幽门螺杆菌感染与胃MALT淋巴瘤的相关性

阐述了胃MALT淋巴瘤的病理学诊断要点.重点综述了从胃幽门螺杆菌（HP）感染与胃MALT淋巴瘤发生和抗HP治疗能使胃MALT淋巴瘤完全或不完全性消退两方面的文献资料,表明HP感染与胃MALT淋巴瘤的相关性.     

6例幽门螺杆菌阴性的胃粘膜相关组织淋巴瘤临床分析

粘膜相关淋巴组织（mucosa-associated lymphoid tissue, MALT）淋巴瘤是一类来源于B细胞的非霍奇金淋巴瘤，临床经过呈低度恶性，最常发生于胃肠道，胃MALT淋巴瘤约占结外型非霍奇金淋巴瘤的40％。近年研究已证实胃淋巴瘤的发生、发展与幽门螺杆菌（Helicobacter pylori，Hp）感染密切相关，文献报道胃MALT淋巴瘤患者Hp感染率为61％～100％。根除Hp治疗可使约75％的早期胃MALT淋巴瘤患者获得完全缓解，因此成为早期胃MALT淋巴瘤首选治疗，     

抗幽门螺杆菌治疗胃黏膜相关淋巴组织淋巴瘤继发血小板增多症一例并文献复习

 目的　提高对胃黏膜相关淋巴组织（MALT）淋巴瘤继发血小板增多症的发病机制及其治疗的认识。方法　回顾分析1例胃MALT淋巴瘤继发血小板增多症患者的临床病理资料并复习相关文献。结果　该患者予抗幽门螺旋杆菌（Hp）治疗后胃MALT淋巴瘤缓解,血小板计数也随之恢复至正常水平。结论　抗Hp治疗对胃MALT淋巴瘤继发血小板增多症是一种有效的治疗方法。     

HP感染与胃黏膜淋巴瘤的相关性及除菌策略的研究进展

幽门螺杆菌（helicobacter pylori,HP）与消化性溃疡,胃癌及黏膜相关性淋巴组织淋巴瘤（Mucosa-associated lymphoidtissue lymphoma,MALT淋巴瘤）密切相关,根除HP可治愈绝大多数早期胃MALT淋巴瘤和延缓胃腺癌的进程[1-2],HP感染是胃MALT淋巴瘤的始动因素,胃MALT淋巴瘤可能是一种＂抗原驱动性肿瘤＂[3],本文仅就HP感染导致胃MALT淋巴瘤发病机制及除菌策略的最新研究进展综述如下。     

胃肠道黏膜相关淋巴组织淋巴瘤形态特点及与Ki-67表达、幽门螺杆菌感染的关系

 目的 探讨胃肠道黏膜相关淋巴组织淋巴瘤（MALT淋巴瘤）形态特点及其与Ki-67表达、幽门螺杆菌（HP）感染的关系。方法 观察22例MALT淋巴瘤的组织形态,并用免疫组织化学链菌素－卵白素生物素（SABC法）对其进行CD20,CD79a,CD3,CD45RO,CD23,CD5,CD10及Ki-67标记。采用Warthin-Starry胃幽门螺杆菌染色法对胃MALT淋巴瘤进行HP染色。结果 22例MALT淋巴瘤依据组织形态分为低度恶性16例,伴高度转化6例。在低度恶性MALT淋巴瘤和伴高度恶性转化的MALT淋巴瘤两组病例中,Ki-67的阳性表达率分别为43.8 %（7／16）,83.3 %（5／6）,其阳性表达率及表达强度差异有统计学意义（P＜0.05）。11例胃MALT淋巴瘤HP阳性率81.6 %。结论 胃肠道黏膜相关淋巴瘤有其独特的病理形态学特点及临床表现,Ki-67在胃肠道MALT淋巴瘤的诊断、组织学分级中具有重要价值;HP的感染与胃MALT淋巴瘤的关系密切。     

Th17和FOXP3+T在胃黏膜相关淋巴组织淋巴瘤发病中的意义

  目的  探讨Th17和FOXP3+T（Treg）阳性细胞在慢性胃炎、淋巴细胞性胃炎和胃黏膜相关淋巴组织（MALT）淋巴瘤中的意义。  方法  采用免疫组织化学方法检测18例慢性胃炎、17例淋巴细胞性胃炎和18例低度恶性胃MALT淋巴瘤组织中Th17及FOXP3+T细胞的表达情况。  结果  Th17在慢性胃炎组、淋巴细胞性胃炎组和胃MALT淋巴瘤组阳性细胞数分别为（11.2±2.4）、（15.1±5.3）和（16.8±5.4）个/每高倍镜视野,胃MALT淋巴瘤与慢性胃炎相比,差别有统计学意义（P < 0.05）,但胃MALT淋巴瘤与淋巴细胞性胃炎间差别无统计学意义（P>0.05）。FOXP3+T在慢性胃炎组、淋巴细胞性胃炎组和胃MALT淋巴瘤组的细胞数分别为（5.1±2.7）、（22.4±4.0）和（30.8±7.2）个/每高倍镜视野,三组间两两比较差异均有统计学意义（P < 0.05）。FOXP3+T和Th17细胞数量改变在胃MALT淋巴瘤组呈正相关（R=0.308,P < 0.05）。  结论  FOXP3+T和Th17细胞数量在淋巴细胞性胃炎和胃MALT淋巴瘤组织中增多,可能在胃MALT淋巴瘤的发生、发展过程中发挥作用。      

MLT1和bcl-6基因表达在胃黏膜相关淋巴组织淋巴瘤鉴别诊断和治疗中的意义

目的研究胃黏膜相关淋巴组织淋巴瘤（MALT淋巴瘤）MLT1、bcl-6基因表达。方法选择已诊断的胃MALT淋巴瘤患者20例作回顾性研究,选择新诊断的患者15例作前瞻性研究。用荧光原位杂交（FISH）法检测石蜡包埋组织MLT1和bcl-6基因表达。结果77.1%胃MALT淋巴瘤表达MLT1基因,分别为Ⅱ～Ⅳ期,化疗后1年内完全缓解率达81.0%。42.9%胃MALT淋巴瘤表达bcl-6基因,均为Ⅲ～Ⅳ期,化疗后1年内完全缓解率达67.0%。Ⅰ期占14.3%,均未检测到MLT1及bcl-6基因表达,选择抗幽门螺杆菌（HP）治疗,1年内完全缓解率达100%。结论FISH法检测胃MALT淋巴瘤患者MLT1和bcl-6基因表达可以为选择个体化治疗方案提供依据。     

胃黏膜相关淋巴组织淋巴瘤的治疗策略

目的:总结国内外对胃黏膜相关淋巴组织(MALT)淋巴瘤的病因学、诊断和治疗的最新进展。方法:应用检索MDELINE及CHKD期刊全文数据库检索系统,以"黏膜相关淋巴瘤"和"胃淋巴瘤"为关键词。纳入标准:1)胃MALT淋巴瘤的病因学和基因病理学特征;2)胃MALT淋巴瘤临床特征和分期;3)胃MALT淋巴瘤的治疗。共纳入分析23篇参考文献。结果:H.Pylori感染是胃MALT淋巴瘤的主要病因,抗感染治疗可以使近80%H.Pylori阳性胃MALT淋巴瘤完全消退。因此,抗感染治疗成为早期胃MALT淋巴瘤的标准一线治疗。抗感染无效或复发的患者可以采取放疗、化疗和分子靶向治疗等综合治疗手段。结论:过去人们对胃MALT淋巴瘤常常行手术切除,术后辅助化疗或放疗。但随着近年来对其病因学和生物学行为的认识,目前治疗以非手术治疗为主,目的是保全器官功能,提高患者生活质量。     

黏膜相关淋巴组织淋巴瘤病因学及分子遗传学研究进展

 黏膜相关淋巴组织（MALT）淋巴瘤是起源于淋巴结外MALT的低度恶性B细胞性淋巴瘤。除早期发现胃MALT淋巴瘤与幽门螺杆菌（HP）感染有关外,最近又发现一些与其他部位MALT淋巴瘤有关的病原体。 t(11;18)(q21;q21)、t(1;14)(p22;q32)、t(14;18)(q32;q21)是MALT淋巴瘤特征性的染色体异常,在不同部位的MALT淋巴瘤中发生率也不同。这三种染色体易位产物激活共同的分子通路NF-κB通路。另外还发现了一些新的基因异常。这些病因学及分子遗传学的研究有助于了解MALT淋巴瘤的发病机制,也有助于早期诊断和合理治疗。     

黏膜相关淋巴组织结外边缘区B细胞淋巴瘤预后相关因素分析

 【摘要】　目的　分析黏膜相关淋巴组织结外边缘区B细胞淋巴瘤（MALT 淋巴瘤）的临床病理学特点,并探讨其预后相关指标。方法　选取86例MALT淋巴瘤患者,依据肿瘤发生部位分为胃MALT淋巴瘤组（32例）和非胃MALT淋巴瘤组（54例）。常规HE染色、免疫组织化学（EnVision二步法）观察其病理学特点,采用间期荧光原位杂交（FISH）方法对部分病例检测肿瘤特征性的分子遗传学改变,并对病例进行临床随访。结果　两组病例临床病理学特点无明显差异。间期FISH检测结果显示t(11;18)和t(14;18)发生率分别为12 %（6／50）和9 %（4／45）。胃MALT淋巴瘤组中20例获得随访,均接受单纯抗幽门螺杆菌治疗,bcl-10核表达阳性、存在t(11;18)病例的缓解率（20 %、33 %）显著低于阴性组（73 %、91 %）,差异均有统计学意义（χ2＝3.842,P＝0.035;χ2＝4.639,P＝0.031）。非胃MALT淋巴瘤组病例中35例获得随访,女性、年龄≤60岁患者的缓解率（60 %、63 %）显著高于男性、＞60岁患者（35 %、25 %）,差异均有统计学意义（χ2＝3.905,P＝0.048;χ2＝7.373,P＝0.007）;临床Ⅰ～Ⅱ期、t（14;18）患者的无进展生存（PFS）率（52 %、75 %）显著高于Ⅲ～Ⅳ期、t（14;18）阴性者（25 %、50 %）,差异均有统计学意义（χ2＝4.207,P＝0.040;χ2＝4.363,P＝0.037）。结论　MALT淋巴瘤是一类好发于中老年人的惰性淋巴瘤,预后较好,胃与非胃MALT淋巴瘤存在不同的治疗反应评估或预后预测指标。     

CXCR3-positive B cells found at elevated frequency in the peripheral blood of patients with MALT lymphoma are attracted by MIG and belong to the lymphoma clone

Chemokine receptors mediate the migration of lymphocytes through binding of their ligands. CXCR3 is expressed in Th1 T cells; however, CXCR3 was recently reported in B-cell mucosa-associated lymphoid tissue (MALT)-type lymphoma and splenic marginal zone lymphoma. To investigate whether CXCR3-positive B lymphocytes in peripheral blood (PB) migrate to MALT and spleen, and whether the lymphoma clone is present in PB, we studied 16 cases of MALT lymphoma. In MALT cases, CXCR3-positive B lymphocytes in PB could migrate to MIG, the CXCR3 ligand. Immunohistochemical analysis showed that MALT lymphoma cells expressed CXCR3, whereas epithelial glands and/or stromal cells expressed MIG. In the PCR analysis for VH gene rearrangements, MALT lymphoma showed monoclonal or oligoclonal bands. In addition, in 8 of 16 MALT cases, the VH gene rearrangement of MALT lymphoma had the same bands as the CXCR3-positive B lymphocytes in PB. In 4 cases, the same clones of DNA sequences were confirmed in MALT lymphoma and CXCR3-positive B lymphocytes of PB. The findings support the theory that CXCR3-positive B lymphocytes in PB of MALT patients belong to the lymphoma clone and migrate to MIG-expressing mucosa-associated lymphoid tissue. It seemed to be associated with the dissemination of MALT lymphoma.     

Transformation of MALT lymphoma to pure plasma cell histology following treatment with the anti-CD20 antibody rituximab

Mucosa associated lymphoid tissue (MALT) lymphoma is a relatively common lymphoma arising from marginal-zone B-cells which are closely related to plasma cells. As opposed to the large majority of plasma cells, MALT lymphoma cells express CD20, and the anti-CD20 antibody rituximab has been reported as active treatment in patients with MALT lymphoma. We present a patient with MALT lymphoma involving stomach and lung which transformed to a pure plasma cell tumor after therapy with rituximab. This observation again supports the close association between the cell of origin of MALT lymphoma and plasma cells, suggesting that “plasmacytoma of the GI-tract” as anecdotally reported may in fact be a MALT lymphoma with extreme plasmacytic differentiation. In addition, our findings suggest that MALT lymphomas with plasmacytic differentiation might have a different 18F-FDG uptake as compared to classical MALT lymphoma.     

Differentiation of low-grade gastric MALT lymphoma and high-grade gastric MALT lymphoma: the clinical value of Ga-67 citrate scintigraphy--a pilot study

Ga-67 citrate scintigraphy has been routinely and extensively used to evaluate non-Hodgkin's lymphoma (NHL) for more than 20 years. Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is by far the most common extranodal primary NHL. Gastric MALT lymphoma can be classified as low-grade (LG) or high-grade (HG). Low-grade gastric MALT lymphoma can be cured by eradication of Helicobacter pylori; but radiotherapy and/or chemotherapy and/or surgery are the major methods of treatment for the HG gastric MALT lymphoma. However, it is difficult to differentiate these two groups by clinical parameters and endoscopic findings. The purpose of this study was to determine whether Ga-67 citrate scintigraphy can distinguish the LG gastric MALT lymphoma from the HG gastric MALT lymphoma. Twenty-one patients (11 men and 10 women ranging in age from 38 to 83 years) with histologically confirmed gastric MALT lymphoma were enrolled. Twelve patients had LG and nine patients had HG. All 21 patients underwent Ga-67 citrate scintigraphy before treatment. The results of Ga-67 citrate scintigraphy were classified as positive or negative. In the LG group, nine patients had negative results and three patients had positive results. In the HG group of nine patients, all patients had positive results. Among the three patients who had positive results in the LG group, the uptake of gastric MALT lymphoma was lower than that of the liver. The Ga-67 citrate scintigraphy is of good clinical value for the differentiation of the LG gastric MALT lymphoma and the HG gastric MALT lymphoma. We think that the major value of Ga-67 citrate scintigraphy will be in following the patients with HG gastric MALT lymphoma after treatment to assess response of therapy and to detect possible recurrence and perhaps in determining transformation from the LG to HG gastric MALT lymphoma. However, further investigation is needed to understand the relationship between the uptake of Ga-67 citrate in gastric MALT lymphoma and transformation.     

Primary mucosa-associated lymphoid tissue lymphoma of the breast

Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal indolent lymphoma with histopatholigic features similar to those of marginal zone B-cell lymphomas. Primary breast MALT lymphomas were first described by Lamovec and Jancar as a low-grade B-cell lymphoma in 1987. Herein, a case is presented of a patient with primary MALT lymphoma of the breast. Issues in diagnosis and breast-conservation treatment, as it pertains to primary MALT lymphoma of the breast, will be discussed.     

Chronic autoimmune thyroiditis (Hashimoto's thyroiditis) in patients with MALT lymphoma.

BACKGROUND: Autoimmune diseases have been implicated in the genesis of MALT lymphoma of various localizations. The development of thyroidal MALT lymphoma has been described as an adverse event in patients suffering from long-standing chronic autoimmune thyroiditis (CAT, Hashimoto's thyroiditis). The percentage and possible association between CAT and extrathyroidal MALT lymphoma, however, have not been assessed so far. PATIENTS AND METHODS: A retrospective analysis of 80 patients with MALT lymphoma diagnosed and treated at our institution identified a total of 13 patients (16%) with MALT lymphoma suffering from an underlying CAT. Patient characteristics including site of disease, stage, genetic changes and clinical course were assessed and evaluated. RESULTS: In total, 10 patients were female and 3 male, with the median age being 57 years (range: 31-80). Four patients suffered from thyroidal lymphoma and nine patients had extrathyroidal lymphoma (four gastric, two orbital, one small intestinal and two salivary gland lymphomas). Three patients had a long-standing history of CAT at diagnosis of MALT lymphoma, while CAT was discovered during staging and clinical work-up of MALT lymphoma in the remaining 10 patients. All 13 patients had localized disease, i.e. stage I or II. Only one of the four patients with gastric MALT lymphoma responded to antibiotic treatment against Helicobacter pylori infection. Genetic aberrations were detected in four patients, two of whom had a t(11;18)(q21;q21) translocation, one patient had trisomies 3 and 18 and one had trisomy 18. CONCLUSION: Our findings suggest that CAT is found in patients with not only thyroidal but also nonthyroidal MALT lymphoma. While the nature of our data does not allow for delineation of a direct association between CAT and development of extrathyroidal MALT lymphoma, further prospective studies on this issue are warranted.     

黏膜相关淋巴组织淋巴瘤临床治疗进展

黏膜相关淋巴组织淋巴瘤好发于胃及头颈部,有多部位播散、惰性发展的特点,其中80%左右为早期患者。根除幽门螺杆菌治疗为早期幽门螺杆菌阳性胃黏膜相关淋巴瘤患者的主要治疗方式。其他早期黏膜相关淋巴瘤及抗幽门螺杆菌失败胃黏膜相关淋巴瘤通过放射治疗可以取得良好疗效。近些年来放疗靶区的范围已由受累野照射向受累区域照射转变,放疗剂量也由高到低。本文主要针对以上几方面内容进行综述。     

黏膜相关淋巴组织淋巴瘤治疗研究进展

黏膜相关淋巴组织淋巴瘤是起源于淋巴结外的低度恶性淋巴瘤,是最常见的边缘区B细胞淋巴瘤(MZL),约占惰性非霍奇金淋巴瘤(NHL)的30％～50％.其发病部位广泛,治疗方法多样.现就近年来黏膜相关淋巴组织淋巴瘤的治疗研究进展进行综述.