唾液腺黏膜相关淋巴组织淋巴瘤的病因学和诊断学研究进展

唾液腺黏膜相关淋巴组织淋巴瘤(SGML)属于边缘区B细胞型非霍奇金淋巴瘤中的一种独立亚型,其发病机制与胃肠型黏膜相关淋巴组织(MALT)淋巴瘤不完全相同,且无特异性临床表现,临床上容易误诊。本文对唾液腺黏膜相关淋巴组织淋巴瘤的病因学和诊断学等方面的研究进展进行综述。     

涎腺黏膜相关淋巴组织型淋巴瘤报告1例及文献系统分析

涎腺黏膜相关淋巴组织型淋巴瘤（Salivary glands mucosa-associated lymphoid tissue lymphoma ,SGML）,为无痛性,进展缓慢的恶性肿瘤,较少发生于头颈部。口腔颌面外科医生因认识不足,临床上易误诊。本文报告以1例典型多发性涎腺黏膜相关组织型淋巴瘤为案例,结合文献分析探讨涎腺黏膜相关淋巴组织型淋巴瘤的发病机制及诊疗方法。     

口腔颌面部肿瘤

诱导型一氧化氮合酶和血管内皮生长因子在成釉细胞瘤中的表达，唾液腺黏膜相关淋巴组织型淋巴瘤的临床特点：1例报告及文献复习,舌鳞癌淋巴管生成与颈淋巴结转移的关系,口腔鳞癌首诊患者血清Cyfra 21-1检测的预后评价价值,CD105和MMP-2在腺样囊性癌中表达及预后判断的临床意义，97例45岁以下舌及口咽鳞癌患者生存率及其影响因素的分析．[编者按]     

颌面部黏膜相关淋巴组织淋巴瘤12例的临床分析

目的 加深对黏膜相关淋巴组织淋巴瘤的临床及病理特征认识。方法 对10年来本院收治的12例(口腔颌面外科9例、眼科3例)颌面部黏膜相关淋巴组织淋巴瘤的临床、病理资料及治疗预后情况进行回顾性分析。结果 12例患者中单纯切除肿瘤原发灶8例、切除原发灶并术后联合化疗(CHOP方案)3例及单纯联合化疗1例。所有病例病情均得到完全缓解。结论 颌面部黏膜相关淋巴组织淋巴瘤多为无痛性过程,发展缓慢,长期局限。多种治疗均可完全缓解病情,达到无瘤生存状态,预后较好。     

涎腺粘膜相关组织型淋巴瘤2例报道及文献复习

粘膜相关淋巴组织(MALT)型淋巴瘤80年代初由Issacson和Wright首先报道[1],因其具有不同于其它类型淋巴瘤的临床病理特点,近年来成为淋巴瘤的研究热点,但国内原发于涎腺的MALT淋巴瘤的报道尚不多见,为了更好的认识此病,我们对本科近年来遇到的涎腺恶淋及其它淋巴组织增生性疾病进行回顾性观察,现将其中2例通过高年资病理医生确诊,并经免疫组化证实的MALT淋巴瘤病例报道如下,结合文献复习对其临床病理特征,诊断与鉴别诊断及发病机理进行讨论.     

36例良、恶性淋巴上皮病临床病理分析

目的：分析恶性淋巴上皮病（MLEL）、良性淋巴上皮病（BLEL）及与之相联系的黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤（MALToma）的临床特点、病理学特征、发病机制、诊断、治疗及转归。方法：对13例MLEL、20例BLEL及3例MT进行免疫组化染色和HE染色观察，复习相关临床资料并随访。结果：MLEL的病理学特征为大量增生的淋巴组织中见成簇或条索状分布的肿瘤细胞，界限不清，核分裂像多见；免疫组化示CKpan全部阳性（13／13），Vim部分阳性（3／13），SMA部分阳性（2／13）；8例MLEL可随访资料中，术后1例死于复发，1例死于其他疾病，1例局部复发，5例未见复发或转移，随访3．5个月-4a。BLEL的病理学特点为腺实质萎缩，间质淋巴细胞浸润及形态温和的腺肌上皮岛；免疫组化示CKpan19例阳性，LCA17例阳性。UCHL-1、L2616例阳性。CK10 10例阳性．S-1002例阳性；12例可随访的BIEL中，2例术后复发诊断为MLEL，其余健在，随访3个月～6a不等。3例MT中。1例术后6个月复发，经再次手术并化疗后缓解；免疫组化L26、LCA、CD79、CD43均阳性；UCHL-1、CKpan、EMA均有2例阳性。结论：MLEL好发于腮腺，且女性多见，来源于唾液腺导管上皮。对已发生颈淋巴结转移的患者行原发灶一颈联合根治，术后放疗，少数MLEL可在BLEL基础上发生，故BLEL局部切除后应长期随访；MT为B细胞淋巴瘤，手术切除辅以适当化疗可获较好疗效。术中冷冻切片是本病目前最可靠的术中诊断手段。     

Warthin瘤合并T淋巴母细胞淋巴瘤1例

Warthin瘤是一种良性唾液腺肿瘤,由导管上皮和淋巴样间质组成,迄今为止,有关Warthin瘤内淋巴成分恶变的报道罕见,且多恶变为B细胞淋巴瘤,合并T细胞淋巴瘤更尤为少见。本文报道1例Warthin瘤合并T淋巴母细胞淋巴瘤,旨在强调要对Warthin瘤内的淋巴组织进行仔细的光学显微镜评估,以识别隐匿性淋巴瘤的存在,减少误诊及漏诊并及时治疗。     

舌根部黏膜相关淋巴组织淋巴瘤1例

<正>黏膜相关淋巴组织淋巴瘤是一种少见的软组织肿瘤,可发生于胃、肠黏膜。至今未见有发生于舌部组织的报道,我科2005年12月收治1例舌根部黏     

腮腺黏膜相关淋巴瘤临床及病理研究

目的：研究腮腺黏膜相关淋巴瘤(Mucosa—Associated Lymphoid Tissue Lymphoma，MALToma)病理诊断特征及临床治疗。方法：收集并分析临床资料，利用HE染色，LCA、CD20、UCHL-l，κ链、λ链免疫组织化学标记观察10例腮腺MALToma，结果：腮腺MALToma组织学具有中心细胞样细胞弥漫浸润，浆细胞分化，淋巴滤泡破坏以及形成上皮-肌上皮岛淋巴上皮病灶的特点。免疫组化证实其来源为B细胞淋巴瘤。结论：①本组ll例原发腮腺恶性淋巴瘤均属于MALToma。②部分(36％)伴良性淋巴上皮病及舍格林综合症提示，本组MALToma可能与自身免疫性疾病有关。③手术切除辅以适当化疗可获较好疗效。     

舌下腺淋巴上皮癌1例报告及文献复习

唾液腺淋巴上皮癌是一种极其少见的未分化癌或低分化的鳞状细胞癌,伴有丰富的淋巴细胞浸润。因其缺乏特异性临床特点,容易误诊。以往文献报道淋巴上皮癌多发于唾液腺中的腮腺及下颌下腺,发生于舌下腺者罕见。本文报告1例舌下腺淋巴上皮癌,并结合文献对其诊断及治疗进行讨论。     

Lymphoma of mucosa-associated lymphoid tissue (MALT) arising in the parotid gland

Malignant lymphoma of the parotid gland is a rare condition. The authors present the case of a 59-year-old woman with primary malignant lymphoma arising from the parotid gland, in which they resected the tumors and surrounding lymph nodes. Histopathologic examination of the tumor demonstrated a lymphoma of mucosa-associated lymphoid tissue (MALT). Chemotherapy and radiotherapy were performed after surgery. The clinical manifestation, treatment, and postoperative course are described.     

Synchronous lymphomas arising in ipsilateral parotid and submandibular glands: video-assisted surgery

The incidence of lymphomas in salivary glands is 5%, and it represents 10% of malignant salivary tumors. Synchronous tumors arising in different major salivary glands are not only very infrequent but also extremely rare; on the other hand, synchronous lymphomas in ipsilateral major salivary glands have not been reported previously. This article reports a case of synchronous lymphomas in mucosa-associated lymphoid tissue in the ipsilateral parotid and submandibular glands. Parotidectomy with facial nerve conservation and resection of the submandibular gland by video-assisted surgery using only a Blair-modified classic incision was performed. One year after the surgical procedure, the patient was followed up at regular intervals, and residual mucosa-associated lymphoid tissue lymphoma did not appear. This case illustrates the importance of the diagnostic possibility of synchronous primary tumors after identification of a simple one; this also reports the video-assisted resection of the submandibular gland using only a Blair incision, when a parotidectomy must be also made.     

Incidental Langerhans cell histiocytosis of the parotid gland resembling marginal zone B-cell lymphoma: a case report

Langerhans cell histiocytosis (LCH) manifesting as a parotid gland mass is an extremely rare clinical presentation. We report a case of LCH involving the bilateral parotid glands in an 81-year-old Japanese female. Pathologically, the lesion was characterized by numerous lymphoid follicles, dense lymphoplasmacytoid infiltrate and cystic dilatation of the parotid gland duct in addition to nodular and diffuse proliferation of LCs. Moreover, both LCs and small T-lymphocytes invaded the ductal epithelium forming a lymphoepithelial lesion-like morphology. The present case indicates that LCHs should be added to the different diagnosis for marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type involving the salivary glands.     

腮腺良性淋巴上皮病临床及病理研究

目的　观察腮腺良性淋巴上皮病 (BLEL)病理及临床特征。方法　收集 13例腮腺BLEL临床及病理资料 ,利用苏木精 -伊红染色 ,CD45R0 、CD45以及CD2 0 等免疫组化标记观察。结果　腮腺BLEL组织学表现为大量淋巴样细胞弥散浸润腺体间质 ,上皮 -肌上皮岛形成并取代腺泡和腺体结构 ,免疫组化证实其大多数为B系淋巴细胞。结论　腮腺BLEL可能是腺体长期炎症影响的结果 ,在其基础上可以引发B系、结节外低度恶性淋巴瘤。手术辅以放疗 ,可获较好疗效。     

Diagnosis of intra-oral MALT lymphoma using seminested polymerase chain reaction

Diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma based on histological examination alone is difficult. We report three patients with histologically suspected MALT lymphoma who developed lymphoproliferative lesions of the sublingual gland. Seminested polymerase chain reaction (PCR) analysis applied to formalin-fixed and paraffin-embedded specimens showed clonal rearrangement of immunoglobulin heavy chain genes in two patients and a polyclonal characteristic in one. The clinical findings and Southern blot analysis confirmed the accuracy of the diagnosis. The molecular method described can be applied routinely to processed specimens to obtain helpful information for the diagnosis of low-grade malignancies of lymphoproliferative disorders, such as MALT lymphoma.     

Marginal zone B-cell lymphoma of minor salivary gland representing tumor-forming amyloidosis of the oral cavity. A case report

We report here a case of mucosa-associated lymphoid tissue (MALT)-type lymphoma arising from the minor salivary gland of the oral cavity exhibiting tumor-forming amyloidosis. The patient was a 64-year-old Japanese woman who presented with 4-year history of a left soft palate mass. Despite multiple and multifocal recurrences including the lip, soft palate, tongue, oral base and vocal code and soft palate, the tumor remained localized in the upper aerodigestive tract, and the patient did not develop multiple myeloma during the course of disease. Histologically, the majority of the lesion was occupied by amyloid deposition. Only the periphery of the lesion contained numerous plasmacytoid cells, along with occasional centrocyte-like cells. In addition, lymphoepithelial lesion and follicular colonization were noted. The present case indicates that primary minor salivary gland MALT-type lymphoma appears to be the cause of tumor-forming amyloidosis of the upper aerodigestive tract including the larynx.     

Primary mucosa-associated lymphoid tissue lymphoma of hypopharynx

Mucosa-associated lymphoid tissue lymphomas are low-grade B-cell lymphomas that arise from a number of extranodal sites, including both nonmucosal and mucosal organs such as the hypopharynx. We reported a patient with a primary hypopharynx mucosa-associated lymphoid tissue lymphoma presenting with a swallowing dysfunction and severe throat pain. The clinical, radiologic, and histopathologic findings are presented. The patient was followed up for 5 years and treated with nonspecific antibiotics, chemotherapy, and radiation therapy. Because of prevertebral fascia invasion at the initial presentation, surgical treatment was not preferred. The last biopsies of the hypopharynx revealed no evidence of lymphoid infiltrate. Mucosa-associated lymphoid tissue lymphoma involving the hypopharynx is rare and there is no consensus on its treatment. The treatment protocol is presented and the relevant literature is reviewed.     

口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤临床及预后分析

目的：探讨口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤（MALT淋巴瘤）的临床特征、分期、治疗方法及预后,为临床治疗提供更强的循证医学证据。方法：回顾分析上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科收治的105例原发于口腔颌面-头颈部的MALT淋巴瘤患者的临床资料,采用SPSS 22.0软件包对其预后进行分析。结果：105例MALT淋巴瘤患者中,男女比例为1∶2.5,中位年龄56岁（18~86岁）。主要临床表现为单纯渐增性肿块,52%的患者有长期口干症状或曾被诊断为自身免疫性疾病或慢性腮腺炎。根据Ann Arbor分期,Ⅰ期48例,Ⅱ期25例,Ⅲ期7例,Ⅳ期25例;有B症状者仅1例,无骨髓受侵的患者。最常见的部位为腮腺、腭、下颌下腺。50例接受单一治疗,49例接受联合治疗。中位随访时间60个月,8例失访,初治后完全缓解率为80%;疾病进展12例,死亡14例。5年总生存期和无进展生存期分别为89%、88%;全身治疗（化疗或利妥昔单抗）可显著提高晚期患者的无进展生存期（P<0.05）,MALT淋巴瘤的国际预后指数（MALT-IPI）是影响总生存期的独立预后因素,Ann Arbor分期是影响无进展生存期的独立预后因素。结论：口腔颌面-头颈部MALT淋巴瘤初治疗效良好,进展缓慢;晚期患者应辅助全身治疗。MALT-IPI和Ann Arbor分期是影响预后的独立因素。