35例原发性恶性胃淋巴瘤临床特点分析

原发性恶性胃淋巴瘤（PMGL）临床表现缺乏特异性，内镜和上消化道钡餐检查确诊率低。目的：了解PMGL的临床特点，以期早期诊断，早期治疗，改善预后。方法：回顾性分析上海仁济医院2000年9月～2006年2月收治的PMGL病例的病史资料。结果：共35例PMGL患者人选。主要消化道症状为上腹痛，伴全身症状者较少。内镜下溃疡型、弥漫浸润型和结节肿块型病变分别占67．7％、22．6％和9．7％，病变主要位于胃窦和胃体。内镜活检病理检查确诊率为54．5％。35例PMGL术后病理诊断均为B细胞性非霍奇金淋巴瘤，其中黏膜相关淋巴组织（MALT）淋巴瘤5例，弥漫性大B细胞淋巴瘤（DLBCL）26例，DLBCL合并MALT淋巴瘤（DLBCML）4例。患者预后与肿瘤病理类型、临床分期和血清乳酸脱氢酶（LDH）水平有关（P〈0．05）。术后3年生存率为81．8％。结论：PMGL患者局部表现严重而全身状况良好。内镜下病变大、范围广且多部位侵犯。多点取材或“挖洞式”活检可提高内镜诊断率。治疗方案的选择应根据肿瘤病理类型、临床分期和是否存在幽门螺杆菌感染而定。

Clinical Features of Primary Malignant Gastric Lymphoma:Analysis of 35 Cases

Background： The clinical manifestations of primary malignant gastric lymphoma （PMGL） are non-specific, and the diagnostic accuracy of endoscopy and upper gastrointestinal barium meal is relatively low. Aims： To investigate the clinical features of PMGL, which may benefit its early diagnosis, early treatment and improve the prognosis. Methods： The medical records of PMGL patients in Shanghai Renji Hospital from Sep. 2000 to Feb. 2006 were analyzed retrospectively. Results： Thirty-five PMGL patients were enrolled in this study. The main gastrointestinal manifestation was epigastric pain with infrequent systemic symptoms. Endoscopically, ulceration, diffused infiltration and nodular mass were seen in 67.7%, 22.6% and 9.7% of the cases, respectively, and the lesions were located mainly in the antrum and body of stomach. The diagnosis rate of biopsy specimen pathology was 54.5%. All 35 cases were diagnosed as B-cell non- Hodgkin lymphoma pathologically, of them 5 were mucosa-associated lymphoid tissue （MALT） lymphoma, 26 were diffuse large B cell lymphoma （DLBCL）, and 4 were DLBCL associated with MALT lymphoma （DLBCML）. The prognosis was correlated with histological type, clinical staging and the serum level of lactate dehydrogenase （LDH） （P〈0.05）. The postoperative 3-year survival rate was 81.8%. Conclusions： Local presentation of PMGL is severe but the performance status is good. The lesions observed at endoscopy are large, more extensive, and involving multiple sites. Multiple and deep biopsy should be used to improve the endoscopic diagnosis rate. The therapeutic regimen should be selected in accordance with histological type, clinical staging, and the presence of Helicobacter pylori infection.