滤泡树突状细胞表达模式变化 在淋巴瘤病理鉴别诊断中的应用价值

目的 探讨滤泡树突状细胞(follicular dendritic cell,FDC)网在各种类型淋巴瘤中的形态变化模式及其在鉴别诊断中的临床应用价值。方法 采用免疫组化方法对56例各种类型的淋巴瘤进行CD21免疫组化染色,观察FDC网的形态变化模式。其中包括弥漫大B细胞淋巴瘤8例、伯基特淋巴瘤2例、小淋巴细胞性淋巴瘤6例、浆细胞瘤6例、MALT淋巴瘤3例、外周T细胞淋巴瘤6例、间变性大细胞淋巴瘤5例、NK/T细胞淋巴瘤8例、滤泡性淋巴瘤4例、套细胞淋巴瘤3例、AITL 3例、FDC肉瘤2例。结果 FDC网在各种类型淋巴瘤中的形态变化可归为4种模式:①破坏消减型:绝大部分淋巴瘤FDC网完全或部分破坏,包括弥漫大B细胞淋巴瘤、伯基特淋巴瘤、小淋巴细胞性淋巴瘤、浆细胞瘤、外周T细胞淋巴瘤、间变性大细胞淋巴瘤、NK/T细胞淋巴瘤; ②存在型:FDC网存在,甚至有数量增多,包括MALT淋巴瘤、滤泡性淋巴瘤、套细胞淋巴瘤; ③增生紊乱型:FDC网增多、变形、紊乱,如AITL; ④全表达型:FDC网在肿瘤组织中每个细胞表达,如FDC肉瘤。结论 FDC在各种类型淋巴瘤中存在不同的形态变化模式,在淋巴瘤鉴别诊断中具有重要的临床应用价值。     

T(11;18)及核bcl-10蛋白在胃肠MALT淋巴瘤中的表达

为了探讨t(11；18)(q21；q21)染色体易位及核bcl-10蛋白在胃肠粘膜相关淋巴组织淋巴瘤(MALT lymphoma)中的表达，用酸性酚氯仿法从石蜡组织中提取RNA；逆转录合成cDNA后用聚合酶链反应(PCR)扩增API2-MALT1融合基因；用免疫组织化学法检测石蜡切片中bcl—10蛋白的表达。结果表明：42例MALT淋巴瘤中，t(11；18)(q21；q21)染色体易位在低度恶性MALT淋巴瘤中的表达为14％，在伴高恶转化型MALT淋巴瘤中的表达为46％，在40例弥漫大B细胞淋巴瘤(diffuse 1arge B cell lymphoma，DLBCL)对照组中没有表达；43例MALT淋巴瘤中bcl-10蛋白在低度恶性MALT淋巴瘤的核表达为61％，在伴高恶转化型MALT淋巴瘤中的核表达为69％。结论：t(11；18)易位可能与高度进展MALT淋巴瘤有一定相关性，但与DLBCL无关;bcl-10蛋白的核表达在恶性程度不同的两组MALT淋巴瘤中无显著性差异，其原因有待进一步研究。     

黏膜相关淋巴组织淋巴瘤的发病机制及治疗策略

黏膜相关淋巴组织(MALT)淋巴瘤是B细胞来源的非霍奇金淋巴瘤,其发生主要与感染、基因突变等相关,常见发病部位为胃肠道.MALT诊断及其分期主要依赖于针对各病变组织的辅助检查,尤其是病理活组织检查及免疫组织化学检查.MALT治疗主要以抗感染治疗及观察等待治疗策略为主,辅以放、化疗及靶向免疫治疗等.MALT淋巴瘤患者的总体预后较好,如何提高复发/难治性MALT患者的预后为进一步研究的主要方向.这主要依赖于对MALT发病机制的深入了解,以及基于MALT发病机制的新药研发.笔者拟就MALT淋巴瘤的发病机制及治疗策略的研究进展进行综述.     

胃肠黏膜相关淋巴组织淋巴瘤43例临床分析

【目的】总结胃肠黏膜相关淋巴组织（MALT）淋巴瘤的诊治体会及经验。【方法】对200l~2008年收治的43例胃肠MALT淋巴瘤患者进行回顾性分析。【结果】①胃肠MALT淋巴瘤多发生于50岁以上者,男性多于女性;②胃肠MALT淋巴瘤内镜下表现多样化、无特异性,镜检时应采取多点活检、免疫组化标记以提高早期检出率;③治疗以化疗为主,巨大胃溃疡或肠MALT淋巴瘤加以手术切除,以改善其生活质量,延长生存期。【结论】胃肠MALT淋巴瘤临床表现不典型,确诊应根据内镜、病理和免疫组化结果综合判断。     

胃黏膜相关淋巴组织淋巴瘤幽门螺杆菌分离株与胃炎分离株的转录组比较

目的本研究对胃黏膜相关淋巴组织淋巴瘤（MALT淋巴瘤）幽门螺杆菌分离株与胃炎分离株的转录组进行比较，以阐述胃MALT淋巴瘤幽门螺杆菌分离株的转录组特征。方法对2株分离自胃MALT淋巴瘤的菌株与胃炎菌株26695的转录组进行比较。结果胃MALT淋巴瘤幽门螺杆菌分离株之间转录组非常相似，而与胃炎菌株26695之间差异较大。 对差异表达基因进行GO功能富集分析，结果显示富集基因数前5位的为催化活性、代谢进程、细胞进程、结合、单组织进程。 Pathway显著性富集分析表明差异基因的功能主要参与氨基酸和核苷酸糖代谢、卟啉和叶绿素代谢以及乙醛和二羧酸代谢。结论胃MALT淋巴瘤幽门螺杆菌相关菌株可能通过代谢调控菌体生长和侵染宿主，从而在胃MALT淋巴瘤形成过程中发挥着重要作用。     

肠粘膜相关淋巴组织淋巴瘤的形态学表现

目的：总结肠粘膜相关淋巴组织淋巴瘤（MALT淋巴瘤）的形态学特征,以提高该病的内镜诊断水平,方法：对14例肠MALT淋巴瘤患者的内镜,手术等临床资料进行回顾分析。结果：肠MALT淋巴瘤累及末端回肠最多见,形态8学表现呈多样性改变,以结节隆起性病变,溃疡及浸润性病变为主要表现者分别占64．3％,21．4％及14．3％,多数患者表现出较典型的恶性征象,但少数患者仅表现为一般的结节隆起,糜烂或溃疡,无恶性征象,内镜活检有助于该病的早期确诊。结论：内镜检查及活检为诊断肠MALT淋巴瘤的有效方法。     

Detection of gastric MALT lymphoma spreading to the small bowel by enteroscopy

Mucosa-associated lymphoid tissue (MALT) lymphoma is thought to be a multifocal disease with sometimes synchronous involvement of various mucosal structures. In this study we aimed to evaluate the potential involvement of the small bowel in patients suffering from gastric MALT lymphoma by analyzing the results of enteroscopy, a technique that allows easy and safe access to the small bowel with the potential for histological assessment of biopsy samples. We have retrospectively evaluated 347 enteroscopies and found nine patients with gastric MALT lymphoma who had undergone push enteroscopy with serial biopsies during staging. All patients tolerated enteroscopy without side effects, and no local complications occurred. In eight cases no evidence of duodenal or jejunal involvement was found macroscopically or by histological assessment of biopsies, while in one patient enteroscopy revealed jejunal MALT lymphoma infiltration with macroscopic accentuation of mucosal parts and consecutive histopathological verification more distal than 50 cm. This single-center retrospective analysis shows that enteroscopy can provide additional diagnostic information in patients with gastric MALT lymphoma, although the number of patients was small and only one out of nine patients showed hitherto undetected MALT lymphoma deposits. Further studies may quantify the additional diagnostic yield provided by this easy and safe endoscopic method.     

黏膜相关淋巴样组织淋巴瘤易位蛋白功能及其在血液肿瘤中对核因子-κB信号通路的调节作用

在机体适应性免疫反应中,黏膜相关淋巴样组织淋巴瘤易位蛋白(MALT)1是抗原诱导的核因子-κB信号通路激活的关键因子,其蛋白酶活性的激活可增强机体免疫反应.近年来,相关研究结果表明,MALT1的蛋白酶活性对MALT1依赖性淋巴瘤[活化B细胞样亚型弥漫大B细胞淋巴瘤(ABC-DLBCL)与MALT淋巴瘤]细胞生存及增殖是必需的;亦有文献报道,MALT1与急性T淋巴细胞白血病(T-ALL)、急性B淋巴细胞白血病(B-ALL)的发生相关,且在骨髓瘤细胞株中过表达.笔者拟就MALT1的功能、对核因子-κB信号通路的调节作用及其与血液系统肿瘤的关系进行综述.     

肠道黏膜相关淋巴组织淋巴瘤3号染色体三体的研究

目的　检测肠道黏膜相关淋巴组织 (MALT)淋巴瘤中 3号染色体三体 (C3三体 )的发生率 ,并探讨此变异与该肿瘤发生的关系。方法　 11例诊断为肠道MALT淋巴瘤的标本 ,根据新的WHO分类标准 ,对实验成功的 8例进行分型 ,7例为经典MALT型淋巴瘤 ,临床为惰性 ;1例在MALT型淋巴瘤基础上有大细胞转化 ,临床为侵袭性。实验中选用生物素标记的染色体特异的着丝粒探针 ,采用染色体原位杂交方法 ,以 16号染色体探针作为技术参照组 ,以肠道慢性炎症作为实验对照组 ,检测肿瘤细胞中 3号染色体的拷贝数。结果　在 7例惰性淋巴瘤患者中 5例为C3三体 ,发生率为 71.4 % ,2例为C3正常 ;1例侵袭性病例为C3三体。结论　C3三体在肠道MALT淋巴瘤中发生率较高 ,该高发生率与肿瘤的发生或演进可能有一定的相关性 ,并对协助临床诊断可能具有价值。     

The possible involvement of micro-organisms other than Helicobacter pylori in the development of rectal MALT lymphoma in H. pylori-negative patients

It remains unclear whether lymphoma of the mucosa-associated lymphoid tissue (MALT) in the extragastric organs is related to Helicobacter pylori infection or not. This report describes three patients with rectal MALT lymphoma negative for H. pylori infection, all of whom showed disease regression after being treated with antibiotics. One patient had MALT lymphoma in both the descending colon and the rectum; the other two patients had rectal disease only. None of the patients had chronic gastritis which was detectable either endoscopically or histologically and H. pylori infection was completely ruled out by various methods, including a urease breath test. These patients received antibiotic therapy. In all the patients, regression of MALT lymphoma was observed endoscopically and histologically, and polymerase chain reaction revealed that a previously observed rearranged band of immunoglobulin heavy chain had also disappeared after antibiotic treatment. These cases therefore suggest involvement of micro-organisms other than H. pylori in the development of rectal MALT lymphoma.     

(18)F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings in Mucosa-associated Lymphoid Tissue Lymphoma of the Larynx: a Case Report and Literature Review

Laryngeal mucosa-associated lymphoid tissue (MALT) lymphoma is rare, with only 25 cases reported in the literature. This report presents a case of laryngeal MALT lymphoma in a 35-year-old female with a 6-year history of progressively worsening hoarseness. MALT lymphoma was diagnosed based on biopsy and immunohistochemical analysis. The patient received two cycles of cyclophosphamide + epirubicin + vincristine + prednisone (CHOP) chemo therapy, which was ineffective. (18)F-fluoro deoxy glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) showed (18)F-FDG accumulation in the larynx only and identified stage IE lymphoma. CHOP chemotherapy was terminated and the patient was treated with radiotherapy. After 3 months (total radiation dose 27 Gy), (18)F-FDG PET/CT scan showed that the laryngeal lesion was in complete remission. A review of the literature on the MEDLINE(?)/PubMed(?) databases regarding laryngeal MALT lymphoma and the use of PET/CT found that radiotherapy is the firstline treatment for stage I and II MALT lymphoma.     

Sonographic detection of secondary MALT lymphoma of the submandibular gland.

This report describes a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal glands that recurred in the submandibular salivary glands. Gray-scale sonography showed small hypoechoic nodules, measuring less than 0.5 cm in diameter, in both submandibular glands. The echogenicity and echotexture of the rest of the submandibular glands and of the parotid glands was normal. Power Doppler sonography revealed increased vascularity within the nodules. A sonographically guided aspiration biopsy of the nodules revealed MALT lymphoma. Secondary MALT lymphoma should be considered in the presence of multiple small hypoechoic nodules in the salivary glands in patients with a history of MALT lymphoma at another location.     

Malignant lymphoma and Helicobacter pylori infection

Lymphoid tissue is acquired in the stomach in response to antigenic stimulation, so called mucosa-associated lymphoid tissue(MALT). In 1983, Isaacson had named a type of malignant B-cell lymphoma "MALT lymphoma" which grow in the marginal zone of lymphoid foliclies in the gastric mucosa. MALT lymphoma has lately attracted attention because of the relation of Helicobacter pylori(H. pylori). There are several studies that H. pylori can be detected in more than 90% of patients with MALT lymphoma and cure of H. pylori infection is followed by a complete regression of these tumors in most patient. This paper reviews the current knowledge about MALT lymphoma, and immunological and molecular aspects in the pathogenesis of the disease.     

Collision tumor: invasive ductal carcinoma in association with mucosa-associated lymphoid tissue (MALT) lymphoma in the same breast

Synchronous occurrence of multiple neoplastic processes is uncommon and the relationship between breast cancer with lymphoproliferative diseases is unusual as well. Furthermore, breast involvement by malignant lymphoma is a rare event and primary breast mucosa-associated lymphoid tissue (MALT) lymphoma is even rarer. We report a patient with synchronous occurrence of malignant lymphoma of MALT type and ductal carcinoma of the breast, presenting as "collision tumor," invading each other and occurring as a single mass in the breast. Involvement of the sentinel lymph node by MALT lymphoma was demonstrated with no evidence of metastatic carcinoma. Staging bone marrow biopsy did not show involvement by malignant lymphoma or carcinoma. Our patient was treated with chemotherapy for the lymphoma. She also received radiotherapy and aromatase inhibitor as adjuvant therapy for the breast carcinoma.     

49例MALT淋巴瘤临床资料分析

本研究旨在探讨黏膜相关淋巴组织淋巴瘤（mucosa-associated lymphoid tissue lymphoma，MALTlymphoma）临床特点、APl2．MALTl基因的表达与预后的关系。通过回顾临床资料，研究我院49例MALT淋巴瘤患者的临床特点，并通过RT．PCR法检测部分石蜡标本APl2．MALTl基因重排。结果表明：MALT淋巴瘤患者的发病平均年龄为52，4岁，50岁以上的患者占67．4％，肿瘤多发生在胃肠道，其次在甲状腺；49例中I、Ⅱ期患者占776．％，Ⅲ、IV期患者占22．4％；APl2-MALTl基因重排在低度恶性组、转化组的阳性率分别为38．1％和12、5％；3年生存率为93．8％。结论：MALT淋巴瘤患者的临床进展缓慢，对化疗敏感，预后较好，可根据有无APl2-MALTl基因重排选择不同的治疗方法，对I期HP阳性患者可采用抗HP治疗。     

小肠克罗恩病与小肠MALT淋巴瘤的临床和病理分析

目的:分析小肠克罗恩病(CD)与小肠MALT淋巴瘤的临床资料,以提高两者的鉴别诊断水平.方法:回顾性分析经手术确诊的小肠CD与MALT淋巴瘤患者的临床表现、术中所见及病理结果.结果:腹痛是这两组最常见的临床表现.8例(40%)小肠CD出现肠腔狭窄,2例(10%)伴肠瘘形成;3例小肠MALT淋巴瘤为肿块型(50%);11例(55%)CD出现透壁性炎症,10例(50%)出现镜下溃疡,3例(15%)表现为非干酪样肉芽肿;B细胞性淋巴瘤5例(83.3%).结论:小肠CD以纵行溃疡为主,伴肠腔狭窄、肠瘘形成,小肠MALT淋巴瘤以肿块型为主,以B细胞性为主.     

MALT淋巴瘤病因及发病机制研究进展

黏膜相关淋巴组织(MALT)淋巴瘤为起源于淋巴结外MALT的低度恶性B细胞淋巴瘤,是非霍奇金淋巴瘤中边缘区B细胞淋巴瘤最常见类型。MALT淋巴瘤常发生于胃、唾液腺、甲状腺及眼眶附属器等部位,其中发生于胃肠道的病例占全部MALT淋巴瘤的50%,胃肠道MALT淋巴瘤已证实与幽门螺杆菌(HP)感染有关,其主要机制为免疫反应,在部分染色体易位患者抗HP治疗无效,提示存在其他致病机制。在MALT淋巴瘤中发现的染色体易位包括t(11;18)(q21;q21)、t(1;14)(p22;q32)、t(14;18)(q32;q21)、t(3;14)(p14.1;q32)。最近研究发现了一些新的染色体异常如6q23.3等,它们对淋巴瘤的临床过程及预后等均有影响。MALT淋巴瘤的染色体异常通常激活共同的分子通路核因子(NF)-κB,持续活化的NF-κB使肿瘤细胞增殖或活化,最终导致MALT淋巴瘤的发生。本文就近年来MALT淋巴瘤病因及发病机制的研究进展做一综述。     

Sonographic appearances of mucosa-associated lymphoid tissue lymphoma of the submandibular gland confirmed with sonographically guided core needle biopsy

A 71-year-old man presented with mucosa-associated lymphoid tissue (MALT) lymphoma of the submandibular gland 52 months after initial diagnosis of MALT lymphoma of the lung. Ultrasonography showed a well-demarcated, markedly hypoechoic, heterogeneous solid mass with linear echogenic strands and hypervascularity. Ultrasound-guided core-needle biopsy demonstrated histological findings of MALT lymphoma. Sonographic features of MALT lymphoma of the submandibular gland are characteristic and ultrasound-guided core-needle biopsy may be a suitable replacement for surgical biopsy.     

Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature

BACKGROUNDMucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of non-Hodgkin lymphoma that is mainly involved in the gastrointestinal tract. The synchronous occurrence of colonic MALT lymphoma and adenocarcinoma in the same patient is extremely rare. We here report a case of synchronous colonic MALT lymphoma found on surveillance colonoscopy five months after surgery and chemotherapy for sigmoid adenocarcinoma.CASE SUMMARYA 67-year-old man was admitted because of hematochezia for two months. Colonoscopy suggested a colonic tumor before hospitalization. Abdominal computed tomography (CT) revealed local thickening of the sigmoid colon. The patient underwent a left hemicolectomy with local lymph node dissection. The histopathology revealed moderately differentiated adenocarcinoma and partially mucinous adenocarcinoma. The pTNM stage was T3N1Mx. The patient received chemotherapy with six cycles of mFOLFOX6 after surgery. Colonoscopy was performed five months later and revealed single, flat, polypoid lesions of the colon 33 cm away from the anus. Subsequently, the patient underwent endoscopic mucosal resection for further diagnosis. The pathological diagnosis was MALT lymphoma. Positron emission tomography /CT suggested metastasis. The patient refused further treatment and died ten months later.CONCLUSIONColonic MALT lymphoma may occur after surgery and chemotherapy for adenocarcinoma as a synchronous malignancy. Regular surveillance colonoscopy and careful monitoring after surgery are critical.     

原发胸腺黏膜相关淋巴组织淋巴瘤七例报告并文献复习

目的分析原发胸腺黏膜相关淋巴组织(MALT)淋巴瘤的临床特征、病理诊断、治疗及预后,并进行相关文献复习。方法收集并分析2017年11月至2019年1月于南京医科大学第一附属医院诊疗的7例原发胸腺MALT淋巴瘤患者的临床表现、病理诊断、实验室检查、治疗及预后。结果7例患者中6例为女性,患者常无明显不适,因体检发现前纵隔肿物就诊。行前纵隔肿物切除,术后病理提示为原发胸腺MALT淋巴瘤。实验室检查显示全部患者抗核抗体、抗Ro52抗体、抗干燥综合征A抗体阳性,红细胞沉降率均升高。其中4例有干燥综合征病史。术后对所有患者进行PET-CT检查并密切随访,截至2019年7月患者生存良好,未见复发。结论原发胸腺MALT淋巴瘤临床罕见,多与自身免疫性疾病(如干燥综合征)相关,此类患者预后好,若无治疗指征,可密切随访,避免过度治疗。