胃MALT淋巴瘤的形态特征及诊断

目的分析胃黏膜相关淋巴组织淋巴瘤的临床特点及内镜特征。方法收集2009年6月-2010年12月,我院经病理证实的17例胃MALT淋巴瘤患者的病史资料、内镜图像及病理资料进行回顾性分析。结果 17例患者中位年龄58.2岁,男女比例1.4∶1。临床症状无特异性,以上腹疼痛、饱胀不适最为常见。病灶范围较大,常累及胃体、胃窦部,形态上以溃疡样改变最为多见。首次胃镜活检病理检查确诊率为52.9%。幽门螺旋杆菌(H.pylori)感染率为78.6%。结论 MALT淋巴瘤的临床症状及内镜下表现无特异性,内镜下多点多方向活检、应用共聚焦激光显微内镜等导向活检、病理检查除常规HE染色外加做免疫组化或进一步行基因重排检测,有助于胃MALT淋巴瘤诊断。     

胃黏膜相关淋巴组织淋巴瘤临床与胃镜表现分析

目的探讨胃黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤临床和内镜下表现特征,提高其在胃镜下的早期诊断率。方法对15例胃MALT淋巴瘤患者临床和内镜下表现特征进行回顾性分析。结果胃MALT淋巴瘤多见于40~60岁患者,男女发病率相近。临床症状无特异性,H.pylori感染率为73.33%。胃MALT淋巴瘤多位于胃窦部,66.67%表现为单个或多个溃疡,质地偏硬,蠕动性及胃腔形态无明显特异性。结论胃MALT淋巴瘤作为一类特殊的原发性胃淋巴瘤,内镜下多块、深而大的活检有助于提高确诊率。     

胃黏膜相关淋巴组织淋巴瘤35例临床特点分析

目的 汇总分析胃黏膜相关淋巴组织（MALT）淋巴瘤临床、胃镜、病理特征.方法 回顾性分析经胃镜活检及手术后病理证实胃MALT淋巴瘤35例患者的临床资料.结果 35例患者临床表现及内镜下表现并无特异性,幽门螺杆茵（Hp）感染率达89.1％ （31/35）,胃镜下病灶好发于胃窦、胃体,但首次胃镜下活检阳性率较低,仅占48.6％（17/35）.结论 胃MALT淋巴瘤临床表现无特异性,胃镜下表现多样,提高临床和胃镜医师对本病的认识以及提高胃镜下活检阳性率及活检标本加做免疫组织化学染色是诊断胃MALT淋巴瘤的关键.     

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。     

胃原发性恶性淋巴瘤22例临床分析

目的探讨胃原发性恶性淋巴瘤临床及内镜表现。方法分析总结22例患者临床、胃镜及病理。结果22例患者临床表现无特异性，上腹痛最常见(22／22)，其次为上消化道出血(16／22)、反酸嗳气(6／22)等。胃镜表现：病变发生2个以上部位多见(10／22)，其次为胃体(6／22)、胃窦(3／22)等；病变直径多大于2cm(占17／22)；病变形态以溃疡型多见(11／22)，其次为弥漫浸润型(7／22)；胃镜活检加免疫组化确诊率为63．63％(14／22)；Hp阳性检出率86．36％(19／22)。结论胃原发性恶性淋巴瘤临床表现无特异性；其镜下形态多种多样，其中累及2个以上部位者多见，病变范围较大。胃镜活检加免疫组化病理检查是诊断本病的重要手段，Hp感染与胃原发性恶性淋巴瘤的发生具有相关性。     

胃黏膜相关淋巴组织淋巴瘤的临床和内镜下表现

背量：原发性胃B细胞淋巴瘤发生于黏膜相关淋巴组织(MALT)，与幽门螺杆菌(H．pylori)感染密切相关。内镜检查是早期诊断胃MALT淋巴瘤的重要方法。目的：探讨胃MALT淋巴瘤的临床和内镜下表现。方法：分析总结经术后病理检查证实为胃MALT淋巴瘤的20例患者的临床、内镜和病理资料。20例患者中，男10例，女10例，男女比例为1：1，平均发病年龄为55．6岁(21～78岁)。结果：20例患者的临床表现均无特异性，上腹疼痛最为常见，其次是饥饿痛、腹胀、恶心、呕吐、黑便等。内镜下表现：病变发生于胃窦部5例，胃体部5例，胃角部1例，贲门部1例，多部位8例：形态表现多样，其中溃疡型10例，弥漫浸润型3例，结节型5例，结节溃疡型2例；内镜活检确诊率较低，仅为5％。20例患者中有12例检测了H.pylori，阳性率为83．3％(10／12)。手术标本免疫组化染色结果均为B细胞恶性淋巴瘤。结论：胃MALT淋巴瘤的临床表现无特异性，内镜下表现多样，病变范围较大。H．pylori感染率高可能与胃MALT淋巴瘤的发病有关。     

原发性胃恶性淋巴瘤的内镜诊断

目的　探讨原发性胃恶性淋巴瘤 (PGML)临床病理特征、胃镜及超声内镜下特点 ,提高对其诊断水平。方法　回顾性分析了经病理证实的 2 2例PGML的临床和内镜资料。结果　 2 2例患者主要症状为腹痛、纳减、体重减轻等。胃镜下表现为肿块性、溃疡性及弥漫浸润性损害 ,胃镜活检病理诊断PGML 13例。 6例行超声内镜检查均显示为起源于胃黏膜下层的低回声病灶 ,其中 2例见胃壁外的肿大淋巴结 ,均诊断为PGML。结论　原发性胃恶性淋巴瘤发病率低 ,临床表现无特异性 ,胃镜下表现与胃溃疡或胃癌等病变难以区分 ,进一步超声内镜检查 ,结合胃镜及病理检查有助于最终确诊。     

胃黏膜相关淋巴组织淋巴瘤临床与内镜诊断分析

目的:探讨胃黏膜相关淋巴组织(MALT)淋巴瘤的临床和内镜下表现,提高对胃MALT淋巴瘤早期诊断率.方法:总结我院1992年2月～2003年6月经内镜检查、组织病理、免疫组化确诊为胃MALT淋巴瘤的18例临床资料并进行分析.结果:18例患者从发病到就诊时间平均5.6个月,男性比女性为5比1.首发症状为上腹部疼痛,依次有腹部饱胀、反酸嗳气、恶心呕吐、食欲减退、呕血与黑便、贫血消瘦等临床表现.内镜下形态表现分弥散浸润型12例、多发溃疡型4例、隆起糜烂型2例.形态表现为多部位、多种形态和病变范围广为特征.内镜下常误诊为胃癌、溃疡等,需经病理学、免疫组化检查确诊.本组17例(94.5%)Hp阳性,2例经根除Hp治疗获治愈.结论:胃MALT淋巴瘤起病较隐匿、病程较长.症状、体征不具特异性.内镜下形态呈多样性,病变累及范围广、部位多.多点深取活检及病理学、免疫组化检查是提高胃MALT淋巴瘤确诊率和早期诊断率的重要方法.Hp感染与胃MALT淋巴瘤密切相关.     

胃粘膜相关淋巴组织淋巴瘤临床及病理特征分析

目的探讨胃粘膜相关淋巴组织(MALT)淋巴瘤临床和病理组织学特征。方法总结分析解放军总医院1988—01／2000—04经病理确诊的21例胃MALT淋巴瘤临床及组织病理资料。结果2l例胃MALT淋巴瘤，平均确诊时间为19个月，平均年龄51．8岁，50--70岁为发病高峰，男女比例1．6：l。病人临床表现无特异性，最常见的表现是腹痛。病变累及胃窦7例、胃体6例、多部位3例。胃镜表现弥漫型5例、溃疡型8例、结节型3例。病理活检确诊率75％。临床分期为IE期10例。ⅡE期8例，ⅢE期2例，ⅣE期1例，有B症状3例。手术18例，单用手术10例，术后有5例合用化疗，3例合用放疗，3例单用化疗。随访16例，失访5例，随访率76．2％。生存期39～156个月，平均69个月，中位数55个月。结论胃MALT淋巴瘤是原发于胃NHL的一种独特亚型，具有起病隐匿、病程长、进展缓慢、发病率低、好发于中老年男性、治疗疗效和预后良好等特点，临床表现无特异性。胃镜下具有病变范围广、病灶多发等特点，内镜取活检时多取或深取可以提高内镜诊断准确率。幽门螺杆菌(Hp)感染与胃MALT淋巴瘤的发生有关。     

原发性胃黏膜相关淋巴组织淋巴瘤29例临床分析

目的：分析胃黏膜相关淋巴组织（MALT）淋巴瘤临床、胃镜、病理特征,提高早期检出率。方法：回顾性分析经胃镜活检及手术后病理证实胃MALT淋巴瘤29例患者的临床资料。结果：29例患者临床表现多样,以上腹痛多见,幽门螺杆菌（HP）感染率高达93%,胃镜下病灶好发于胃窦、胃体,但胃镜下活检阳性率较低,仅占48%。结论：胃MALT淋巴瘤临床表现无特异性,胃镜下表现多样,提高临床和胃镜医师对本病的认识以及提高胃镜下活检阳性率活检标本加做免疫组织化学染色是早期诊断胃MALT淋巴瘤的关键。     

胃粘膜相关淋巴组织淋巴瘤的内镜下表现

目的 胃粘膜相关淋巴组织淋巴瘤（ＭＡＬＴ淋巴瘤）的内镜特征。方法 对１９例胃ＭＡＬＴ淋巴瘤患者的临床资料进行回顾分析。结果 胃ＭＡＬＴ淋巴瘤的内镜下表现呈多样性改变。病变主胃体最多（７８．９％），主要病变形态包括溃疡（６３．２％）、肿块（１５．８％）、浸润病变（１５．８％）及糜烂（５．３％）。大多数２（７３．７％）有较典型的恶性征象，但少数可无典型恶性征象，甚至仅表现为一般的炎症及糜烂。本组病例内     

A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis

Recently, we reported a case of gastric mucosaassociated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestonelike mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.     

Target biopsy using magnifying endoscopy in clinical management of gastric mucosa-associated lymphoid tissue lymphoma

Background and Aim: We have reported the characteristics of magnified endoscopic images of gastric mucosa‐associated lymphoid tissue (MALT) lymphoma before and after treatment. In this study, we investigated the diagnostic efficacy of magnified endoscopic images for target biopsy and evaluation of clinical remission. Methods: Twenty‐one patients diagnosed with localized gastric MALT lymphoma were enrolled. Magnified endoscopy was performed prior to treatment and at a mean period of 1.8 months (1–6 months) after therapy (Helicobacter pylori eradication in 19 patients and radiation therapy in two patients). Microstructural pattern and abnormal vessels in the lesions were assessed, and corpus mucosa without lymphoma was divided into H. pylori‐negative mucosa and H. pylori‐positive mucosa. Biopsy was the gold standard in this study. Results: Nonstructural areas with abnormal vessels were observed in all patients before treatment. Fifteen patients achieved pathological complete remission. Disappearance of nonstructural areas and abnormal vessels after therapy was associated with pathological remission. Sensitivities of these findings for diagnosis were 76.9% and 85.7%, respectively, and the specificities were 87.5% and 85.7%, respectively. H. pylori eradication therapy was invalid in three patients with H. pylori‐negative mucosa in magnified images. Conclusions: Magnifying endoscopy may be useful for target biopsy of superficial gastric MALT lymphoma in clinical management.     

Clinical study of 31 patients with primary gastric mucosa-associated lymphoid tissue lymphoma

BACKGROUND: The purpose of the present paper was to investigate the clinical, endoscopic and histological features of 31 patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma to enable correct, early stage diagnosis. METHODS: A retrospective study was undertaken of 31 patients with gastric MALT lymphoma. The cases were examined immunohistologically with anti-CD(20CY) and CD(45RO) antibodies for further diagnosis. Helicobacter pylori infection was also detected with modified Giemsa staining. RESULTS: Patients with MALT lymphoma were aged between 22 and 73 years (mean, 45.0 years), and the male:female ratio was 11:20. The patients presented with non-specific symptoms, but chronic epigastric pain was the common symptom in a large proportion of the cases. The gastric smaller curvature was involved in 83.9% of cases (26/31) and in 13/31 cases (41.9%) it was confined the antrum. Under endoscopy, large and deep ulcers were similar to cancers in the majority of patients. Only 29.0% of patients were diagnosed by endoscopy on first examination. CD(20CY) were expressed in all cases and CD(45RO) expressed in only one case among 10 cases of indefinite diagnosis. Helicobacter pylori infection was found in 87.1% of patients. CONCLUSIONS: These findings suggest that primary gastric MALT lymphoma has unique clinical, endoscopic and histological features. The diagnosis for primary gastric MALT lymphoma was delayed not only due to the non-specific symptoms but also due to lack of attention to its features. Endoscopy and submucosal multiple biopsy were the principal diagnostic tools in patients with gastric MALT lymphoma. CD(20CY) and CD(45RO) immunological staining are recommended, especially for patients with indefinite diagnosis of gastric MALT lymphoma.     

Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment

BACKGROUND AND AIMS: Discrepant remission rates (41-100%) have been reported for patients with localised low grade gastric mucosa associated lymphoid tissue (MALT) lymphoma after eradication of Helicobacter pylori. The aim of this study was to explain these discrepancies and to determine the predictive factors of gastric lymphoma regression after anti- H pylori treatment. PATIENTS AND METHODS: Forty six consecutive patients with localised gastric MALT lymphoma (Ann Arbor stages I(E) and II(E)) were prospectively enrolled. All had gastric endoscopic ultrasonography and H pylori status assessment (histology, culture, polymerase chain reaction, and serology). After anti-H pylori treatment, patients were re-examined every four months. RESULTS: Histological regression of the lymphoma was complete in 19/44 patients (43%) (two lost to follow up). Median follow up time for these 19 responders was 35 months (range 10-47). No regression was noted in the 10 H pylori negative patients. Among the 34 H pylori positive patients, the H pylori eradication rate was 100%; complete regression rate of the lymphoma increased from 56% (19/34) to 79% (19/24) when there was no nodal involvement at endoscopic ultrasonography. There was a significant difference between the response of the lymphoma restricted to the mucosa and other more deep seated lesions (p<0.006). However, using multivariate analysis, the only predictive factor of regression was the absence of nodal involvement (p<0.0001). CONCLUSION: In H pylori positive patients with localised gastric MALT lymphoma, carefully evaluated and treated without any lymph node involvement assessed by endoscopic ultrasonography, complete remission of lymphoma was reached in 79% of cases.     

Collision Tumors of Gastric Adenocarcinoma and Mucosa-associated Lymphoid Tissue Lymphoma

A 65-year-old woman with a history of treatment for splenic marginal zone B-cell lymphoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma underwent esophagogastroduodenoscopy. A reddish elevated lesion was found in the fundus of the stomach. On image-enhanced endoscopy, several findings, such as glandular structures of varying sizes suggesting well-differentiated adenocarcinoma, pruned blood vessels, and dilated blood vessels in deeper mucosa suggesting MALT lymphoma, were observed. The final pathological diagnosis after surgical resection was collision tumors of well-differentiated adenocarcinoma and MALT lymphoma. The features of both tumors could be observed simultaneously with image-enhanced endoscopy.     

Frequent and rapid progression of atrophy and intestinal metaplasia in gastric mucosa of patients with MALT lymphoma

OBJECTIVES: Association of gastric mucosa-associated lymphoid tissue (MALT) low-grade lymphoma and adenocarcinoma has repeatedly been reported. The aim of this study was to evaluate the frequency and the spreading of atrophy and intestinal metaplasia in gastric mucosa of patients with gastric MALT lymphoma followed after conservative treatment. METHODS: Forty-five patients (mean age 45 +/- 2.1 yr) with gastric MALT lymphoma, treated by Helicobacter pylori eradication, chemotherapy with per os single alkylating agents, or both treatments have been followed by gastroscopy with biopsies in antrum and corpus at least once a year. Univariate and multivariate analysis evaluated the association between the appearance of atrophy and intestinal metaplasia in antrum or corpus and different factors related to patients, H. pylori status, lymphoma features, and treatment. In addition, histological aspects of gastric biopsies at the diagnosis period and at the end of follow-up were compared with those of two control groups of age-matched patients with H. pylori gastritis. RESULTS: At the diagnosis time, only intestinal metaplasia in corpus was more frequent in patients with gastric MALT lymphoma than in patients with nonulcer dyspepsia. Within median follow-up of 54.4 months (range 9-196), the percentage of patients with gastric atrophy and intestinal metaplasia increased significantly and became significantly higher than in age-matched nonulcer dyspepsia patients. Multivariate analysis showed significant association between corpus intestinal metaplasia and corpus atrophy, intestinal metaplasia in antrum, and duration of the follow-up. CONCLUSIONS: Conservative management of gastric MALT lymphoma including H. pylori eradication is associated with progression of gastric atrophy and intestinal metaplasia with frequent involvement of the corpus which is known to be a precancerous condition. These findings show that long-term endoscopic monitoring should be recommended in such patients.