘤的影像学、大体形态、组织学和免疫组织化学特点,帮助对肺MALT淋巴瘤的认识和诊断。方法:收集15例肺MALT淋巴瘤,根据大体形态和HE图像其组织学特点;并回顾各病例的胸片或(和)CT资料,收集特异性表现;免疫组织化学EnVision法评价BCL10蛋白的表达。结果:在组织学图像上,肺MALT淋巴瘤具有与胃MALT淋巴瘤类似的细胞学特点,但也有肺组织特异性的诊断图像;BCL10免疫组化显示61.5%(8/13)的病例具有核染色;影像学分析显示肺MALT的图像可分为两型:炎症型和肿块型。炎症型表现为单发或多发或弥漫性斑片状模糊影、毛玻璃样影和实变影,内可有支气管充气征;肿块型表现为单发或多发结节或肿块,周围型多见,呈类圆形,边界清楚或模糊,可有分叶及毛刺。结论:肺MALT淋巴瘤有相对特异性的病理形态学特点,BCL10免疫组化能辅助MALT淋巴瘤的诊断,影像特点可能对手术、治疗反应和复发等有作用,但临床病理的关键是与肺"炎性假瘤"及其他非特异性炎症的鉴别诊断。     

Histopathologic features and expression of Bcl-2 and p53 proteins in primary gastric lymphomas

The aim of this study is to present a histopathologic and immunohistochemical analysis of primary gastric lymphomas which were reclassified according to the concept of mucosa associated lymphoid tissue (MALT). The resected specimens from 41 patients with primary gastric lymphoma were investigated retrospectively. Immunohistochemical study was done to analyze the immunophenotype and bcl-2 and p53 proteins expression. Twenty three of the cases had tumors mainly located in the antrum. Histologically, 12 were low grade and 20 were high grade B-cell lymphoma of MALT, 9 other B-cell nonHodgkin's lymphomas. Helicobacter pylori was identified in 72% of the cases. According to Musshoff's modification, most of the MALT lymphoma cases had stage I or II disease. There was significant difference between low and high grade cases, in respect to depth of invasion in gastric wall. Immunohistochemically, the neoplastic cells in all MALT lymphomas expressed B-cell phenotype. Bcl-2 protein was found to be expressed in 59% and p53 protein expression was detected in 72% of cases. Among the B-cell lymphoma of MALT, bcl-2 positivity decreased and p53 positivity increased significantly as the histological grade advanced. So, an inverse correlation was observed between the expression of bcl-2 and p53. In conclusion, most primary gastric lymphomas are low or high grade B-cell MALT lymphomas and appear to arise in MALT acquired as a reaction to Helicobacter pylori infection. Expression of bcl-2 and p53 in gastric lymphomas may be associated with transformation from low-grade to high-grade disease.     

Genetic and epigenetic factors involved in B-cell lymphomagenesis

Malignant lymphomas have been classified by the WHO into disease categories based not only on histological features, but also on cell surface markers, cytogenetic and clinical features. It is known that chromosome translocation plays an important role in lymphoma development, but it is not entirely clear yet why a given type of chromosome translocation is associated with a specific type of lymphoma. This review deals with molecular mechanisms of B-cell lymphoma development in association with chromosome translocations. The outcome of chromosome translocations can be categorized into three factors: enhancement of proliferation, inhibition of differentiation and anti-apoptotic activity. It is well known that chromosome translocation by itself cannot cause cells to become malignant because it is only one of the growth advantages leading to malignancy, while additional genetic and epigenetic alterations are required for cells to become fully malignant. Mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach are unique in that a majority can be cured by Helicobacter pylori eradication, although 20 to 30% remain resistant. Others as well as we have demonstrated that the presence of the API2-MALT1 chimeric gene correlates well with resistance to H. pylori eradication treatment. These characteristics have led to the speculation that the classification of MALT lymphoma falls somewhere between tumor and inflammation. Although MALT lymphoma seems to have unique features in comparison with other types of B-cell lymphomas, it shares common molecular mechanisms with B-cell lymphoma development.     

State-of-the-art therapeutics: marginal-zone lymphoma.

Marginal-zone lymphomas comprise the mucosa-associated lymphoid tissue (MALT) type (extranodal marginal-zone lymphoma [EMZL]), the nodal marginal zone B-cell lymphoma (NMZL) and the splenic MZL (SMZL). EMZL is relatively common, whereas the remaining two entities are relatively rare disorders. EMZL, especially in its gastric localization, is the most studied MZL, and there are many data both on the underlying genetic lesions and on the role of infectious agents. These data have determined unique approach among all other lymphoma subtypes: the possibility of treating a subset of patients with antibiotics alone as first line of treatment. Indeed, there is compelling evidence that histologic regressions can be achieved in most gastric MALT lymphomas by eradicating Helicobacter pylori infection. However, molecular follow-up studies showed the persistence of the malignant clone in half of the cases in histologic remission after antibiotic treatment and transient, either histologic or molecular, relapses have been reported, too. Hence, a careful long-term follow-up is mandatory after antibiotic treatment. Radiotherapy, chemotherapy, anti-CD20 monoclonal antibodies are effective alternative therapies. The precise role of surgical resection should be redefined in view of the encouraging results of conservative approaches. Differently from EMZL, both SMLZ and NMZL often present with disseminated disease at diagnosis. The therapeutic approach comprises splenectomy, for SMZL, and chemotherapy, but with no consensus about the best treatment. This review addresses the current knowledge on the clinical features and therapeutic approaches for the individual MZLs.     

胃黏膜相关淋巴样组织淋巴瘤42例临床分析

探讨胃黏膜相关淋巴样组织淋巴瘤的临床表现、病理特征和治疗方法。方法:回顾性分析1990年7月至2008年5月间42例胃MALT淋巴瘤的病理特征和临床分期等资料,并按治疗方式不同划分为单纯根除Hp组（7例）、单纯手术组（9例）、手术+根除Hp组（20例）、手术+放、化疗组（6例）,对各治疗组随访结果使用Kaplan-Meier方法进行生存率分析,Log Rank检验评估各组间的统计学差异。结果:全组患者均接受胃镜检查,确诊率26.2%（11/42）,HP染色阳性率70.6%（24/34）。免疫表型分析证实全部为B细胞性淋巴瘤。全组Cotswolds改良Ann Arbor分期:ⅠE2期17例,ⅡE1期16例,ⅡE2期6例,ⅢE期2例,Ⅳ期1例。各组5年生存率分别为100%、83.7%、82.4%及43.0%（P=0.027）。结论:胃MALT淋巴瘤的临床表现和辅助检查均无明显特异性,故初治时接受手术治疗的患者较多。病理确诊者可首选根除Hp治疗,疗效与手术无异;晚期患者可在术后选择放、化疗等综合治疗,但远期生存率相对较差。      

p27kip1 expression is inversely related to the grade of gastric MALT lymphoma

Background: Decreased or lost expression of the cyclin-dependent kinase inhibitor p27^kip1 protein has been found to be a poor prognostic factor in many cancers, including gastric cancer. Aim: To evaluate p27^kip1 expression in gastric mucosa-associated lymphoid tissue (MALT) and gastric B-cell lymphoma. Methods: Fifty-two cases of gastric lymphoma, mean age 68.7 yr (range 23–90 yr), 11 of chronic Helicobacter pylori-associated gastritis, and 5 of normal gastric mucosa were studied. Patients were classified into two groups. Stage IE gastric lymphomas were defined as local gastric lymphoma of MALT and more advanced stages as advanced gastric lymphoma. Twenty-three patients diagnosed as stage IE, 13 of these were low-grade and 10 diffuse large B-cell lymphoma (DLBL). Twenty-nine patients were at stage IIE or above, 18 with low-grade and 11 with DLBL. Serial sections were evaluated by immunohistochemistry after staining with antibodies against p27/Kip1 and Ki-67. Results: The proliferative index was higher in gastric DLBL than in low-grade MALT lymphomas, 57.1±31.2 vs 17.3±20.6 (p=0.0001). The mean p27^kip1 expression score for high-grade patients was significantly lower compared with that of low-grade patients, 0.5 ± 0.4 and 1.6±0.8, respectively (p=0.001). Comparative evaluation of p27^kip1 expression in malignant lymphoid cells revealed that B cells of the localized gastric DLBL patients expressed the least p27^kip1, 0.36±0.32. This value was lower than that of malignant lymphoid cells of patients with advanced DLBL, 0.64±0.53, advanced low-grade MALT lymphoma, 1.59±0.79, and localized low-grade MALT lymphoma, 1.59±0.84. In the multivariate model in which all p27^kip1 variables were entered, the expression of p27^kip1 in malignant lymphoid cells was inversely correlated with the grade of the lymphoma irrespective of the stage of the disease (p=0.0001), and significantly predicted grade: OR:0.07, 95% CI 0.07–0.31, p=0.0001. Conclusion: p27^kip1 may be a putative distinct molecular marker to differentiate between low-grade and high-grade gastric lymphoma.     

Extranodal marginal zone B-cell lymphoma of malt type involving the cavernous sinus.

Mucosa-associated lymphoid tissue (MALT) lymphomas are low-grade B-cell neoplasms that occur in a variety of extranodal sites. Only rarely has this entity been discovered as a primary tumor involving the dura of the cavernous sinus. We report the case of a 46 year old woman who presented with a mass involving the cavernous sinus that was originally diagnosed as a meningioma by MRI. However, at surgery the mass was found to be an extranodal marginal zone B-cell lymphoma of the MALT type. The patient underwent partial excision of the lesion followed by radiation. There are only seven other cases of marginal zone B-cell lymphoma involving the intracranial dura reported in the literature. These patients were females who presented with intracranial lesions thought to be consistent with meningioma by preoperative radiographic imaging. MALT lymphomas of the dura, as their counterparts in other organs, appear to have favorable clinical outcomes and excellent long-term prognoses with local therapy alone.     

CDR3 Sequences of MALT Lymphoma Show Homology with Those of Autoreactive B-Cell Lines

We have examined the CDR3 sequence and adjacent regions of immunoglobulin genes from B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Twenty-nine sequences (15 sequences from 13 low-grade MALT lymphomas, marginal zone B-cell lymphomas; 7 sequences from 6 highgrade MALT lymphomas; 7 sequences from 7 diffuse large cell lymphomas) were obtained after cloning of the polymerase chain reaction-amplified segments. In the low-grade MALT, high-grade MALT and diffuse large cell lymphomas, the mean length of the CDR3 region was 47.6 ± 10.31 (range 21 to 60), 38.71 ± 10.37 (range 27 to 57) and 40.86 ± 3.34 (range 39 to 48) nucleotides, respectively. The length of the CDR3 region was significantly greater in the low-grade MALT lymphoma group than in the other two groups. CDR3 sequences in lymphoma cell clones of 14 cases showed 60 to 81% homology with autoantibody-associated lymphocyte clones including rheumatoid factor. The incidences of these autoantibody-associated lymphocyte clones were higher in the high-grade MALT (4/6) and diffuse large lymphomas (5/7) than in the low-grade MALT lymphoma (5/13). Cases with more than 70% homology at the nucleotide level were found to have 71 to 82% homology with autoantibodies at the protein level in the low-grade MALT lymphomas (2/13), and 67% homology in the high-grade MALT lymphomas (2/7). These results indicate that MALT lymphomas may be derived from the malignant transformation of autoreactive B-cells.