粘膜相关淋巴组织(MALT)型淋巴瘤的临床特点和处理

粘膜相关淋巴组织(MALT)型淋巴瘤是非霍奇金恶性淋巴瘤中一个独立的亚型，有其独特的临床病理特点。它是结外低度恶性B细胞淋巴瘤中最常见的一型。此型淋巴瘤病人常有慢性感染病史或自身免疫性疾病。MALT淋巴瘤是一种惰性病变，可较长时间局限于局部。局部治疗有效。胃MALT淋巴瘤最常见。本文以胃MALT淋巴瘤为重点，对MALT淋巴瘤的临床特点和处理作一个综述。     

Synchronous adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma in a single stomach

BACKGROUND: Synchronous gastric adenocarcinoma and primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma are rare, and the characteristics of these tumors are still unclear. METHODS: Histology of endoscopic and surgical specimens of 6012 gastric adenocarcinoma and 25 primary gastric MALT lymphoma cases were reviewed. RESULTS: Five cases of synchronous tumors were found among 25 primary gastric MALT lymphoma patients (20.0%) and among 6012 gastric adenocarcinoma patients (8.3%). Helicobacter pylori was detected only in two cases (40.0%) of these five synchronous cases. In only one case, two types of malignant cells were mingled each other as a colliding tumor. In other four cases, two pathologies coexisted separately. These two types of malignant tumors were not distinguished by endoscopic or gross findings. CONCLUSIONS: Although gastric adenocarcinoma coexists with MALT lymphoma at a relatively high frequency, synchronous carcinoma can be misinterpreted as a multifocal separated lesion of MALT lymphoma owing to their macroscopic resemblance. Therefore, gastric MALT lymphoma patients should be carefully examined by endoscopy, and any suspicious area must be biopsied considering the possibility of coexisting adenocarcinoma. In addition, etiologies other than H. pylori should be considered in these synchronous tumors.     

77例胃的黏膜相关淋巴组织淋巴瘤的临床分析

目的 回顾分析原发于胃的黏膜相关淋巴组织淋巴瘤(MALT)的治疗结果、预后因素和失败类型.方法 搜集20余年间收治的原发胃MALT淋巴瘤病例,病理证实且为Ⅰ、Ⅱ、ⅡE期.77例患者进入分析,手术切除组60例(手术14例、手术+化疗32例、手术+化放疗4例、手术+放疗9例、化疗+手术+化疗1例),非手术切除组17例(化放疗11例、化疗5例、放疗1例).放疗采用常规放疗(20例)和三维适形放疗(5例).化疗采用CHOP、BACOP或COP方案(53例).结果 随访1～198个月,中位值57个月.全组患者5年总生存率为74%,5年无瘤生存率为70%,5年局部控制率为76%,5年无远处失败生存率为87%.单因素分析显示临床分期与总生存率显著相关(P=0.02),肿瘤大小(P=0.03)和手术程度(P=0.02)与无瘤生存率显著相关,临床分期(P=0.04)、肿瘤大小(P=0.01)和手术程度(P=0.03)与局部控制率显著相关,未发现与无远处失败生存率显著相关因素.Ⅰ、Ⅱ期患者手术治疗后失败主要在远处,非手术治疗患者的失败主要在局部.ⅡE期患者,无论手术组还是非手术组,失败主要在局部.结论 胃原发黏膜组织相关淋巴瘤采用手术和非手术治疗均可取得很好的治疗效果,临床分期是非常重要的预后因素.     

胃黏膜相关淋巴组织淋巴瘤临床分析

 目的 探讨胃黏膜相关（MALT）淋巴瘤的临床特点和合理治疗方法。方法 回顾性分析总结10例胃MALT淋巴瘤临床资料,包括临床表现、胃镜、胃活组织病理检查、免疫组化检查及幽门螺杆菌（HP）检测和治疗方法。结果 10例均有上腹部不适或疼痛,其中6例伴有黑便。胃镜检查均见病灶处分布大小不等结节状隆起,病灶质地僵硬,接触易出血,7例见病灶处分布大小不等溃疡。6例病灶位于胃窦,2例位于胃角,2例位于胃体;胃活组织病理检查均显示胃黏膜组织中间质内有大量小淋巴细胞弥漫性浸润,浸润淋巴滤泡的边缘带,取代和破坏部分胃黏膜腺体和上皮成分。免疫组化：LCA（+）,CD+20,CD+79a,bcl-2（+）,CD-3,CD-5,CD-10,KP-1（-）,Ki-67（-）。HP检测7例阴性,3例阳性。治疗：5例手术+化疗,2例单纯化疗,2例单纯手术,1例单纯抗HP治疗。除2例手术治疗患者失访外,其余8例至今均处于完全缓解期（CR）,CR时间7 ~ 36个月,中位CR时间17.8个月。结论 胃MALT淋巴瘤临床表现不典型,其发生和HP感染密切相关,诊断主要依据病理和免疫组化检查,其显示免疫表型以结外边缘带B细胞呈单克隆浸润为特点,抗HP治疗是有效治疗方法。     

胃黏膜相关淋巴组织淋巴瘤的临床治疗观察

目的：提高对胃黏膜相关淋巴组织（mucosa-associated lymphoid tissue,MALT）淋巴瘤的认识和诊疗水平。方法：回顾性总结我院10年间115例胃黏膜相关淋巴组织淋巴瘤资料,手术标本重新病理诊断,明确分期,并进行追踪随访。结果：98例经手术治疗,17例内科非手术治疗,胃MALT淋巴瘤的病变累计范围较广,胃窦、胃体、小弯侧多见形态多样,腹腔淋巴结易受累。病理属低度恶性,预后良好。结论：胃MALT淋巴瘤是一类新型淋巴瘤,与幽门螺旋菌感染有关,及时有效治疗,预后较好,生存期可延长。     

肺黏膜相关淋巴组织淋巴瘤临床病理观察

目的:探讨肺黏膜相关淋巴组织淋巴瘤的临床病理特点及诊断与鉴别诊断。方法:对4例肺黏膜相关淋巴组织淋巴瘤的临床资料、组织学形态及免疫组化结果进行分析。结果:肿瘤大体呈结节状,镜下见边缘区B细胞结节样增生,并向周围肺泡和肺泡间质弥漫性浸润,形成特征性的飘带样和串珠样结构。免疫组化标记,肿瘤细胞CD20、CD79a、Igλ、BCL-10阳性,CD3、CD45RO、CD5、CD23、CyclinD1、CD10、BCL-2阴性。结论:肺的黏膜相关淋巴组织淋巴瘤较为少见,组织形态特征是其诊断的主要依据,免疫组化有助于鉴别诊断。     

40例早期胃外黏膜相关淋巴组织淋巴瘤的治疗结果

目的 分析胃外黏膜相关淋巴组织(MALT)淋巴瘤的临床特征和预后.方法 回顾性分析40例首程治疗的Ⅰ_E～Ⅱ_E期原发胃外MALT淋巴瘤,其中男女比例为1:2,中位年龄54岁.原发病部位为肠道10例,眼附属器9例,甲状腺8例,肺5例,韦氏环2例及其他部位6例.Ⅰ_E期27例,Ⅱ_E期13.17例患者接受放疗(其中7例合并化疗),18例接受化疗(未合并放疗),5例单纯手术切除.结果 中位随访58个月.5年总生存率和无进展生存率分别为86%和82%.Ⅰ_E期和Ⅱ_E期5年总生存率分别为92%和76%(χ~23.66,P=0.060),无进展生存率分别为85%和76%(χ~2=1.04,P=0.300).原发眼附属器MALT淋巴瘤的5年总生存率和无进展生存率均为100%.17例接受放疗的患者无局部区域复发,局部区域控制率为100%,而23例未接受放疗者局部区域复发率为13%(3例).结论 Ⅰ_E期胃外MALT淋巴瘤可取得较好的治疗效果,放疗仍是标准治疗手段,原发眼附属器MALT淋巴瘤预后最好.     

90例粘膜相关淋巴瘤患者的临床预后分析

背景与目的：粘膜相关淋巴瘤是一种边缘带非霍奇金淋巴瘤,由于其惰性的临床过程,对其临床特点及预后因素的报道比较少见。本研究对该肿瘤的临床特点及预后因素进行探讨。方法：收集1997年12月至2007年2月经病理确诊的粘膜相关淋巴瘤病例共90例,分为胃组和胃外组进行回顾性分析。结果：全组90例患者中,中位年龄52岁（13～77岁）,原发于胃的23例（25．6％）,胃外67例（74．4％）临床分期为Ⅰ～Ⅱ期的75例（83．3％）,Ⅲ～Ⅳ期15例（16．7％）多器官累及的患者占34．4％,淋巴结累及的患者占44．4％,原发胃外的患者更易出现淋巴结转移（P=0．040）。经治疗后完全缓解率为72．1％。中位随访时间31．4个月,淋巴结阳性和阴性患者的5年生存率分别为58．7％和88．4％（P=0．012）。IPI评分0～2分和首次治疗后完全缓解的患者中位无进展时间分别为61．9个月和未达到,而IPI评分〉2分和首次治疗未达完全缓解的患者中位无进展时间分别为5．2个月和15．0个月,结果差异具有统计学意义（P=0．005和P=0．030）。在67例胃外组患者中,IPI评分是总生存的独立预后指标（P=0．023）。结论：粘膜相关淋巴瘤应被认为是一种广泛播散的惰性淋巴瘤,原发胃外的患者更易出现淋巴结侵犯。具有不良预后因素包括淋巴结侵犯,IPI评分〉2和首次治疗疗效未达到完全缓解的患者应给予更加积极的治疗．     

Primary renal mucosa-associated lymphoid tissue ymphoma, the result of chronic pyelonephritis？

Objective： To report 2 cases of primary renal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue （MALT lymphoma）, and observe the relations between this rare tumor of kidney and chronic pyelonephritis. Methods： 2 renal MALT lymphomas were collected from referral consultation. Detailed clinical information were reviewed, morphological analysis based on the HE section, and immunohistochemistry were performed by CD20, CD79a, CD5, CD10, CD43, CD23, BCL10 and Cyclin D1 antibodies. Results： 2 female patients with age of 48 and 55, respectively, all had a history of chronic pyelonephritis. Under the B ultrasonic and CT scanning a bump in the kidney was found. Renal carcinoma suspected and hereby the whole nephrectomy performed. In the macroscopic, tumors were laid in the renal medulla, with dark red color and ill-defined boundary. In the microscopic, there were mixed lymphoid cells infiltrate which mainly consisted of small lympho- cytes, centrocyte-like cells, lymphoplasmacytoid and plasma cells, reactive follicles and lymphoepithelial lesions also could be seen in the lesion, but follicles colonization was rare. In fact, except changes of lymphoma, basic renal disease also could be seen. Most glomeruli were atrophic, some glomeruli were hyperplastic and hypertrophic. Tubules were dilated or contacted, many dilated tubules contained pink-color glassy-appearing casts that suggest the appearance of thyroid tissue. As a result, those 2 cases showed juxtaposed changes of lymphoma and pyelonephritis. Immunohistochemistry showed that tumor cells were CD20 and CD79a positive, CD43 was weak positive, but CD5, CD10, CD23, BCL10 and Cyclin D1 were all negative. Conclusion： Primary renal MALT lymphoma was very rare disease. According to the clinical manifestation, it＇s hard to differentiate from renal cell carcinoma. But the morphological features were consistent with the classic MALT lymphomas in other sites. Immunophenotypic profiles were helpful for diagnosis. Based on the truth that many MALT lymphomas in other sites were connected with chronic inflammations, we suppose that the renal MALT lymphoma may originate from chronic pyelonephritis.     

肾脏黏膜相关淋巴瘤2例报道并文献回顾

背景与目的：原发肾脏的黏膜相关组织淋巴瘤十分罕见,目前世界报道不足50例。本文介绍2例肾脏黏膜相关淋巴瘤的形态学特点和免疫表型特征,旨在使临床和病理对这种低度恶性的B细胞肿瘤的特点有所了解。方法：收集病史资料,形态学评价根据HE切片,用免疫组化法检测肿瘤细胞的表型,使用的抗体包括CD20、CD79、CD5、CD10、CD43、CD23、BCL10和Cyc linD1。结果：2例患者均为女性,年龄分别为48岁和55岁,临床上均有慢性肾盂肾炎病史。B超和CT检查发现肾脏肿块,行全肾切除。大体检查可见肿块位于肾髓质,呈境界不清的暗红色;镜检见肾盂至肾实质弥漫淋巴样细胞浸润,以小淋巴细胞、中心细胞样细胞、淋巴浆细胞和浆细胞浸润为主,可见肿瘤细胞浸润肾小管和肾球囊形成淋巴上皮病变和反应性淋巴滤泡,但没有显著滤泡殖入;免疫组化显示增生细胞以B淋巴细胞为主,散在分布反应性T细胞,肿瘤细胞CD20、CD79 a阳性,CD43弱阳性,CD5、CD10、BCL10、CD23和Cyc linD1均为阴性。结论：原发肾脏黏膜相关淋巴瘤临床极为罕见,临床表现和辅助检查与肾细胞癌不易鉴别,但组织学特点符合经典黏膜相关淋巴瘤的所有特征,免疫表型有助于病理诊断。     

肾脏黏膜相关淋巴瘤,是慢性肾孟肾炎的后果吗?

Objective:To report 2 cases of primary renal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma), and observe the relations between this rare tumor of kidney and chronic pyelonephritis. Methods: 2renal MALT lymphomas were collected from referral consultation. Detailed clinical information were reviewed, morphological analysis based on the HE section, and immunohistochemistry were performed by CD20, CD79a, CDS, CD10, CD43, CD23,BCL10 and Cyclin D1 antibodies. Results: 2 female patients with age of 48 and 55, respectively, all had a history of chronic pyelonephritis. Under the B ultrasonic and CT scanning a bump in the kidney was found. Renal carcinoma suspected and hereby the whole nephrectomy performed. In the macroscopic, tumors were laid in the renal medulla, with dark red color and ill-defined boundary. In the microscopic, there were mixed lymphoid cells infiltrate which mainly consisted of small lymphocytes, centrocyte-like cells, lymphoplasmacytoid and plasma cells, reactive follicles and lymphoepithelial lesions also could be seen in the lesion, but follicles colonization was rare. In fact, except changes of lymphoma, basic renal disease also could be seen. Most glomeruli were atrophic, some glomeruli were hyperplastic and hypertrophic. Tubules were dilated or contacted, many dilated tubules contained pink-color glassy-appearing casts that suggest the appearance of thyroid tissue.As a result, those 2 cases showed juxtaposed changes of lymphoma and pyelonephritis. Immunohistochemistry showed that tumor cells were CD20 and CD79a positive, CD43 was weak positive, but CD5, CD10, CD23, BCL10 and Cyclin D1 were all negative. Conclusion: Primary renal MALT lymphoma was very rare disease. According to the clinical manifestation, it's hard to differentiate from renal cell carcinoma. But the morphological features were consistent with the classic MALT lymphomas in other sites. Immunophenotypic profiles were helpful for diagnosis. Based on the truth that many MALT lymphomas in other sites were connected with chronic inflammations, we suppose that the renal MALT lymphoma may originate from chronic pyelonephritis.     

早期肺原发黏膜相关淋巴组织淋巴瘤的预后分析及文献回顾

目的 分析早期肺原发黏膜相关淋巴组织(MALT)淋巴瘤的临床特征、治疗方式和预后因素。方法 回顾分析2001—2013年32例早期肺MALT淋巴瘤的临床资料、疗效及生存情况。中位年龄56岁,Ⅰ_E期23例、Ⅱ_E期9例;边缘区B细胞淋巴瘤预后指数(MZLPI)评分0分23例、1分9例。9例接受放疗,8例接受单纯手术,3例手术＋化疗,12例单纯化疗。Kaplan-Meier法计算OS、PFS,Logrank法检验和单因素分析。结果 5年样本数22例。5年OS率为85%,5年PFS率为73%。放疗总缓解9/9,其中CR为6/9,PR为3/9。单因素分析显示未放疗为PFS的影响因素,放疗与未放疗患者5年PFS分别为100%和63%(P=0.029),5年OS分别为100%和79%(P=0.129)。年龄>60岁、ECOG评分2分及MZLPI评分1分为PFS及OS的影响因素(P=0.041、0.018、0.044及P=0.001、0.001、0.003)。结论 早期肺MALT淋巴瘤的预后因素包括年龄、ECOG及MZLPI评分。予以受累野低剂量(24~30 Gy)放疗能提高LC率进而延长生存。     

合并单克隆免疫球蛋白血症的黏膜相关淋巴组织淋巴瘤临床特征分析

目的 探讨单克隆免疫球蛋白(M蛋白)血症在黏膜相关淋巴组织淋巴瘤(MALToma)中的发生率及患者临床特征.方法 回顾性分析2010年10月至2015年10月接受M蛋白检测的16例住院MALToma患者的临床资料.结果 16例MALToma患者中,6例初诊时合并M蛋白血症.其中4例为男性,中位年龄56岁(25～82岁),肿瘤原发部位多为胃肠道(4例),临床分期多为Ⅰ～Ⅱ期(4例),国际预后指数(IPI)评分多为0～2分(5例).6例合并M蛋白血症的患者中有4例分泌单克隆性IgM(3例为κ轻链,1例为λ轻链),2例分泌单克隆性IgG(均为κ轻链).6例合并M蛋白血症的患者中有4例伴有浆细胞分化(PCD),10例未合并M蛋白血症的患者有1例伴有PCD(P=0.036).此外,3例合并M蛋白血症的患者在获得疾病缓解的同时M蛋白水平均较初诊时明显下降,其中2例降至正常水平.结论 M蛋白血症可能在MALToma患者中较常见,可能与伴有PCD有关,且M蛋白水平的降低可能与临床疗效相关.     

iNOS在胃黏膜相关淋巴组织淋巴瘤中的表达及临床意义

目的 探讨诱导型一氧化氮合酶（inducible nitric oxide synthase,iNOS）在胃黏膜相关淋巴组织淋巴瘤中的表达及临床意义。方法 用Evision两步法免疫组化检测31例胃黏膜相关淋巴组织淋巴瘤及其癌旁正常组织中的iNOS表达,并分析其与胃黏膜相关淋巴组织淋巴瘤临床病理特征的关系。结果 iNOS在胃黏膜相关淋巴组织淋巴瘤中的表达水平明显高于癌旁正常组织,iNOS在胃黏膜相关淋巴组织淋巴瘤及癌旁正常组织中的阳性表达率分别为64.5%（20/31）和29.03%（9/31）。iNOS的表达与临床分期、幽门螺杆菌（Helicobacter pylori,Hp）感染相关（P<0.05）;而与年龄、性别、LDH水平无关（P>0.05）。结论 iNOS可能参与胃黏膜相关淋巴组织淋巴瘤的发生、发展,可作为评估其生物学行为的指标。     

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。     

苯达莫司汀联合利妥昔单抗治疗胃外复发黏膜相关淋巴组织淋巴瘤

目的 探讨利妥昔单抗联合苯达莫司汀(R-Benda)治疗胃外复发黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)的疗效.方法 回顾性分析接受R-Benda方案化疗的10例诊断为复发胃外的MALT淋巴瘤患者临床资料.9例患者分别在化疗第2天和第3天接受90 mg/m2苯达莫司汀,1例患者因体能原因接受70 mg/m2苯达莫司汀;所有患者均在第1天接受375 mg/m2利妥昔单抗治疗;21 d为1个疗程.结果 8例患者接受了6个疗程化疗,1例患者因个人原因仅接受5个疗程化疗,另外1例老年患者在接受3个疗程化疗后疾病进展.8例患者达到了完全缓解,1例患者达到了部分缓解,另外1例老年患者在化疗4个疗程后因疾病进展而死亡.患者主要存在血液学不良反应事件,但程度较轻.中位随访24个月(5～43个月),9例患者生存,其中8例处于疾病缓解期.结论 R-Benda方案治疗胃外复发MALT淋巴瘤疗效好,而且不良反应轻.     

14例肺原发性黏膜相关淋巴组织淋巴瘤疗效分析

目的 分析肺原发性黏膜相关淋巴组织淋巴瘤的临床特征和预后。方法 回顾分析1999—2012年间14例肺原发性黏膜相关淋巴组织淋巴瘤患者临床资料,其中Ⅰ_E期8例、Ⅱ_E期5例、Ⅲ_E期1例。4例单纯手术治疗,5例术后放疗或化疗,3例化放疗,2例单纯化疗。结果 中位年龄为55岁,男女之比为1∶1.33。中位随访时间为48.3个月。全组患者均存活,3例患者出现治疗失败。全组患者2、4年无进展生存率分别为91%和69%。治疗失败发生在疗后25~37个月,失败部位为双肺、纵隔淋巴结、右肺和脑膜。结论 肺原发黏膜相关淋巴组织淋巴瘤为惰性淋巴瘤,预后良好;临床上可根据患者病变范围和身体状况选择适当治疗。     

胃黏膜相关淋巴组织淋巴瘤PCNA和Survivin表达及其临床意义的研究

目的:探讨PCNA、Survivin在胃相关淋巴组织(mucosa-associated lymph-oid tissue,MALT)淋巴瘤中的表达及其在肿瘤发生、发展中的意义。方法:应用免疫组织化学SP法对46例胃黏膜MALT淋巴瘤进行PCNA、Survivin标记。结果:在淋巴结有转移组与无转移组Survivin阳性率分别为83.3%和35.7%,差异有统计学意义,χ2=5.101,P=0.022;在肿瘤局限于黏膜下层与浸润肌层两组间Survivin阳性率分别为55.0%和53.8%,差异无统计学意义,χ2=1.433,P=0.240;在不同的临床分期Ⅰ、Ⅱ与Ⅲ期Survivin阳性率分别为28.0%和76.2%,差异有统计学意义,χ2=3.481,P=0.042。PCNA的表达强度随着肿瘤恶性程度的增高而增强。结论:PCNA的表达程度与胃MALT淋巴瘤的侵袭性病程有关;Survivin核表达提示胃MALT淋巴瘤的侵袭性增强。