21例原发性肠道非霍奇金淋巴瘤误诊分析

胃肠道是原发性非霍奇金淋巴瘤最常见的结外累及部位。原发性肠道非霍奇金淋巴瘤临床表现无特异性，内镜活检诊断率较低。目的：回顾性分析原发性肠道非霍奇金淋巴瘤误诊病例，以期提高其诊断准确率。方法：收集上海仁济医院2003年1月-2011年10月所有经手术病理证实、符合Dawson标准的原发性肠道非霍奇金淋巴瘤病例，复习误诊病例，分析可能的误诊原因。结果：共入组误诊病例21例，其中弥漫性大B细胞淋巴瘤10例，原发性肠道T细胞淋巴瘤7例，套细胞淋巴瘤3例，黏膜相关淋巴样组织（MALT）淋巴瘤1例，大多数患者在诊断过程中曾行影像学和内镜检查。弥漫性大B细胞淋巴瘤多误诊为阑尾炎或胃肠炎，原发性肠道T细胞淋巴瘤常误诊为克罗恩病，套细胞淋巴瘤均误诊为结肠息肉，此外尚有误诊为肠道血管炎、淋巴细胞性胃肠炎以及未能明确消化道出血原因者。结论：不同病理类型原发性肠道非霍奇金淋巴瘤在误诊为其他肠道疾病时表现各有其特点，了解这些特点可能有助于正确诊断原发性肠道非霍奇金淋巴瘤。

Misdiagnosis of Primary Intestinal non-Hodgkin' s Lymphoma: Analysis of 21 Cases

Background:Gastrointestinal tract is the most commonly involved extranodal site of primarv non-Hodgkin ’ s lymphoma(NHL).The clinical manifestations of primary intestinal NHL are not specific and the diagnosis rate of endoscopic biopsy is considerably low.Aims:To improve the diagnostic accuracy of primary intestinal NHL by analyzing misdiagnosed cases retrospectively.Methods:Patients with primary intestinal NHL proved by surgical pathology and Dawson’s criteria were collected from Jan.2003 to Oct.2011 at Shanghai Renji Hospital.The misdiagnosed cases were reviewed for exploring the possible causes of misdiagnosis.Results:Twenty-one misdiagnosed cases were enrolled, including 10 diffuse large B-cell lymphoma,7 primary intestinal T cell lymphoma,3 mantle cell lymphoma,and one mucosa-associated lymphoid tissue(MALT) lymphoma.Most of the patients had received imaging examinations and endoscopy during the diagnostic process.Most of the diffuse large B-cell lymphoma cases were misdiagnosed as appendicitis or gastroenteritis,some primary intestinal T cell lymphoma cases were misdiagnosed as Crohn’ s disease,and all mantle cell lymphoma cases were misdiagnosed as colonic polyps.The rest primary intestinal NHL cases were misdiagnosed as intestinal vasculitis,lymphocytic gastroenteritis,and obscure gastrointestinal bleeding.Conclusions:When primary intestinal NHL with different pathological type is misdiagnosed as other intestinal disease,it might have its own distinctive features.Understanding these features may improve the diagnostic accuracy of primary intestinal NHL.