胃黏膜相关淋巴组织淋巴瘤临床与内镜诊断分析

目的:探讨胃黏膜相关淋巴组织(MALT)淋巴瘤的临床和内镜下表现,提高对胃MALT淋巴瘤早期诊断率.方法:总结我院1992年2月～2003年6月经内镜检查、组织病理、免疫组化确诊为胃MALT淋巴瘤的18例临床资料并进行分析.结果:18例患者从发病到就诊时间平均5.6个月,男性比女性为5比1.首发症状为上腹部疼痛,依次有腹部饱胀、反酸嗳气、恶心呕吐、食欲减退、呕血与黑便、贫血消瘦等临床表现.内镜下形态表现分弥散浸润型12例、多发溃疡型4例、隆起糜烂型2例.形态表现为多部位、多种形态和病变范围广为特征.内镜下常误诊为胃癌、溃疡等,需经病理学、免疫组化检查确诊.本组17例(94.5%)Hp阳性,2例经根除Hp治疗获治愈.结论:胃MALT淋巴瘤起病较隐匿、病程较长.症状、体征不具特异性.内镜下形态呈多样性,病变累及范围广、部位多.多点深取活检及病理学、免疫组化检查是提高胃MALT淋巴瘤确诊率和早期诊断率的重要方法.Hp感染与胃MALT淋巴瘤密切相关.     

胃黏膜相关淋巴组织淋巴瘤1例

胃黏膜相关淋巴组织淋巴瘤临床表现不典型,诊断主要依靠病理活检,但因其内镜下表现不典型,易漏诊、误诊,临床工作中对于多发溃疡、糜烂灶需多点、深凿,必要时内镜下黏膜剥离切除,病理活检时需同时免疫组织化学,避免漏诊、误诊.     

胃黏膜相关淋巴组织淋巴瘤临床病理分析

回顾性分析我院21例胃黏膜相关淋巴组织(MALT)淋巴瘤临床资料.本病临床表现以腹部疼痛及上消化道出血为主,胃镜检查均见病灶处大小不等结节状隆起、溃疡,病灶质地僵硬,接触易出血;病变多位于胃窦和(或)胃体部.胃组织病理活检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.本组Hp阳性18例(85.7%),2例经根除治疗获治愈.本组行手术 化疗12例,单纯手术3例,单纯化疗4例,单纯抗Hp治疗2例.手术切除胃原发病灶加抗Hp及联合化疗治疗效果较佳.     

胃黏膜相关淋巴组织淋巴瘤临床研究及随访

目的探讨胃黏膜相关淋巴组织淋巴瘤的临床特征及治疗策略。方法采用回顾性方法对32例经组织学确诊的胃黏膜相关淋巴组织淋巴瘤进行随访。结果32例患者中多数起病隐匿，上腹痛为主要症状，也有以消化道出血入院者。内镜下病变主要分布在胃窦部，以隆起型和溃疡型表现为主。首次胃镜检查约25％获正确诊断。本组病例幽门螺杆菌感染率约为88％。20例（62．5％）接受了手术治疗，15例（46．88％）行幽门螺杆菌根除治疗，其中，3例早期阶段患者获得组织学完全缓解。结论胃黏膜相关淋巴组织淋巴瘤的临床表现、内镜下特征和病理特点的认识有待进一步提高。对早期阶段患者幽门螺杆菌治疗当属首选。     

根除幽门螺杆菌对胃黏膜相关淋巴组织淋巴瘤疗效研究进展

胃黏膜相关淋巴组织(mucosa associated lymphoid tis-sue,MALT)淋巴瘤是原发于胃黏膜相关淋巴组织的一种B细胞淋巴瘤,由Isaacson和Wright首先于1983年提出,其组织学与小肠黏膜下淋巴集结(peyer s patch,PP)相似,而与外周淋巴结不同。1994年经修订后的欧美淋巴瘤分类法及1997年     

幽门螺杆菌感染与胃黏膜相关淋巴组织淋巴瘤

1983年幽门螺杆菌首次被Warren及Marshall发现并开始对其进行研究。同年,黏膜相关淋巴组织(MALT)淋巴瘤的概念也首次被Isaacson和Wright提出,用于描述胃原发性低密度B细胞淋巴瘤和小肠免疫增生性疾病,于2001年新WHO分类将其单列为一个独立类型,命名为MALT型结外边缘区B细胞淋巴瘤(MALT淋巴瘤),是结外最常见     

胃黏膜相关淋巴组织淋巴瘤BCL10核表达与其对幽门螺杆菌根除治疗无反应相关

背景：经幽门螺杆菌（H．pylori）根除治疗，约75％的早期胃黏膜相关淋巴组织（MALT）淋巴瘤患者可获得完全缓解。肿瘤细胞有BCL10核表达和t（11；18）（q21；q21）可能提示胃MALT淋巴瘤对根除治疗无反应。目的：探讨单纯H．pylori根除治疗对国人早期胃MALT淋巴瘤的疗效，以及肿瘤细胞BCL10核表达和t（11；18）（q21；q21）对治疗方案选择的提示作用。方法：收集19例早期胃MALT淋巴瘤患者，以免疫组化方法检测BCL10核表达，以间期荧光原位杂交方法检测t（11：18）（q21；q21）。所有患者均首选H．pylori根除治疗，并行内镜活检病理随访。结果：本组19例早期胃MALT淋巴瘤患者中10例（52．6％）经单纯H．pylori根除治疗获得完全缓解。10例完全缓解者中2例（20，0％）肿瘤细胞BCL10核表达阳性，9例对根除治疗无反应者中7例（77．8％）阳性，阳性率显著高于完全缓解者（P〈0．05）。14例患者行t（11；18）（q21；q21）检测，8例完全缓解者均未检出该易位，6例对根除治疗无反应者中3例（50．0％）检出该易位．两组检出率差异无统计学意义（P〉0．05）。结论：单纯H．pylori根除治疗可使本组52．6％的早期胃MALT淋巴瘤患者获得完全缓解。胃MALT淋巴瘤肿瘤细胞BCL10核表达与其对根除治疗无反应相关。     

早期胃黏膜相关淋巴组织淋巴瘤患者52例的临床分析

目的 探讨早期胃黏膜相关淋巴组织（MALT）淋巴瘤患者的临床特点及抗幽门螺旋杆菌（Hp）治疗和抗肿瘤治疗的疗效。方法 收集2003年4月至2013年5月在天津医科大学附属肿瘤医院确诊并治疗的早期胃MALT淋巴瘤患者52例的病例资料。对Hp感染的患者进行抗Hp治疗。对抗Hp治疗失败的患者进行抗肿瘤治疗。结果 52例早期胃MALT淋巴瘤患者中,Hp感染率为88.4%。抗Hp治疗的有效率为91.3%。18例患者进行抗肿瘤治疗,有效率为66.7%。52例患者5年的总生存率为92.3%,5年无疾病进展生存率为83.1%。结论 对于早期胃MALT淋巴瘤患者,抗Hp治疗是合理和有效的治疗方法。抗Hp治疗失败的患者应进行抗肿瘤治疗,从而使患者得到长久的获益。     

Hp阴性及进展期胃黏膜相关淋巴组织淋巴瘤初始根除Hp疗效分析

[目的]分析幽门螺杆菌(Hp)阴性及进展期胃黏膜相关淋巴组织(MALT)淋巴瘤患者初始根除Hp治疗效果。[方法]收集我院2009-05-2017-12期间44例胃MALT淋巴瘤患者资料,对临床特点、内镜表现、病理检查及转归进行回顾性研究。[结果]44例中33例Hp阳性(阳性组)、11例Hp阴性(阴性组),中位发病年龄分别为58岁、52岁(2组比较P0.05),阳性病例病灶多位于胃远端,阴性以胃近端及弥漫性病变为主(P0.05)。总完全缓解(CR)率86.4%,化疗前接受Hp根除治疗者CR率高于未接受Hp根除治疗者(94.1%∶60%;P0.05)、而复发率远远小于未接受Hp根除治疗者(2.9%∶37.5%;P0.05)。相对阳性组,阴性组患者治疗后到达CR所需时间更长(P0.05)。阳性组与阴性组接受Hp根除治疗后早期患者的CR率比较差异无统计学意义。[结论]Hp阴性胃MALT淋巴瘤患者发病更早。根除Hp治疗可以作为Hp阴性及进展期胃MALT淋巴瘤患者有效的初始治疗方案,但Hp阴性患者疗效评估需要更长的随访时间。     

胃黏膜相关淋巴组织淋巴瘤的临床和内镜下表现

背量：原发性胃B细胞淋巴瘤发生于黏膜相关淋巴组织(MALT)，与幽门螺杆菌(H．pylori)感染密切相关。内镜检查是早期诊断胃MALT淋巴瘤的重要方法。目的：探讨胃MALT淋巴瘤的临床和内镜下表现。方法：分析总结经术后病理检查证实为胃MALT淋巴瘤的20例患者的临床、内镜和病理资料。20例患者中，男10例，女10例，男女比例为1：1，平均发病年龄为55．6岁(21～78岁)。结果：20例患者的临床表现均无特异性，上腹疼痛最为常见，其次是饥饿痛、腹胀、恶心、呕吐、黑便等。内镜下表现：病变发生于胃窦部5例，胃体部5例，胃角部1例，贲门部1例，多部位8例：形态表现多样，其中溃疡型10例，弥漫浸润型3例，结节型5例，结节溃疡型2例；内镜活检确诊率较低，仅为5％。20例患者中有12例检测了H.pylori，阳性率为83．3％(10／12)。手术标本免疫组化染色结果均为B细胞恶性淋巴瘤。结论：胃MALT淋巴瘤的临床表现无特异性，内镜下表现多样，病变范围较大。H．pylori感染率高可能与胃MALT淋巴瘤的发病有关。     

胃黏膜相关淋巴组织淋巴瘤39例临床分析

背景:胃黏膜相关淋巴组织(MALT)淋巴瘤是一种相对少见的胃恶性肿瘤,具有特殊的病因学、组织病理学和临床生物学行为特点。目的:提高对胃MALT淋巴瘤诊治的认识。方法:回顾性分析39例胃MALT淋巴瘤患者的临床、内镜、组织病理学表现以及治疗方案和随访结果。结果:本组胃MALT淋巴瘤患者临床表现缺乏特异性,多有上腹痛;内镜下可见病变主要位于胃窦和胃体部,以溃疡型最为多见:18例患者的免疫组化标记结果显示多数为LCA~+ CD20~+ CD79α~+ CD3~- CD43~- CD45RO~-,16例为B细胞来源,2例为T细胞来源。经根除幽门螺杆菌(H.pylori)、手术、化疗以及手术联合化疗等方案治疗,随访发现多数患者预后良好。结论:内镜检查可早期发现胃MALT淋巴瘤,可通过活检标本组织病理学检查和免疫组化标记确诊。根除H.pylori、手术、化疗等治疗方案可获得较好的临床疗效。     

CD4 + Th1-cells Predominate in Low-grade B-Cell Lymphoma of Gastric Mucosa-associated Lymphoid Tissue (MALT type)

Background: Little is known about the function of T cells in the inflammatory infiltrate in Helicobacter pylori -associated gastritis and B-cell lymphoma of mucosa-associated lymphoid tissue (MALT type). Previous studies have proposed a dominant Th1-type response in low-grade MALT lymphoma consistent with the Th1 response observed in H. pylori -associated gastritis. Methods: We performed a novel flow cytometric approach in which CD3 panning for enrichment and activation of small numbers of T cells and intracellular cytokine analysis were combined to selectively characterize the cytokine profile of T cells (IFN- &#110 for Th1) derived from the gastric mucosa of 23 patients with low-grade MALT lymphoma stage IEI 1 (lymphoma infiltration of mucosa/submucosa sparing the muscularis). Endosonography was performed in each case to control the depth of lymphoma infiltration. For comparison, 19 patients with H. pylori -positive gastritis were also analysed. Results: There was a CD4/CD8 ratio of 4 in patients with MALT lymphoma and of 2 in chronic gastritis. The proportion of IFN- &#110 producing cells within the CD4- positive T-cell population in MALT lymphoma was 22%; in chronic gastritis it was 13% while no such difference could be encountered in CD8-positive T cells. Conclusions: The data point towards a dominant intratumoral IFN- &#110 dominated T-cell response associated with early low-grade MALT lymphoma. A polarized IFN- &#110 dominated Th1-type response may either contribute to the inability of the immune system to eradicate H. pylori infection, thereby promoting the activation status of the lymphocytic infiltrate in low-grade MALT lymphoma, or may mirror a concomitant tumor-specific T-cell response accompanying early stages of tumor progression.     

Diagnosis of a Gastric Mucosa-associated Lymphoid Tissue Lymphoma by Endoscopic Ultrasonography-guided Biopsies in a Patient with a Parotid Gland Localization

We report the case of a 32-year-old man with a low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the parotid gland associated with Sjögren syndrome. He underwent an upper endoscopy as part of the screening of a gastric localization which showed a diffuse non-specific gastritis. However, endoscopic ultrasonography (EUS) evidenced a focal wall thickening of the vertical portion of the smaller curvature. EUS-guided biopsies of this area disclosed a MALT lymphoma, whereas biopsies under endoscopy concluded to mild chronic gastritis. The search for Helicobacter pylori infection remained negative. Four months after treatment with anti-CD20 antibodies, EUS showed a diminution of the abnormal thickening of the second layer. Regression was confirmed histologically on new EUS-guided biopsies. MALT lymphoma is usually considered a localized disease; however, dissemination is probably more frequent than initially believed. Our case reflects the importance of a systematic screening for a gastric localization in patients with MALT lymphoma of the salivary glands. In this situation, association to autoimmune disease such as Sjögren syndrome is more likely to explain the gastric location than infection with H. pylori. Endoscopic ultrasonography has a major impact for the staging of gastric MALT lymphoma, but may also help diagnose focal infiltration by the disease.     

Relationship Between Gastric Localization of Hepatitis C Virus and Mucosa-associated Lymphoid Tissue in Helicobacter pylori Infection

Background: Hepatitis C virus (HCV) has been localized in several extra-hepatic sites. Recent evidence suggests that the stomach can harbour HCV. We therefore evaluated the prevalence of gastric localization of HCV and its possible relationship with the chronic inflammatory response to Helicobacter pylori infection. Methods: Sixty patients with HCV infection (group A) and 60 subjects without HCV infection (control group), who underwent upper endoscopy for dyspeptic symptoms, were consecutively enrolled. Biopsy specimens of gastric mucosa obtained from each patient were assessed for H. pylori and chronic inflammatory infiltrates (classified as mild, moderate or marked). Furthermore, polymerase chain reaction (PCR) analyses were performed on the gastric biopsies to detect HCV and immunoglobulin heavy-chain (IgH) gene rearrangements of mucosal B cells. Results: In group A, 24 of 36 patients with H. pylori infection and 6 of 24 without H. pylori hosted HCV in their stomach ( P = 0.0017). In these subjects, the presence of both HCV in the gastric mucosa and H. pylori was significantly associated with marked or moderate inflammatory infiltrates. Oligoclonal IgH gene rearrangements were detected in three group A patients who harboured both H. pylori and HCV in their stomach. In the control group, PCR analyses failed to find HCV in the gastric mucosa, and polyclonal patterns were detected in all individuals. Conclusions: HCV is frequently localized in the stomach and is associated with the chronic lymphocytic inflammatory response to H. pylori. H. pylori and HCV, when both present, may favour the selection of clonal B cells.     

Limited Role of Bone Marrow Aspiration and Biopsy in the Initial Staging Work-up of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma in Korea

Background/Aims

The aim of this study was to investigate the frequency of disseminated gastric mucosa-associated lymphoid tissue (MALT) lymphoma and the role of bone marrow study in the initial staging work-up.

Methods

A total of 194 patients with gastric MALT lymphoma was enrolled. The incidence of disseminated disease was evaluated in the initial staging work-up. The demographic data and tumor characteristics were compared according to Helicobacter pylori infection status.

Results

Localized disease of Lugano stage I accounted for 97.4% of the enrolled cases. Abdominal computed tomography revealed abdominal lymph node metastasis in five patients (2.6%). Bone marrow (BM) involvement was found in only one patient without H. pylori infection (0.5%). No patient showed positive findings on chest computed tomography or positron emission tomography. H. pylori-negative cases showed a significantly higher frequency of advanced-stage disease than H. pylori-positive cases (10.0% vs 0.6%). In patients achieving complete remission, no extragastric recurrence occurred during follow-up.

Conclusions

The incidence of disseminated disease, including BM involvement, was very low in Korean gastric MALT lymphoma patients. It might be beneficial to perform BM aspiration and biopsy as a part of staging work-up only in patients with risk factors for advanced disease such as H. pylori negativity.