肠道黏膜相关淋巴组织恶性淋巴瘤临床病理分析

收集肠道黏膜相关淋巴组织(MALT)恶性淋巴瘤24例，全部病例均采用石蜡切片、HE、CD35、CD20、CD3、CD45染色，普通光学显微镜观察。结果显示，22例来自B细胞，2例来自T细胞。组织学特点是瘤细胞弥漫浸润肠黏膜，形成淋巴上皮病变，并伴有残存淋巴滤泡和浆细胞浸润，易误诊为淋巴组织增生。该病病因不明，目前认为与HP感染有关。     

非胃肠道的黏膜相关淋巴组织淋巴瘤48例临床分析

目的分析非胃肠道黏膜相关淋巴组织（MALT）淋巴瘤患者的临床特点,以提高临床诊断及治疗水平。方法回顾性分析北京协和医院2000年1月至2011年7月经病理证实明确诊断为非胃肠道MALT淋巴瘤的48例患者的资料。结果48例患者中男16例,女32例;诊断时的年龄为21～76岁,平均55．4岁。发病部位为肺23例,涎腺9例,甲状腺8例,眼及附属器3例,其他部位5例,同时发生于两个部位的5例。临床表现为无症状者27例,有非特异性全身症状者13例。实验室检查中,8例低中度贫血,6例乳酸脱氢酶水平升高,19例血沉加快。影像学检查提示20例淋巴结肿大。6例患者合并自身免性疫疾病,其中3例为涎腺病例。肺部受累患者确诊经支气管活检获得病理诊断3例,CT引导下经皮肺穿刺11例,外科肺活检9例。肺外受累患者确诊均经外科活检。23例肺部受累患者中,有1例未经处理,其余22例接受各种组合治疗（单纯手术3例,手术联合化疗6例,单纯化疗13例）;25例肺外受累患者中,11例患者接受单纯手术治疗,10例患者接受手术＋化疗联合治疗,3例接受单独的化疗,此外还有1例患者予以手术＋化疗＋放疗联合治疗。随访4—133个月。平均46．7个月,肺部受累患者1例死于肺部感染,1例死因不详,其余患者均病情平稳。结论非胃肠道MALT淋巴瘤常见于中老年女性,肺、涎腺和甲状腺为其好发部位,临床上多无明显症状或仅限于非特异性全身症状,部分合并自身免疫性疾病。CT引导下经皮穿刺肺活检和手术活检获取病理组织有助于明确诊断。本淋巴瘤的预后较好,部分患者可经外科手术治愈。     

胃肠道粘膜相关型淋巴瘤12例临床病理观察

胃肠道粘膜相关淋巴组织 (mucosa- associated lym phoidtissue,MAL T)淋巴瘤是一种常见的结外淋巴瘤 ,有其特殊的病理形态学特征。临床表现为非特异性 ,容易误诊。为加深对本病的认识 ,笔者对 1992年 1月～ 2 0 0 1年 12月收治的 12例胃肠道 MAL T淋巴瘤的临床和病理资料进行分析。1　材料与方法1.1　临床资料　本组 12例 ,其中男性 8例 ,女性 4例 ,男女之比 2∶ 1,年龄 5 0 .2 5± 13.4 0岁 (2 4～ 6 8岁 )。就诊时间 2 d～ 3年 ,临床表现缺乏特异性。内窥镜检查 ,多数病例可见 1个或多个呈浅表或不同程度溃疡 ,个别病例有肿块形成或…     

腮腺原发性黏膜相关淋巴瘤7例

目的：探讨腮腺黏膜相关淋巴瘤的临床病理学特征和免疫表现。方法：回顾研究7例腮腺原发性黏膜相关淋巴瘤的临床及随访资料和组织学形态。结果：除1例临床诊断为恶性肿瘤外，其他均为混合瘤。7例病变均完整切除，随访时间为术后4个月～7年6个月。完全治愈、无复发5例（71％）；1例术后7个月组织学证实为复发，并行化疗；1例临床考虑为复发，未行病理检查，仍存活。结论：腮腺黏膜相关淋巴瘤为一种低度恶性、预后较好的B细胞源性肿瘤，形态学表现为中心样细胞和淋巴上皮病变。     

肺黏膜相关淋巴组织结外边缘区淋巴瘤19例临床病理分析

目的：探讨肺黏膜相关淋巴组织结外边缘区淋巴瘤（mucosa-associated lymphoid tissue lymphoma,MALToma）的临床病理学特点,提高对该病的认识,并为临床诊治提供依据。方法：回顾性分析19例肺MALToma的临床、病理学及影像学资料,其中2例进行基因重排分析,并复习相关文献。结果：影像学上,胸部CT主要为实变密度结节型团块影,少见磨玻璃型团块影以及肺炎型实变密度影,瘤肺界面不清晰,可见移行带及充气支气管征。组织学上,肿瘤细胞为弥漫一致小到中等大小的单核样细胞及中心细胞样细胞,并可见“滤泡植入”现象及淋巴上皮病变,其中1例肿瘤间质内见多量散在分布的浆细胞（胞浆内含Russell小体）;免疫组织化学染色结果显示肿瘤细胞CD20、CD79α、Bcl-2阳性,CD3、CD10和Bcl-6阴性,CD21示残存滤泡阳性,CKpan示残存的支气管黏膜上皮阳性,Ki-67增殖指数较低。基因重排结果示IgH/Igκ克隆阳性。结论：原发性肺MALToma发病率低,无明显临床特征,具有一定的影像学特征。明确诊断需结合组织病理学和免疫组织化学,必要时进行分子检测。     

唾液腺干燥综合征继发黏膜相关淋巴组织淋巴瘤的临床病理分析

目的: 分析唾液腺干燥综合征(Sjögren's syndrome,SS)继发黏膜相关淋巴组织(mucosa associated lym-phoid tissue,MALT)淋巴瘤(SS-MALT淋巴瘤)的临床病理特点,并探索联合应用组织病理形态、蛋白表达和分子表型检测在唾液腺SS-MALT淋巴瘤病理诊断和预后评估中...     

子宫颈粘膜相关淋巴组织淋巴瘤6例临床病理分析

目的：探讨子宫颈粘膜相关淋巴组织淋巴瘤（MALT-ML）的临床病理特征。方法：分析6例临床表现。病理常规染色及ABC法免疫组化染色。结果：6例均为B细胞性；CCL细胞型和淋巴浆细胞型4例，大细胞型2例。结论：大多数子宫颈MALT-ML为低度恶性，手术为首选治疗方法；若发生大细胞转化，则预后差。     

口咽环黏膜相关淋巴组织型淋巴瘤临床病理及免疫组化研究

探讨口咽环黏膜相关淋巴组织型淋巴瘤的诊断标准、鉴别诊断及发病机制。采用活检或手术标本做石蜡切片、HE染色及免疫组化ABC法检测。6例口咽环黏膜相关淋巴组织型淋巴瘤均为B细胞低度恶性。1例为CCL型，1例为淋巴浆细胞型，4例为浆细胞型。免疫表型IgG、IgM为主．缺乏IgD。局部生长缓慢，较少转移，临床预后较好。因此手术为首选疗法。对口咽环黏膜慢性炎,应予以有效抗菌治疗，并注意与黏膜相关淋巴组织型淋巴瘤鉴别。     

37例黏膜相关淋巴组织型淋巴瘤的病理、临床资料分析

目的：为开展黏膜相关淋巴组织型（MALT）淋巴瘤的标准化诊断和规范化治疗提供病理及临床依据。方法：对我院2000年1月至2002年6月诊断的37例MALT型淋巴瘤的病理、临床分期、恶性程度、预后因素及治疗进行回顾性分析。结果：442例非霍奇金淋巴瘤（NHL）中MALT型39例占8.82%（可追踪病例37例），发病中位年龄52岁，50岁以上患者占63．6％。MALT型NHL的发病部位以胃肠最多见，共28例，占71．8％；其次为甲状腺、腮腺、眼眶、肺。MALT型NHL中低度恶性占70．3％，低度恶性伴转化（中度恶性）占27％。临床分期I期占53．6％，Ⅱ期28.6%,Ⅲ期14．3％，Ⅳ期3．6％。37例可追踪MALT型NHL的病理标本中35例表达CD20抗原，2例不确定，其中4例疑难病例通过PCR检测IgH克隆性重排协助诊断。13例胃MALT型淋巴瘤行幽门螺杆菌（HP）检测，阳性率为46．15％。胃MALT型淋巴瘤患者均接受抗HP三联治疗，仅1例接受单纯抗生素治疗。28例胃肠MALT型淋巴瘤患者除5例外，均曾接受手术治疗；多数患者接受系统化疗，部分加局部放疗，尚无接受单纯胃放射治疗者。结论：MALT型淋巴瘤多发生于老年患者，以低度恶性为主，肿瘤发展进程缓慢；不同的发病部位、分类、分期及分子遗传学改变均为重要的预后风险因素，可用于协助选择合适的治疗方案。     

胃肠道黏膜相关淋巴组织淋巴瘤中凋亡增殖相关蛋白的表达

目的　探讨胃肠道黏膜相关淋巴组织型淋巴瘤 (MALToma)中凋亡、增殖相关蛋白的表达情况。　方法　采用免疫组化法检测胃肠道 34例MALToma中PCNA和p5 3(SP法 ) ,Bcl 2和Caspase 3(CSA法 )的表达。　结果　Caspase 3和PCNA的表达与肿瘤恶性度有关 ,高恶组Caspase 3和PCNA的阳性表达均高于低恶组 (u =2 .5 15 ,P <0 .0 5 ;u =2 .74 5 ,P <0 .0 1)。Bcl 2、p5 3在不同恶性组中的表达无显著性差异。　结论　凋亡、增殖相关蛋白Caspase 3、PCNA可能参与了胃肠道黏膜相关淋巴组织型淋巴瘤的发病及恶性进展。     

胃黏膜相关淋巴组织淋巴瘤20例临床分析

目的:提高临床医生对胃黏膜相关淋巴组织淋巴瘤诊治的认识。方法:回顾性分析20例胃黏膜相关淋巴组织淋巴瘤患者的临床症状、内镜检查、免疫学检查、病理组织学检查、治疗过程及随访结果等资料。结果:本组病例临床主要表现为上腹部不适、上腹痛、消化道出血、体重下降和食欲下降等;胃镜检查明确病灶位于胃窦部13例,胃体4例,胃底体3例;镜下观察呈黏膜隆起表面糜烂或溃疡(单个或多个)16例,弥漫浸润型3例,1例表现为巨大包块;16例患者采用手术治疗,1例未行手术或者放化疗,3例行单纯放化疗和抗幽门螺杆菌(Hp)治疗;随访1～10年,手术患者5年生存率为81.25%,未手术患者5年生存率为25.00%。结论:对于具备手术条件的胃黏膜相关淋巴组织淋巴瘤患者应尽早行手术治疗,可提高患者的生存率。     

胃黏膜相关淋巴组织淋巴瘤40例内镜下表现分析

[目的]探讨胃黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤内镜下表现特征,以提高早期诊断水平.[方法]总结40例经内镜及手术病理确诊的胃MALT淋巴瘤患者的内镜下表现资料.[结果]病变多位于胃窦部、胃体部,累及多部位者25例(62.5%),表现为溃疡型、隆起型、...     

Diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue lymphoma

Background Primary non-Hodgkin＇s lymphoma in lung is very rare, and the most common among them is mucosa-associated lymphoid tissue lymphoma （MALToma）, whose clinical features and laboratory characteristics are poorly defined, making diagnosis difficult. The purpose of this study was to study the diagnosis and treatment of pulmonary MALToma. Methods The clinical data of 12 patients treated for MALToma between August 1992 and December 2005 were analyzed. Results No specific symptoms or signs, or results of bronchoscopy, ultrasonagraphy or bone marrow examination could be found in the 12 patients. Only radiography was useful in diagnosis, though the final diagnosis of all the patients was based on histology and immunohistochemistry. Two patients also had gastric MALToma. Operations were performed on 6 patients, including 5 radical operations and 1 partial resection： 4 patients also received adjuvant chemotherapy. One patient experienced recurrence 152 months after the operation, while the other 5 patients have survived disease-free. Four patients were treated with chemotherapy alone, two of whom experienced complete remission and the others partial remission. The final 2 patients received no treatment and had survived for 7 and 27 months respectively. All the patients were still alive at the most recent follow-up, 7 to 160 months （mean 71.3 months）. Conclusions Except radiography, no specific clinical manifestations could be identified for pulmonary MALToma. The final diagnosis should be based on histology and immunohistochemistry. Several treatment methods can be used to achieve good outcomes.     

胃肠粘膜相关淋巴组织淋巴瘤20例临床分析

目的总结胃肠粘膜相关淋巴组织(MALT)淋巴瘤的诊治体会及经验。方法对近5年收治的20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岁以上患者,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、深挖活检以提高早期检出率;③治疗应首选手术治疗,失去手术机会的患者,若坚持化疗,可改善其生活质量,延长生存期;④传统的CHOP方案效果可靠,花费少;⑤部分MALT淋巴瘤病理切片中可见少量印戒样细胞,需与高度恶性的印戒细胞癌鉴别。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。     

Clinical and prognostic characteristice of pulmonary mucosa-associated lymphoid tissue lymphoma:a retrospective analysis of 23 cases in a chinese population

Background Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is the most frequent type of non-Hodgkin's lymphoma (NHL) that primarily involves the lungs. It represents a rare entity accounting for less than 1%of all NHLs and the clinical features have yet to be clearly elucidated.Methods The clinicopathological features and radiological data of 23 patients with pulmonary MALT lymphoma confirmed by biopsy in Peking Union Medical College Hospital from January 2001 to December 2010 were retrospectively analyzed.Results At diagnosis,there were 15 women and 8 men. The median age was 55.1 years (range,37-73 years). One patient had a history of primary Sjoren's syndrome,another patient had a history of systemic lupus erythematosus (SLE)and secondary Sjoren's syndrome. One patient had a history of previous hematological malignancy (lymphomatoid papulosis in complete remission). In addition,one patient had simultaneous gastric and pulmonary involvement and one patient had simultaneous parotid gland and pulmonary involvement. The other 21 patients had disease localized within the lungs at the initial diagnosis. Among them,10 patients were asymptomatic while two had non-specific pulmonary symptoms. There were six patients with fever,four patients had low grade fever and two patients had moderate-high fever.The most common manifestations were cough (n=10),expectoration (n=8),exertional dyspnea (n=8),fatigue (n=7),body weight loss (n=6) and crackles (n=6). Blood tests showed low to moderate anemia in six cases,elevated erythrocyte semimentation rate (ESR) in 10 cases and only one patient had elevated lactate dehydrogenase (LDH). High resolution computed tomography (HRCT) of the chest revealed bilateral disease in 13 patients,air space consolidation with or without air bronchogram in 15 patients,lung nodules in 15 patients,patchy opacities in eight patients,lung mass in three patients and pleural effusion in five patients. Flexible fiberoptic bronchoscopy showed multiple nodules in five patients and almost normal morphology in 18 patients. Pathological diagnosis was obtained by bronchial biopsies in three cases,by CT-guided percutaneous lung biopsies in 11 cases and by surgical biopsies in nine cases. Of the 23 patients,one remained untreated,while 22 received various combinations of treatment (surgery alone in three patients,surgery plus chemotherapy in six patients,and chemotherapy alone in 13 patients). Twenty-one patients remained alive during the median follow-up of 23 (0.25-84) months,while one patient died from unknown causes,one patient died from lung infection.Conclusions Pulmonary MALT lymphoma tends to occur in old-aged females and to be limited to the lungs on the initial diagnosis and LDH's level was normal in most patients. Lung nodules,patchy opacities and air space consolidation     

涎腺淋巴瘤临床与病理研究

目的　探讨涎腺粘膜淋巴瘤的病理诊断特征及发病机理。方法　分析临床资料 ,利用HE染色 ,白细胞共同抗原、CD2 0、CD4 5RO、上皮膜抗原的SP法免疫组化及电镜观察32例涎腺粘膜淋巴瘤。结果　男性 2 7例 ,女性 5例 ,平均年龄 54 76岁 ,其中腮腺 17例 ,颌下腺 15例。涎腺粘膜淋巴瘤是由弥漫性中心细胞样 (CCL)细胞组成 ,并有“淋巴上皮病变”。免疫组化 :CCL细胞CD2 0阳性、CD4 5RO阴性。电镜下瘤细胞圆形 ,高核浆比 ,胞浆内少量溶酶体和免疫球蛋白的颗粒 ,无胞质丝 ,无细胞外基膜 ,无细胞间连接。随访 :存活 5年以上者 9例 ,3～ 4年者 5例 ,不足 1年 6例 ,3例死亡。结论　大多数涎腺粘膜淋巴瘤为低度恶性 ,瘤细胞有“回归”现象 ,治疗以手术加化疗为主 ,少数可转变为高度恶性 ,预后差。自身免疫性疾病和 或感染可导致机体产生获得性涎腺粘膜淋巴瘤 ,并在持续性刺激下发展为涎腺肌上皮炎 ,进而转变为涎腺粘膜淋巴瘤。     

Clinicopathologic study of mucosa-associated lymphoid tissue lymphoma of the salivary gland

Objective　To study the histopathologic features and pathogenesis of mucosa-associated lymphoid tissue lymphoma (MALT-oma) of salivary glands. Methods　Clinical data, paraffin-embedded sections, immunohistochemical slides (SP method) and electron microscopic features of surgical specimens of 32 cases of salivary gland MALT-oma were studied. Results　The patients were 27 males and 5 females, with a mean age of 54.76 years. The lesions were located in the parotid area in 17 cases, and in the submandibular gland in the remaining 15 cases. Much of the MALT-oma was replaced by infiltration of a great amount of centrocyte-like cells (CCL) as background and occasional large cells (centroblast- or immunoblast-like). In MALT-omas “lymphoepithelial lesions' were present. Immunohistochemically, CD20 expression was found to be positive and CD45RO expression was negative in all MALT-omas. Conclusion　Most of the MALT-omas are low grade malignant tumors and have a “homing back' phenomenon. The cases were managed by surgery and chemotherapy. In a few MALT- omas which turned into high grade malignant tumors, the prognosis was poor. Acquired MALT may develop as a reaction to autoimmune disease and infection. Hyper-immune reaction and MALT hyperplasia under stimulation may result in myoepithelial sialadenitis and lead to MALT-oma of the salivary gland.     

胃粘膜相关淋巴组织淋巴瘤的临床探讨

目的：探讨胃粘膜相关淋巴组织（MALT）淋巴瘤的病理特征、临床诊断和治疗。方法：收集我院1993－2000年6例胃MALT淋巴瘤,采用胃镜、病理组织学和免疫组化标记对其临床、病理资料和治疗进行分析。结果：临床表现和辅助检查无明显特异性,以低度恶性淋巴瘤多见,免疫组化标记证实均为B细胞性淋巴瘤。经手术和化疗,患者均存活。结论：提高对胃MALT淋巴瘤的认识,有助于明确诊断。治疗以手术为主,配合化疗或放疗。对幽门螺杆菌的治疗应引起足够的重视。     

原发性胃MALT淋巴瘤的临床分析

目的 探讨原发性胃MALT淋巴瘤临床诊断与治疗。方法回顾性分析10a来48例原发性胃MALT淋巴瘤的诊断与治疗情况。结果术前胃镜确诊48．8％(21／43)，消化道造影确诊22．6％(7／31)，术后组织标本幽门螺杆菌检出阳性率45．2％(19／42)；全组手术切除率87．5％(42／48)；5a生存率62．7％，IE期单一切除生存率60．4％，术后加用化疗和／或放疗者达87．5％。结论幽门螺杆菌感染与原发性胃MAIT淋巴瘤存在关联。原发性胃MALT淋巴瘤与胃癌相比临床上无特异性，术前确诊率低，应结合消化道造影，胃镜及反复活检综合判断。外科手术切除原发灶，联合术后化疗和／或放疗是合理的。     

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(MALT)淋巴瘤的认识和诊疗水平,提高治愈率。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,明确分期诊断,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,患者胃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,预后较好,生存期可延长。