肺黏膜相关淋巴瘤的诊断与鉴别诊断

目的 探讨肺黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALToma）的临床、影像、病理学特征和可靠的诊断依据,并与形态非常相似的3种肺良性淋巴组织增生性病变相鉴别.方法 分析3例肺MALToma患者的病史、影像学、病理组织学等检查,与淋巴细胞性间质性肺炎、淋巴细胞性炎性假瘤、滤泡性支气管炎鉴别.结果 肺MALToma临床表现和影像学缺乏特异性,与肺癌不易鉴别.病理示边缘区淋巴细胞增生、围绕生发中心并相互融合,侵入支气管上皮形成“淋巴上皮病变”,侵入滤泡生发中心形成“滤泡植入”.结论 肺MALToma是一种少见的低度恶性肿瘤,临床症状和影像学无特异性,确诊需依据病理组织学.与其他肺淋巴组织增生性病变的主要鉴别点在于边缘带的范围大小、有无融合、有无“滤泡植入”、有无“淋巴上皮病变”、滤泡之间的细胞类型等.

Diagnosis and differential diagnosis of pulmonary marginal zone B cell lymphoma of mucosa associated lymphoid tissue

Objective To study the clinical,imaging and pathological characteristics and diagnostic methods of pulmonary mucosa-associated lymphoid tissue-derived lymphoma （MALToma）,and differentiate from three kinds of pulmonary lymphatic hyperplasia.Methods Medical history,imaging and pathological examination of three cases of pulmonary MALToma were introduced in detail.And differentiated from lymphocytic pseudolymphoma （nodular lymphoid hyperplasia）,follicular bronchiolitis and lymphocytic interstitial pneumonia.Results The clinical manifestations and imaging examination of pulmonary MALToma had no special and were not easy to differentiate from cancer.Histopathologically,widened marginal zones encircled one or more germinal centers.The neoplastic lymphocytes invaded germinal center and bronchiole resulting in follicle colonization and lymphoepithelial lesions.Conclusion Pulmonary MALToma is a rare low grade malignant tumor.Histopathology is the key method to diagnosis,while clinical manifestations and imaging examination have no special symptoms at diagnosis.MALToma is differed from pulmonary lymphatic hyperplasia in widened marginal zone encircled one or more germinal centers,follicular colonization,lymphoepithelial lesions,cell types between follicular.