胃原发性恶性淋巴癌

目的　通过观察胃原发性恶性淋巴瘤的临床,胃镜、X线表现及治疗结果,探讨提高早期诊断率。方法　复习近年来经手术和病理确诊的10例胃原发性恶性淋巴瘤进行分析。结果　2例经胃镜活检病理证实,8例均手术病理证实,随访病例2例于手术后一年死亡。结论　胃原发性恶性淋巴瘤的临床表现无特异性,胃镜检查必须探挖多取才能得到阳性结果,结合X线及活检组织免疫组化检查可提高早期诊断率。治疗以手术后化疗(CHOP方案)为主,清除HP是治疗的关键,其预后与临床分期有关。     

26例胃原发恶性淋巴瘤的临床及预后分析

目的：探讨提高胃原发恶性淋巴瘤的早期诊断率和长期生存率的方法。方法：对经手术和病理确诊的10例胃原发性恶性淋巴瘤进行分析。结果：10例经胃镜活检病理证实,16例均手术病理证实,随访22例,5年生存率50％（11例）。结论：胃原发性恶性淋巴瘤的临床表现无特异性,胃镜检查必须深挖多取才能得到阳性结果,结合X线及活检组织免疫组化检查可提高早期诊断率。治疗以手术后化疗（CHOP方案）为主,清除HP是治疗的关键,其预后与临床分期有关。     

原发性胃恶性淋巴瘤28例临床分析

目的 探讨原发性胃恶性淋巴瘤的临床特点、诊断方法、外科治疗方法.方法 回顾性分析经手术治疗的28例原发性胃恶性淋巴瘤的临床资料.术前常规行胃镜、X线钡餐造影、CT检查.对早期伴有出血、穿孔或化疗期间有出血、穿孔风险及胃镜病理诊断疑癌的患者采取手术治疗.结果 术式:D1根治术13例,D2根治术11例,姑息切除术3例,联合...     

原发性胃恶性淋巴瘤的临床特点和外科治疗

目的 :探讨原发性胃恶性淋巴瘤的临床特点和治疗。方法 :回顾性分析 2 1例原发性胃恶性淋巴瘤的诊治情况。结果 :2 1例中术前经胃镜活检确诊 7例 ,确诊率仅为 33 3% ,手术切除 2 0例 ,行全胃切除 12例 ,胃大部切除 8例 ,剖腹探查 1例 ,5年生存率为 5 7 1%。结论 :原发性胃恶性淋巴瘤术前确诊以胃镜活检为主要手段 ,但确诊率仍待提高。治疗以手术切除为主 ,术前辅助化疗有助于晚期肿瘤的手术切除     

5例原发性胃恶性淋巴瘤胃镜特征

[目的]分析原发性胃恶性淋巴瘤的临床和胃镜特征.[方法]5例患者均经手术及病理学证实,观察其临床及内窥镜下表现.[结果]5例患者主要症状为中上腹隐痛或不适、上消化道出血、消瘦等;胃镜下主要表现为多发性溃疡,活检标本均为Hp( );病理类型为非霍奇金淋巴瘤,免疫组化分型为B细胞型.[结论]原发性胃恶性淋巴瘤无特异性临床表现,胃镜检查对其有确诊价值.     

原发性胃恶性淋巴瘤的临床特点和外科治疗

目的：探讨原发性胃恶性淋巴瘤的临床特点和治疗。方法：回顾性分析21例原发性胃恶性淋巴瘤的诊治情况。结果：21例中术前经胃镜活检确诊7例，确诊率仅为33．3％，手术切除20例，行全胃切除12例，胃大部切除8例，剖腹探查1例，5年生存率为57．1％。结论：原发性胃恶性淋巴瘤术前确诊以胃镜活检为主要手段，但确诊率仍待提高。治疗以手术切除为主，术前辅助化疗有助于晚期肿瘤的手术切除。     

原发性胃淋巴瘤56例临床病理分析

目的:探讨提高原发性胃淋巴瘤的诊断与治疗方法.方法:回顾性分析56例原发性胃淋巴瘤患者的临床病理资料,对其诊断治疗结果进行分析.结果:术前误诊率为33.3%,手术切除率为97.2%.手术加化疗5年生存率,低度恶性胃淋巴瘤为80.0%,高度恶性胃淋巴瘤为33.3%.结论:胃镜活检能有效降低胃原发性淋巴瘤的误诊率.针对原发灶部位、大小、病理分期不同,采用手术、化疗、放疗和生物治疗等多种治疗手段,制定个体化治疗方案,可以提高原发性胃淋巴瘤患者的生存率.     

原发性胃恶性淋巴瘤的临床分析

目的探讨原发性胃恶性淋巴瘤的临床特点及其与幽门螺杆菌感染的关系。方法对31例原发性胃恶性淋巴瘤的临床病理、免疫组化及幽门螺杆菌感染的结果进行分析。结果患者有上腹不适、肿块、黑便或贫血等临床表现。31例中原发于胃底3例，胃体6例，胃角9例，胃窦13例。18例术前经胃镜活检确诊；所有病例做免疫组化染色及幽门螺杆菌监测，证实为B细胞型淋巴瘤29例，T细胞型淋巴瘤3例，幽门螺杆菌感染率为90．2％。全部病例均行手术治疗及术后辅助化疗。29例获得随访，5年生存率为45．1％。结论原发性胃恶性淋巴瘤多属B细胞来源，并且与幽门螺杆菌感染有关。胃镜检查是术前最有效诊断价值的方法之一。手术方式与胃癌相似，术后化疗与手术治疗同等重要，病理类型是判断预后的重要指标之一。     

原发胃恶性淋巴瘤的X线诊断(附25例分析)

原发于胃的恶性淋巴瘤,临床上局限于胃的淋巴组织,预后较好,五年生存率可达50%以上。其临床症状与胃镜检查常难与胃癌鉴别。术前 X 线检查是明确诊断及提供适当治疗方案的重要手段。本文收集我院收治的临床资料较完整的,均经 X 线钡餐造影和手术病理证实的25例原发性胃恶性淋巴瘤作以下分析,探索其特性,以提高 X 线钡餐检查诊断准确率。     

胃原发性恶性淋巴瘤(附11例报告)

目的　探计胃原发性恶性淋巴瘤的内镜下形态和病理特点。方法　回顾内镜活检、病理诊断及手术切除证实的 11例胃恶性淋巴瘤。结果　本组占同期胃恶性肿瘤 0 .98% ,平均发病年龄 43 .9岁 ,发病部位胃体占 81.8% ,术前明确诊断 45 .5 %。结论　本病临床少见 ,病变发生于粘膜下层 ,各种病变形态并存较多 ,极易误诊。内镜下活检是诊断的主要手段 ,不断提高术前诊断率 ,对治疗起重要指导意义。     

胃腺癌内镜活检和术后标本HER-2 表达的一致性分析

目的:分析胃腺癌内镜活检和术后标本HER-2 蛋白表达状态的一致性,探讨胃腺癌内镜活检标本HER-2 检测结果对应用曲妥珠单抗治疗的指导价值。方法:选取2013年3 月至2014年2 月上海长海医院病理科诊断明确的胃腺癌内镜活检标本及相应的肿瘤根治手术切除标本167 例,并收集相关临床病理资料。采用免疫组织化学（immuno histochemistry,IHC ）方法检测内镜活检标本的HER-2 蛋白表达情况,用IHC 及原位荧光杂交（fluorescence in situ hybridization,FISH）方法检测相应肿瘤手术切除标本的HER-2 蛋白表达和基因扩增状况,对检测结果进行比较,并结合临床病理特征进行分析。结果:167 例根治标本中,共有18例（10.8%）HER-2 检测呈阳性,其中包含10例IHC 3 + 与8 例IHC 2 + 且FISH+ 的病例。相对应的内镜活检标本与根治手术标本的IHC 检测结果的一致率为82.0% ,剔除IHC 2 + 的样本后,真阳性率和真阴性率分别为73.3% 和97.0% 。结论:内镜活检标本HER-2蛋白IHC 检测具有较好预测价值,根治与活检标本不一致的主要原因是肿瘤表达的异质性。通过提高内镜活检标本取材数,并结合FISH检测结果,可以减少误判。      

胃肠道恶性淋巴瘤的临床诊治分析

目的探讨原发性胃肠道恶性淋巴瘤的临床特点、诊断及治疗。方法回顾性分析28例原发性胃肠道恶性淋巴瘤的临床资料。结果28例原发性胃肠道恶性淋巴瘤患者主要表现为腹胀、消瘦,均为非霍奇金淋巴瘤,内镜活检确诊率85.7%,接受手术及化疗等治疗的患者病情均有不同程度好转。结论原发性胃肠道恶性淋巴瘤的临床表现缺乏特异性,误诊率高,患者主要为非霍奇金淋巴瘤,手术加放疗治疗本病疗效较好。     

Cancer detection in biopsy specimens taken from different types of gastric lesions

From January 1974 to October 1983, 5072 gastroscopies were performed in 3351 patients with a total of 14,554 biopsy specimens taken from 2565 lesions in the stomach. The endoscopic diagnoses and their histologic counterparts were recorded and the diagnostic yield of specimens from each type of lesion analyzed. Gastric adenocarcinoma was finally diagnosed in 139 patients. The diagnosis was delayed, from 1 to 4 months, in five patients because of false-negative diagnoses. These patients all had ulcerating cancers. Moreover, early gastric cancer was mainly of the ulcerating type. Accordingly, an ulcer lesion is the most important one to biopsy. Only four cancers were found in 959 benign-appearing gastritic lesions. Twenty-one patients with negative biopsy results at the first endoscopy were later shown to have cancer. When these biopsy specimens were re-examined, malignant lymphoma was found in one and adenocarcinoma in three cases. In spite of false-negative endoscopic findings, nonrepresentative biopsy material and false-negative histologic reports, the combination of biopsy results and clinical judgement led to correct and timely treatment in nearly all patients.     

Usefulness and limitation of multiple endoscopic biopsy sampling for epidermal growth factor receptor and c-erbB-2 testing in patients with gastric adenocarcinoma

BACKGROUND: Our objective was to examine the utility of endoscopic biopsy specimens in judging the status of epidermal growth factor receptor (EGFR) and c-erbB-2 genes and proteins in the entire tumor. METHODS: Endoscopic biopsy specimens and specimens of whole representative cut surfaces of corresponding surgically resected tumors were obtained from 14 patients with gastric carcinoma, and immunohistochemistry and fluorescence in situ hybridization were then performed to determine the protein expression and gene amplification profiles, respectively, of EGFR and c-erbB-2 in these biopsy and surgical specimens. RESULTS: Among the eight endoscopic biopsy specimens obtained from three gastric carcinomas in which EGFR protein overexpression and gene amplification were judged to be positive in the corresponding surgically resected tissue specimens, EGFR overexpression was detected in three specimens (38%), but EGFR amplification was not detected (0%). Among the 19 endoscopic biopsy specimens obtained from five gastric carcinomas in which c-erbB-2 protein overexpression and gene amplification were judged to be positive in the corresponding surgically resected tissue specimens, c-erbB-2 overexpression and amplification (c-erbB-2/CEP17 ratio) were detected in 14 (74%) and 16 (84%) specimens, respectively. All three cases with EGFR overexpression and all five cases with c-erbB-2 overexpression showed intratumor heterogeneity with regard to their EGFR and c-erbB-2 status, respectively. CONCLUSIONS: The c-erbB-2 status could be adequately assessed not only by examining surgically resected materials, but also by examining multiple endoscopic biopsy specimens. On the other hand, to assess the EGFR status accurately, the use of surgically resected samples appeared to be more reliable than the use of multiple endoscopic biopsy samples.     

Risk of cancer in patients with gastric dysplasia. Follow-up study of 67 patients

This work is based on the follow-up evaluation of 67 moderate (MD) or severe gastric dysplasias (SD) diagnosed by endoscopic biopsy. Forty-one patients had moderate gastric dysplasia, 22 (53.65%) had regression of MD, 14 patients (34.4%) had persistence, three (7.31%) had progression to SD, and two (4.87%) had transformation in gastric adenocarcinoma. Twenty-six patients were diagnosed with severe gastric dysplasia: in 12 patients (46.15%) gastric lesions regressed to normality (five cases), mild (six cases) or moderate dysplasia (one case); six patients (23.07%) showed persistent histologic changes of SD in the subsequent biopsy specimens; eight patients (30.7%) presented progression of lesions to gastric adenocarcinoma after 1 to 79 months of follow-up evaluation. The authors conclude that moderate and severe gastric dysplasias are preneoplastic lesions and a valuable marker of gastric cancer risk; the risk of gastric cancer after moderate or severe dysplasia is of 9.52%, excluding those cases with short follow-up. The authors claim that these patients may receive a conservative clinical treatment with frequent endoscopic studies until the appearance of either early carcinoma to indicate gastrectomy, or no dysplasia at all or mild dysplasia in specimens from at least two consecutive biopsies.     

Effect of Route of Preoperative Biopsy on Endoscopic Submucosal Dissection for Patients with Early Gastric Cancer

Objective: To observe and compare the effects of multi-patch biopsy under conventional white light imagingendoscopy (C-WLI) and precise targeted biopsy under magnifying narrow-band imaging endoscopy (M-NBI)on the endoscopic submucosal dissection (ESD) of early gastric cancers and intraepithelial neoplasias. Methods:According to the way of selecting biopsy specimens, patients were divided into C-WLI and M-NBI groups, 20cases. The ESD operations of the 2 groups were compared quantitively. Results: The mean frequency of biopsyin M-NBI group was (1.00±0.00), obviously lower than in the C-WLI group (4.78±1.02) (P<0.01).The averagetotal number of selected biopsy specimens was also fewer (1.45±0.12 and 7.82±2.22, respectively, P<0.01).There was no significant difference in the time of determining excision extension, marking time and the time ofspecimen excision of 2 groups during the ESD (P>0.05), whereas submucosal injection time, mucosal dissectiontime, stopping bleeding time, wound processing time in the M-NBI group were significantly shorter than in theC-WLI group (P<0.01). Conclusion: Precise targeted biopsy under M-NBI can obviously shorten the time ofESD operation, with small quantity of tissues but high pathological positive rate.     

Endoscopic diagnosis of minute gastric cancer of less than 5 mm in diameter

The accuracy of diagnosis by endoscopic visual and histocytologic examination of minute gastric cancers of less than 5 mm in longest diameter was investigated. Between 1959 and 1981, 55 minute cancers were found in 54 patients at The Center for Adult Diseases, Osaka in Japan: 15 foci were solitary and 40 were associated with other larger gastric cancer. Histologic and/or cytologic confirmation of carcinoma was obtained before operation in 73.3% of cases with a solitary lesion, but in only 7.5% of cases with multiple lesions, for an overall positive result of 25.5%. The diagnostic rate was higher for elevated type and depressed type with converging folds than for flat type and depressed type without converging folds. No cancers of less than 3 mm in longest diameter were correctly diagnosed before operation. Because endoscopic visual diagnosis itself is not sufficiently reliable in determining the nature of the minute lesions, the final diagnosis should be confirmed by endoscopic direct biopsy. However, the first biopsy should be done as carefully as possible, because bleeding in the target area may prevent multiple direct biopsy specimens from being taken. Results also indicate that lesions which could not be diagnosed before operation could not be endoscopically inspected. Therefore, endoscopic detection and subsequent accurate biopsy of suspicious lesions is very important for diagnosis of minute gastric cancer.     

78例青年人胃癌的临床诊疗过程分析

Objective： To summarize the causes of difficulty in gastric cancer diagnosis in young people and explore potential methods of improving diagnostic accuracy. Methods： We retrospectively analyzed 78 cases of gastric cancer in young people （14-35 years）. Results： The clinical manifestations of gastric carcinoma in young people show no specificity, and the initial symptoms were diverse, with discomfort in the upper abdomen as the main symptom. There are four causes of difficulty in early detection： （1） The previous physician relied on antacids and did not use or analyze the results of gastroscopic examination and barium meal examination of the upper digestive tract; （2） The physician performing the endoscopic examination did not strictly follow the standards in the biopsy of fine pathological changes in suspected early cancer; （3） The physician lacked a good understanding of the clinical progress of ulcerating-healing-ulcerating in the ulcerating type of early gastric cancer; （4） Lacked a good understanding of precancerous lesions in the gastric mucosa. Conclusion： Early gastroscopy and pathological examination must be conducted for people who above 20 years of age with one or more of the following symptoms： dull pain in the upper abdomen, anorexia, fatigue, tarry stool and vomiting of unknown origin. The results of gastroscopic examination should be taken into consideration for patients with recurrent ulcer, and biopsy should be standardized. Biopsy specimens should be taken from several loci in the suspected lesions, and should be repeated if necessary. Precancerous lesions of gastric mucosa should be closely followed up using gastroscopy.