消化道恶性淋巴瘤临床与内镜表现特征研究

重视消化道恶性淋巴瘤特别是粘膜相关淋巴组织淋巴瘤(MALT Lymphoma)的研究十分必要。该文对三十年间在该院经病理检查证实为消化道恶性淋巴瘤50名患者临床和内镜资料进行了总结分析,其中3例诊断为MALT Lymphoma。主要临床表现为腹痛、消瘦、腹部包块、消化道出血等。病变分布为单纯累及胃60％、小肠22％、回盲部6％、食管及结肠其它部位各占2％、多灶性分布为8％。病理学检查有19例为B淋巴细胞源性低度恶性淋巴瘤。35例术前内镜检查所见巨大溃疡型40％、结节隆起型20％、弥漫浸润型20％、混合表现型20％。内镜下拟诊本病者均获病理支持,内镜活检确诊率为57％。3例MALT Lymphoma患者均为男性,主要内镜表现1例呈粘膜多发点片状糜烂,病变累及食管、胃底、十二指肠、全部小肠及结直肠;1例食管、末段回肠及结肠多发纵行大溃疡;1例呈胃多发溃疡伴出血,皱壁粗大。总结认为本病在内镜下有一定特征表现,内镜下多点活检或配合粘膜剥脱术有助于提高本病的早期确诊率。     

原发性胃淋巴瘤内镜下表现及分析

目的探讨原发性胃淋巴瘤的内镜下特点并进行分析,以期提高内镜对原发性胃淋巴瘤的诊断率。方法收集近4年我院通过内镜活检确诊的原发性胃淋巴瘤17例和内镜拟诊的原发性胃淋巴瘤20例,分析其内镜下特点。结果17例确诊的原发性胃淋巴瘤绝大部分为弥漫性大B细胞淋巴瘤,内镜下特点主要为病变大、范围广、以胃体为主的多部位侵犯．表现为大的溃疡（10／17,58．8％）、广泛的小结节或小息肉样病变可形成鹅卵石样外观（4／17,23．5％）。20例疑诊原发性胃淋巴瘤组内镜下表现为以胃窦为主的相对较小的溃疡型（5／20,25．0％）和较大结节样增生隆起性病变的结节型（9／20,45．0％）。二者内镜下病变形态差异有统计学意义（P〈0．01）,而在病变的蠕动性及活检质地方面差异无统计学意义（P〉0．05）。结论原发性胃淋巴瘤内镜下形态具有多型性,呈现一定的内镜特征,提高对其内镜下表现的认识并结合深取活检对原发性胃淋巴瘤的内镜确诊具有重要意义。     

原发性胃恶性淋巴瘤胃镜下表现分析

目的：探讨原发性胃恶性淋巴瘤（PGML）的胃镜下表现。方法：回顾分析本院2000年9月至2006年2月收治的33例PGML患者的胃镜图像资料，观察病灶形态、分布特征及胃镜活检确诊情况。结果：PGML病变分布广泛，33例患者中15例（45．5％）病灶广泛累及胃内多个部位；19例（57．5％）伴胃窦受累。33例中胃镜下表现为弥漫浸润型13例（39．4％）,结节肿块型3例（9．1％），溃疡型17例（51．5％）。5例胃黏膜相关性淋巴组织（MALT）淋巴瘤患者中，4例（80．0％）为弥漫浸润型,1例（20．0％）溃疡型：24例弥漫大B细胞淋巴瘤（DLBCL）患者中，14例（583％）为溃疡型，7例（29．2％）弥漫浸润型，3例（12．5％）结节肿块型；4例弥漫大B细胞合并MALT淋巴瘤（DLBCML）病例中弥漫浸润型和溃疡型各2例（50．0％），33例PGML．胃镜下疑诊为PGML者12例（363％），诊断为进展期胃癌20例（60．6％），复合性溃疡1例（3．0％）；经胃镜活检确诊PGML22例，确诊率为66．7％。结论：PGML病灶胃镜下形态多样，易与进展期胃癌混淆，且分布广泛,胃窦最常受累胃镜活检对PGML确诊率不高，而深部活检结合免疫组化可提高确诊率。     

16例消化道MALT淋巴瘤的内镜下特点及临床表现

目的探讨消化道黏膜相关淋巴组织型(MALT)淋巴瘤的临床表现以及内镜下特点。方法回顾分析16例明确诊断为MALT淋巴瘤的患者。结果消化道MALT淋巴瘤的好发部位以胃体为主,胃体部10例(62.50%),其次为胃部多部位受累3例(18.75%),胃窦部1例(6.25%),食管1例(6.25%),直肠1例(6.25%)。病变内镜下表现类型以溃疡型多见(8例,50.00%),其次为隆起型(4例,25.00%),平坦糜烂型(3例,18.75%),凹陷型最为少见(1例,6.25%)。幽门螺杆菌(Hp)感染阳性率为75.00%(12/16)。结论消化道MALT淋巴瘤内镜下表现多样。胃MALT淋巴瘤与Hp感染密切相关。溃疡型及隆起型易在内镜检查时发现,但平坦糜烂型及凹陷型由于与其他炎症性疾病难鉴别,很难早期发现,故早期诊断率较低。在临床工作中需提高对年轻患者及早期MALT淋巴瘤患者的重视,以做到早发现、早治疗。     

胃恶性淋巴瘤的X线诊断（附17例报告）

本文回顾性分析１７例经手术病理证实的胃恶性淋巴瘤的Ｘ线表现．并将其分为三大类型：（１）肿块型：可表现为单发巨大肿块或多发结节状肿块．伴有粘膜皱襞粗大；（２）溃疡型：表现与溃疡型胃癌或良性溃疡相似；（３）浸润型：病变弥漫浸润类似皮革胃或局限性胃窦狭窄．伴多发糜烂或小溃疡。胃恶性淋巴瘤具有病变广泛．多中心性溃疡、糜烂、肿块及巨大皱襞同时存在的特点．当Ｘ线显示恶性病变征象．而内镜多次活检阴性者．应该想到本病的可能。     

原发性胃肠道恶性淋巴瘤内镜诊断应用分析

目的 总结分析原发性胃肠道恶性淋巴瘤(PGIML)的内镜下特征及诊断要点,进一步提高该病的诊断阳性率,为临床治疗提供依据。方法 回顾性分析2004-2009年诊治的67例PGIML患者的临床资料。结果 PGIML临床症状缺乏特异性。主要表现为腹痛、黑便、腹部包块。胃是最常见的发生部位,达55.8％(37/67)。黏膜表面呈肿块结节是PGIML最常见的内镜表现。内镜活检诊断PGIML的阳性率为68.7％ (46/67)。67例均为非霍奇金淋巴瘤。免疫分型以B细胞为主,为50例。30例为黏膜相关淋巴组织(MALT)淋巴瘤。结论 PGIML早期诊断较困难,可采取多种诊断手段综合诊断,手术治疗作用尚未肯定,还需进一步随访观察。     

胃黏膜相关淋巴组织淋巴瘤的内镜和病理诊断

目的 探讨胃黏膜相关淋巴组织(MALT)淋巴瘤的内镜和病理特征，以减少误诊、漏诊，提高诊断正确率。方法 对1986～2003年该院经病理证实的32例胃MALtT淋巴瘤的临床、内镜和病理资料进行回顾性分析。结果 32例患者平均57.1岁，男女比例1：3，临床症状无特殊性。肿瘤多位于胃体下部和／或胃窦部．占90．6％；侵犯全层者，占44.0％；区域淋巴结转移，占32.0％。病理形态学改变肿瘤组织由中心细胞样细胞组成、淋巴上皮病变及反应性淋巴滤泡。该组病例内镜活检确诊率达15．6％，内镜病理诊断正确率达40．6％，术后病理确诊率达100％。免疫组织化学证实为B细胞淋巴瘤。结论 内镜下多块取检、深取检，结合以上病理特点和免疫组织化学，有助于诊断胃MALT淋巴瘤。     

原发性胃淋巴瘤的临床和内镜下表现

目的 探讨原发性胃淋巴瘤的临床和内镜下表现特征及其内在联系。方法 总结1993年1月～2004年4月该院经手术与病理证实的24例原发性胃淋巴瘤患者的临床、内镜和病理资料。结果 24例患者临床表现无特异性，临床误诊率高（91．7％）。病变主要在胃体和胃窦，同时累及胃体胃窦部10例，局限于胃体部9例，胃窦部4例，胃底部1例。形态表现多样，溃疡型18例；弥漫型4例：结节型2例。内镜活检确诊率低（41．7％）。病理以B细胞为主。H．pylori感染率为83．3％。结论 原发性胃淋巴瘤临床表现无特异性，内镜下病变范围广、病灶多发为其特点，内镜下多点、多块深取检以及及时行免疫组化检查可提高诊断准确率。H、pylori感染可能与胃淋巴瘤的发生有关。     

原发性胃恶性淋巴瘤内镜及病理特点分析

目的探讨原发性胃恶性淋巴瘤的内镜和病理特点。方法 60例经胃镜检查及组织病理学检查确诊为原发性胃恶性淋巴瘤患者,回顾性分析其内镜下表现及病理特点。结果内镜下表现为溃疡型病变32例(53.3%),浸润型病变14例(23.3%),肿块型病变7例(11.7%),结节型7例(11.7%);30例行超声胃镜检查,显示胃壁第2、3层呈低回声改变,且明显增厚;60例患者的组织病理结果均为B细胞型非霍奇金淋巴瘤,其中弥漫大B细胞淋巴瘤40例(66.7%),包括非生发中心来源22例和生发中心来源18例;结外黏膜相关淋巴组织边缘区淋巴瘤20例(33.3%)。结论原发性胃恶性淋巴瘤以溃疡型病变多见,内镜下形态具有多型性,病理类型表现多样。     

原发性胃肠道恶性淋巴瘤临床分析

目的 探讨原发性胃肠道恶性淋巴瘤（PGIML）的临床表现、内镜病理组织学特点及治疗方法。方法 回顾性总结分析病理组织学证实的2l例PGIML患者的临床和内镜资料。结果 21例患者主要症状为腹痛、纳差、腹块、便血,胃是PGIML最常见的发生部位,内镜下的表现为肿块性、溃疡性及弥漫浸润性损害,内镜活检确诊PGIML共10例。21例均为非霍奇金淋巴瘤,其中10例为粘膜相关淋巴组织淋巴瘤。结论 PGIML以腹痛为主要表现,胃的发生率最高,内镜下表现与溃疡及癌难以区分,主要病理组织学类型为MALT型结外边缘区B细胞淋巴瘤,临床进一步超声内镜检查,结合病理有助于最终确诊。预后较胃肠道其他肿瘤好。     

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。     

Impact of miniprobes compared to conventional endosonography in the staging of low-grade gastric malt lymphoma

BACKGROUND AND STUDY AIMS: In patients with low-grade gastric MALT lymphoma, conventional endoscopic ultrasonography (EUS) is considered to be the most accurate modality for locoregional staging. The aim of this study was to evaluate the diagnostic role of ultrasonic miniprobes as part of routine clinical staging. PATIENTS AND METHODS: A total of 39 patients who were histologically diagnosed with low-grade MALT lymphoma were reviewed retrospectively before treatment (n = 15) and during follow-up (n = 24). Assessment of tumor penetration into the gastric wall was based on the TNM system. Pathological lymph-node involvement was suggested by the presence of inhomogeneous hypoechoic echo patterns, with clearly demarcated borders. All examinations were carried out using a mechanical miniprobe (Olympus; diameter 2.4 mm, 12 MHz) introduced through the working channel of the endoscope. Ultrasonic miniprobe findings were compared with conventional EUS data and histology. RESULTS: Using pretreatment endoscopic ultrasonography, gastric lymphomas presented endoscopically with an ulcer (in five of 15 patients) or a diffuse infiltrative pattern (ten of 15 patients). The ultrasonic miniprobe identified a T1 lesion in 53 % (T2, 33 %) and EUS in 60 % (T2, 20 %) of cases. Pathological lymph-node involvement in T1-T2 lesions was diagnosed with the ultrasonic miniprobe in 53 % of cases and with EUS in 60 %. Using endoscopic ultrasonography during the follow-up period, in patients with normal miniprobe ultrasonography (n = 15), the histological examination confirmed a complete remission in all patients. Hypoechoic thickening of the mucosa or submucosa, or both, was seen in nine patients. Endoscopic biopsies in four of these nine patients revealed recurrent lymphoma. CONCLUSIONS: The ultrasonic miniprobe can be recommended as part of routine care in patients with gastric MALT lymphoma, both initially and during the follow-up period. The clinical significance of ultrasonic miniprobe examinations is that they can be performed as a single-step procedure during diagnostic endoscopy.     

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.     

原发性胃肠道淋巴瘤的临床、内镜及组织病理学特点分析(附41例报告)

目的 探讨原发性胃肠道淋巴瘤(PGIL)的临床、内镜及组织病理学特点,以提高其诊治水平.方法 回顾性分析2008年1月-2019年12月该院经内镜或手术活组织病理检查确诊的41例PGIL患者的临床、内镜及组织病理学特点.结果 病变部位依次为胃(73.2％)、小肠(12.2％)、结肠(9.8％)和直肠(4.8％).患者临...     

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.     

超声分型对原发性甲状腺淋巴瘤的诊断价值

目的探讨超声分型对原发性甲状腺淋巴瘤（PTL）的诊断价值。 方法回顾性分析浙江省肿瘤医院2010年1月至2019年12月病理证实的58例PTL患者的超声图像特点及临床特征。以病理结果为金标准,分析并比较最常见的2种病理类型［弥漫性大B细胞淋巴瘤（DLBCL）和黏膜相关淋巴组织淋巴瘤（MALT）］超声图像特点及临床特征的差异,采用χ²检验比较2种病理类型的超声特征差异。 结果58例病例病理类型均为非霍奇金淋巴瘤,19例经超声引导下粗针穿刺活检,39例经手术获得组织病理。其中DLBCL 37例,MALT 21例。根据超声图像特点,分为肿块型26例、弥漫型11例、混合型21例。DLBCL中超声分型为混合型的比例最高（48.6%）,MALT中超声分型为混合型的比例最低（14.3%）,两者比较差异具有统计学意义（χ²=14.305,P=0.001）。与MALT对比,肿块型DLBCL血流信号分级更高,并且包膜受侵比例更高（41.2% vs 0）,差异有统计学意义（χ²=12.021,P=0.003;P=0.013）。 结论超声检查能够较准确提供PTL的声像图特征,结合临床表现及超声分型可以辅助诊断PTL的病理类型,对临床治疗具有指导意义。     

Gastric Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue and Signet Ring Cell Carcinoma,Synchronous Collision Tumour of the Stomach: A Case Report

Objective

To report a rare case of synchronous marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) signet ring cell carcinoma occurring as a collision tumour in the stomach.

Clinical Presentation and Intervention

A 53-year-old man was diagnosed initially with signet ring cell carcinoma of the stomach. The microscopy of the subsequent total gastrectomy revealed a collision tumour of MALT lymphoma and signet ring cell carcinoma associated with Helicobacter pylori gastritis.

Conclusion

This case highlighted the importance of a careful evaluation of the accompanying lymphoid population in the biopsy samples of gastric adenocarcinoma and underlined the need for multiple endoscopic biopsies to detect these rare synchronous tumours.Key Words: Mucosa-associated lymphoid tissue lymphoma, Adenocarcinoma, Collision, Stomach     

Helicobacter pylori strikes again: gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Infection with Helicobacter pylori is common. Over 50% of the world's population is estimated to be colonized with the bacteria. The association between Helicobacter pylori and gastric mucosa-associated lymphoid tissue (MALT) lymphoma is well documented. Anti-Helicobacter pylori treatment and the successful eradication of the bacteria can potentially cure patients who test positive for the bacteria and who are diagnosed with low-grade gastric MALT lymphoma. The purpose of this article is to review the evidence implicating Helicobacter pylori as a causal pathogen for the development of gastric MALT lymphoma and to determine that anti-Helicobacter pylori therapy is an effective first-line treatment. The clinical presentation, endoscopic findings, diagnosis, staging, treatment, and follow-up of patients with gastric MALT lymphoma who are treated with anti-Helicobacter pylori therapy are also discussed.