腮腺黏膜相关淋巴瘤1例报道并文献复习

黏膜相关淋巴瘤的概念于1983年英国病理学家Isaacson和Wright首先提出，指长期抗原刺激黏膜上皮相关组织产生免疫应答及局部炎症，并从无到有发生免疫反应性淋巴增殖，由良性到恶性，产生异常克隆而导致淋巴瘤。黏膜相关淋巴瘤属于非霍奇金淋巴瘤的一种独特亚型，多发生于胃肠道，较少见于涎腺。本文报道1例腮腺原发黏膜相关淋巴瘤，结合文献复习对其组织学、     

B细胞淋巴瘤的免疫学表型及其在诊断和鉴别诊断中的意义

世界卫生组织（WHO）在新版的“造血系统肿瘤和淋巴组织肿瘤病理学分类”中将淋巴组织肿瘤分为B细胞肿瘤、T细胞和NK细胞肿瘤及霍奇金淋巴瘤3大类，并将B细胞淋巴瘤定义为13种独立的疾病。在B细胞淋巴瘤分类中，免疫表型成为最突出的内容之一。众所周知，在临床病理学实践中，免疫表型是确定每一类淋巴瘤的重要指标，是达成共识的客观依据。为了加深临床病理医师对免疫表型在淋巴瘤诊断及鉴别诊断中的作用的认识，笔者将陆续介绍B细胞肿瘤、T细胞和NK细胞肿瘤及霍奇金淋巴瘤的免疫表型及其在诊断与鉴别诊断中的应用，现首先就B细胞淋巴瘤免疫表型进行介绍。     

中性粒细胞碱性磷酸酶染色对恶性淋巴瘤患者的临床价值

目的：为了解中性粒细胞碱性磷酸酶染色（ALP）对淋巴瘤患者的临床价值。方法：将我院120例恶性淋巴瘤患者的新鲜干燥血片，用偶氮偶联法做ALP染色，将其结果进行分析并与20例正常人的ALP染色结果比较。结果：表明恶性淋巴瘤患者随着病情的进展，其ALP积分逐渐增高，积分〉250分的出现率在正常对照、恶性淋巴瘤骨髓未侵犯、骨髓侵犯及淋巴瘤细胞白血病组分别为0％、5．2％、41．7％、58．3％，具有统计学差异。结论：随着恶性淋巴瘤的病情进展，其ALP活性可逐渐增高，提示中性粒细胞碱性磷酸酶活性的增高，可直接反映恶性淋巴瘤病情的活跃及进展程度，对恶性淋巴瘤临床分期及预后的判断具有一定的临床价值。现将我室初诊的120例恶性淋巴瘤患者的ALP染色结果报告如下。     

原发性渗出性淋巴瘤1例报道

对1例原发性渗出性淋巴瘤患者临床资料进行分析，患者88岁，以纳差、腹胀，并逐渐加重为首发表现，行腹腔镜探查术及网膜活组织检查术，病理诊断为原发性渗出性淋巴瘤，预后差。     

石蜡包埋组织恶性淋巴瘤免疫球蛋白重链基因重排研究

目的探讨免疫球蛋白重链基因重排现象应用于石蜡包埋非何杰金氏淋巴瘤（NHL）病理诊断及鉴别诊断中的意义，分析影响实验结果的可能因素。方法应用B细胞性淋巴瘤细胞株Raji作为阳性对照，免疫球蛋白重链V区及J区特异性引物，单轮PCR扩增方法对存档的29例恶性淋巴瘤（B细胞性对例，T细胞性2例），6例淋巴组织反应性增生，2例上皮性肿瘤石蜡包埋组织进行了研究。结果70．4％（19／27）的B细胞性淋巴瘤免疫球蛋白重链基因存在重排现象，并均表现为单克隆性。而T细胞性淋巴瘤以及非淋巴瘤性病变无重排现象。本研究所用方法免疫球蛋白重链基因重排的阳性检出率低于半筑巢式peR扩增（80％）。结论免疫球蛋白重链基因重排在B细胞性淋巴瘤具有特异性，能够用于该类疾病诊断及鉴别诊断中。     

免疫固定电泳技术检测恶性淋巴瘤的应用

[目的]应用免疫固定电泳法，对恶性淋巴瘤（T细胞淋巴瘤，B细胞淋巴瘤）分型及签别诊断。[方法]经Hydrasys琼脂糖凝胶电泳，在γ球蛋白区，呈现深染M蛋白异常区带，再做免疫固定电泳，免疫球蛋白定量，以鉴定恶性淋巴瘤的类别。[结果]选择110例恶性淋巴瘤患者，经血清蛋白电泳检测发现有M蛋白异常区带的有14例，占12％。经免疫同定电泳图谱显示各异，结合Ig定量检测并根据临床病理学诊断确认110例恶性淋巴细胞瘤中，T细胞淋巴瘤61例，占患者总例数的55％；B细胞淋巴瘤13例，占11％；其他类型36例，占32％。[结论]免疫同定电泳检测有助于恶性淋巴瘤的鉴别分型。     

血管内大B细胞淋巴瘤临床病理学特征分析

目的探讨血管内大B细胞淋巴瘤的临床病理学特征。 方法回顾性分析2008年1月至2017年12月经泰安市中心医院病理科确诊的12例血管内大B细胞淋巴瘤患者的临床资料，观察血管内大B细胞淋巴瘤的病理形态学特征及免疫表型。 结果12例血管内大B细胞淋巴瘤患者中男性7例，女性5例，年龄58~76岁；临床症状主要有皮肤红斑及皮下结节（发生于皮肤者）、头痛头晕及行走不稳（发生于中枢神经系统者）咳嗽咳痰（发生于肺者）；光镜下表现血管腔内充满肿瘤细胞，肿瘤细胞大多相似于中心母细胞或免疫母细胞；免疫组织化学检测显示肿瘤细胞CD20阳性。 结论血管内大B细胞淋巴瘤是一种相对少见的淋巴瘤，以淋巴瘤细胞选择性的在血管腔内生长为特征；临床表现与其发生部位有关，掌握其共同的特征并结合免疫组织化学检测结果方能正确诊断。     

原发性胃淋巴瘤的临床特点分析

随着肿瘤发病率的增高，淋巴瘤的发病率也显著增高。原发性胃淋巴瘤，主要是指胃黏膜相关组织的淋巴瘤（mucosa—associated lymphoid tissue lymphoma，MALT淋巴瘤）。本研究对我院经胃镜及病理确诊为胃淋巴瘤的16例患者的资料进行统计分析，旨在探讨原发性胃淋巴瘤的临床特点和内镜、病理检查特征，以提高临床对胃淋巴瘤的认识。     

肝脾T细胞淋巴瘤转变为淋巴瘤白血病1例临床观察及文献复习

目的：提高对肝脾T细胞淋巴瘤诊断和治疗的认识。方法：报道1例罕见肝脾T细胞淋巴瘤并胸膜浸润及转变为淋巴瘤白血病的全过程。并进行文献复习。结果：肝脾T细胞淋巴瘤属外周T细胞淋巴瘤的一种亚型。临床以发热、脾脏显著肿大、肝大为主要表现。淋巴结一般不受累。其病理特征是淋巴瘤细胞的增殖高度局限在肝脾和骨髓的窦内。PCR检测TCRγ或δ基因重排阳性。结论：本病进展快、疗效差，生存期短，可转变为白血病。PCR检测骨髓标本TCRγ,基因重排对该病诊断有帮助。对于合并骨髓浸润的肝脾T细胞淋巴瘤应考虑应用白血病的化疗方案，可能会获得较好疗效。     

肺原发性恶性淋巴瘤一例报告并文献复习

肺原发性恶性淋巴瘤一例报告并文献复习宁远县人民医院裴迎东，何辉平肺原发性恶性淋巴瘤（ＰｒｉｍａｒｙＰｕｌｎｏｎａｒｙＭａ－ｌｉｇｎａｎｔＬｙｍｐｈｏｍａ，ＰＰＭＬ）临床表现复杂，病人往往不易得到及时诊断及治疗。本文报告１例并通过文献复习，就其临床表现...     

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

The sonographic studies of 72 patients with pathologically proven Hodgkin's or non-Hodgkin's hepatic lymphoma were retrospectively reviewed. Sixty-eight patients (94%) had secondary hepatic lymphoma (nine of them had AIDS-related lymphoma) and four patients (6%) had primary lymphoma of the liver. Forty-six of 72 patients (64%) had diffuse hepatic involvement, and 26 of 72 patients (36%) had focal liver lesions as demonstrated by sonography. Four patterns of disease were identified: (a) hepatomegaly was depicted by sonography in 26 of the 59 patients with secondary hepatic lymphoma not related to AIDS, in two of the nine patients with AIDS-related secondary hepatic lymphoma, and in one of the four patients with primary hepatic lymphoma; (b) multiple rounded well-delineated hypoechoic liver lesions were found in 22 of the 68 patients with secondary hepatic lymphoma; (c) a large heterogeneous echoic mass, which was an evocating clue to the diagnosis of primary lymphoma of the liver, was found in the four patients with primary lymphoma of the liver; and (d) an absence of sonographic abnormalities was found in 20 of the 59 patients with secondary lymphoma not related to AIDS. Liver involvement with lymphoma should be considered in any patient who develops multiple homogeneous hypoechoic liver masses, even in the absence of known underlying lymphomatous disease.     

Lymph node hilus: gray scale and power Doppler sonography of cervical nodes.

OBJECTIVE: To investigate the difference in the nodal hilus evaluated by gray scale and power Doppler sonography. METHODS: One hundred ninety-two patients with proven cervical lymphadenopathy were included in the study (metastases, n = 118; tuberculosis, n = 56; and lymphoma, n = 18). Lymph nodes were evaluated by gray scale sonography for the echogenic hilus and power Doppler sonography for hilar vascularity. RESULTS: Hilar vascularity was found even though the lymph node did not show an echogenic hilus on gray scale sonography (metastases, 59%; tuberculosis, 66%; and lymphoma, 91%). CONCLUSIONS: Sonologists should be aware that gray scale and Doppler sonography show different aspects of the hilus, and the absence of the hilus on gray scale sonography does not necessarily imply an associated absence of hilar vascularity.     

Straight Vessel Pattern and Rapid Filling Time

Six patients with 7 lesions that were histologically confirmed as primary testicular lymphoma were preoperatively investigated with a standardized sonographic protocol including contrast‐enhanced sonography. Duplex and contrast‐enhanced sonography showed marked hypervascularization in all 7 lesions. On contrast‐enhanced sonography, the filling time of lymphomatous lesions was significantly shorter than the filling time of a size‐matched sample of 10 patients with seminomas (P < .0001). The sonographic hallmarks of testicular lymphoma in our case series were as follows: (1) sharply demarcated homogeneous hypoechoic testicular lesions with marked hypervascularization; (2) a rapid (<7 seconds) filling time of contrast bubbles; and (3) a straight and parallel course of intralesional vessels on contrast‐enhanced sonography.     

Sonographic features of liver involvement by lymphoma.

OBJECTIVE: The liver is one of the most frequent extranodal locations of non-Hodgkin lymphoma and Hodgkin disease. Nevertheless, lymphoma constitutes only 6% to 8% of focal lesions of the liver. Few studies have evaluated the sonographic patterns of lymphoma with liver involvement. The purpose of this study was to describe the sonographic features and to evaluate the accuracy of sonography for the diagnosis of lymphoma with liver infiltration. METHODS: The abdominal sonographic findings of 23 consecutive patients with histologically proven diagnosis of lymphoma with liver involvement were reviewed. RESULTS: The most prevalent sonographic features were hepatomegaly and splenomegaly. Abdominal lymphoadenopathies were identified in 34.8% of cases. Liver nodules were seen in half of patients, and the most frequent sonographic appearance was as multiple small focal lesions. Differences in sonographic patterns between high- and low-grade non-Hodgkin lymphoma were not seen. None of the patients with Hodgkin disease had liver nodules. Concordance between sonography and computed tomography for the diagnosis of focal liver lesions was observed. CONCLUSIONS: Sonography may contribute to the diagnosis of liver infiltration by lymphoma. The presence of multiple focal liver lesions associated with splenomegaly and lymphoadenopathies should make us consider the diagnosis of lymphoma with liver involvement. Nevertheless, the low specificity of these findings requires histologic confirmation of lymphomatous infiltration of the liver.     

Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale,Color Doppler,and Contrast‐Enhanced Ultrasound and Strain Elastographic Appearances With Histologic Correlation

Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast‐enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B‐cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast‐enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast‐enhanced ultrasound and increased lesion stiffness on strain elastography.     

肾恶性肿瘤超声造影与病理对照分析

目的探讨肾恶性肿瘤超声造影的超声特征表现并与病理结果进行对照分析。方法回顾性分析肾细胞癌（RCC）88例,均经手术病理证实。结果88例RCC中,透明细胞肾细胞癌（CCRCC）72例,乳头状肾细胞癌（PRCC）6例,嫌色细胞肾细胞癌（CRCC）4例,肾母细胞瘤4例,转移性肾癌2例（乳腺癌1例、淋巴瘤1例）。超声造影呈＂快进快退＂75例,＂快进慢退＂10例,＂慢进慢退＂3例。结论超声造影对早期肾细胞癌的明确诊断治疗具有十分重要的临床价值。     

Sonographic appearances of malignant lymphoma of the salivary glands.

PURPOSE: We undertook this retrospective study to describe the sonographic findings in patients with malignant lymphoma of the major salivary glands. METHODS: We reviewed the sonograms and medical records of 7 patients with histologically proven lymphoma of the parotid (3 patients) or submandibular glands (4 patients). RESULTS: Primary lymphoma was found in 1 parotid gland and 2 submandibular glands. The remaining 4 cases were secondary lymphomas. One patient had been diagnosed with Sj?gren's syndrome and had been followed up with sonography. In parotid glands, both parenchymal and intraparotid nodal lymphomas were found. All submandibular gland tumors were parenchymal. Intraparotid nodal involvement appeared as multiple small nodules with relatively smooth margins, whereas the parenchymal parotid and submandibular gland lymphomas were larger (25 to 45 mm in longitudinal diameter) and showed various degrees of margin irregularity. All tumors were hypoechoic relative to the normal parenchyma. The primary parotid lymphoma and intraparotid nodal lymphomas had a homogeneous echotexture; the secondary parotid lymphomas and submandibular gland lymphomas were heterogeneous. One submandibular gland lymphoma showed intratumoral echogenic stripes. Neither calcification nor cystic degeneration was observed within the lesions. CONCLUSIONS: Lymphomas of the salivary glands present a variety of sonographic appearances, ranging from multiple small, hypoechoic nodules to an irregularly shaped heterogeneous mass without cystic areas or calcifications.     

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.     

Endorectal sonographic appearances of rectal MALT lymphoma, its response to therapy, and local recurrence

Endorectal sonography may significantly help to evaluate rectal lymphoma. We report the sonographic findings in a case of rectal non-Hodgkin's MALT (mucosa-associated lymphoid tissue) lymphoma, including the monitoring of response to therapy and confirmation of recurrence, in a 45-year-old man. On endorectal sonography of the rectal wall, the mucosa was markedly thickened to 1.1 cm and was diffusely hypoechoic and risen into multiple polypoid folds. The submucosa and muscularis propria appeared normal. Multiple lymph nodes were visualized in the perirectal fat; they were homogeneously hypoechoic, were round or oval, and ranged from 1.0 cm to 2.6 cm. Endoscopic biopsies revealed a grade I non-Hodgkin's MALT lymphoma. Following chemotherapy, endorectal sonography showed that the surface of the rectal mucosa had a smoother appearance and near-normal thickness, but lymph nodes, although smaller, remained visible in the perirectal fat. Four months later, endorectal sonography demonstrated a local relapse of disease, with significant thickening of the rectal mucosa and multiple lymph nodes visible in the perirectal fat. Following high-dose chemotherapy for the recurrence, endorectal sonography demonstrated a near-normal appearance of the rectal mucosa.     

Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause

PURPOSE: B-mode and color Doppler sonography were used to assess the incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunt in adults without detectable cause. METHODS: A total of 25,579 adults without potential cause of intrahepatic portosystemic venous shunt were screened using B-mode sonography. Suspicion of shunt was confirmed by color Doppler sonography. Patients with shunt were followed up with sonography at 6- to 12-month intervals and received dietary education to prevent the ingestion of extra-large amounts of protein. During each sonography session, the patients were asked to report any experience of consciousness disturbance. RESULTS: Six patients (0.0235%) showed evidence of shunt on color Doppler sonography. Direct communication between a right portal branch and the inferior vena cava was found in 3 patients; a small aneurysm connecting a peripheral portal branch to the hepatic vein was found in the remaining 3 patients. Five patients were followed up (range, 12-60 months) and showed no change in the size of the shunt. None of the patients with shunt reported an experience of consciousness disturbance. CONCLUSIONS: The incidence of spontaneous intrahepatic portosystemic venous shunt is extremely low in asymptomatic adult patients. Follow-up and dietary control seen to be suitable for their management.