胃粘膜相关淋巴组织淋巴瘤与幽门螺杆菌感染

胃粘膜相关淋巴组织淋巴瘤与幽门螺杆菌感染韩盛玺陈和平文锦杨红近来，越来越多的研究显示幽门螺杆菌（Ｈｐ）感染与胃粘膜相关淋巴组织（ＭＡＬＴ）淋巴瘤有关。本研究旨在用免疫组化方法对病理证实的１５例胃ＭＡＬＴ淋巴瘤进行分型并探讨其与Ｈｐ感染之间的关系。一、...     

胃粘膜相关淋巴组织淋巴瘤的内镜下表现

目的 胃粘膜相关淋巴组织淋巴瘤（ＭＡＬＴ淋巴瘤）的内镜特征。方法 对１９例胃ＭＡＬＴ淋巴瘤患者的临床资料进行回顾分析。结果 胃ＭＡＬＴ淋巴瘤的内镜下表现呈多样性改变。病变主胃体最多（７８．９％）,主要病变形态包括溃疡（６３．２％）、肿块（１５．８％）、浸润病变（１５．８％）及糜烂（５．３％）。大多数２（７３．７％）有较典型的恶性征象,但少数可无典型恶性征象,甚至仅表现为一般的炎症及糜烂。本组病例内     

胃粘膜相关淋巴组织淋巴瘤的内镜和病理特点

目的 探讨胃粘膜相关淋巴组织（MALT）淋巴瘤的内镜和病理特点,以提高其在内镜下的确诊率。方法 回顾性结合部分前瞻性分析28例患者。结果 胃MALT淋巴瘤多见于40－60岁患者,确诊病程的中位数为8．5月。临床症状无特异性,抗酸剂治疗无效,25％可引起上消化道出血。Hp感染率为78．6％,10．7％患者的CA125可升高,17．9％患者的ESR升高。高度恶性者可发生浸润或转移。肿瘤多位于胃体下段和／或胃窦部,占96．4％,75％表现为单个或多人浅表性溃疡,质地偏硬,但大部分患者的粘膜尚可稍提起,少见的病变有稍隆起性、糜烂和坏死性病变。胃镜下形态诊断的误诊率为89．3％。胃镜下常规活检组织病理检查,恶性疾病漏诊率为57．1％,而胃MALT淋巴国漏诊率为82．1％,术后病理检查确诊率达100％。深而大的活检和免疫组织化学检查有助于确诊。B细胞淋巴瘤占88．9％,T细胞淋巴瘤占11．1％。结论 胃MALT淋巴瘤是一类独特的原发性胃淋巴瘤,具有一定的病理和内镜特点。     

幽门螺杆菌感染与胃粘膜相关淋巴组织及胃粘膜相关淋巴组织淋巴瘤

现已确认,幽门螺杆菌(Hp)是慢性胃炎的主要致病因子,且与消化性溃疡密切相关,Hp根除后可以显著降低或防止溃疡复发。Hp与胃腺癌的关系十分密切,世界卫生组织已明确Hp为第一类致癌因子。近年又发现Hp与胃粘膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤密切相关,根除Hp后MALT淋巴瘤可缩小或消退。这引起了有关学者对胃淋巴瘤的病因、病理、诊断和治疗等一系列理论和实践问题的新认识,尤其是在指导临床方面出现了重大进展。本文重点就有关问题作一综述。     

78例胃粘膜相关淋巴组织淋巴瘤临床、内镜及病理特征分析

目的：探讨胃粘膜相关淋巴组织淋巴细胞的临床、内镜及病理特征，以提高早期诊断水平。方法：分析手术切除并经病理证实的78例胃粘膜相关淋巴瘤患者的临床、内镜和病理资料。结果：患者男女比例为1．05：1，平均年龄48．2岁，平均病程25．6个月，症状非特异性，以EⅠ2和EⅡ1期病变为主，内镜检查70例结果显示，病变多见于胃窦体，表现为溃疡性，隆起性及浸润性损害，以多灶性，多形性及弥漫性病变为特征。56例胃活检中，组织学结合免疫组化可对41例（73．2％）术前确诊。78例均为B细胞淋巴瘤，高恶性居多，67例（85．9％）幽门螺杆菌阳性。结论：胃粘膜相关淋巴组织淋巴瘤患者内镜改变具特征性。内镜下病变形态识别，多取，深取活检以及同期作免疫组化检查可提高早期诊断准确率。     

胃黏膜相关淋巴组织淋巴瘤临床与胃镜表现分析

目的探讨胃黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤临床和内镜下表现特征,提高其在胃镜下的早期诊断率。方法对15例胃MALT淋巴瘤患者临床和内镜下表现特征进行回顾性分析。结果胃MALT淋巴瘤多见于40~60岁患者,男女发病率相近。临床症状无特异性,H.pylori感染率为73.33%。胃MALT淋巴瘤多位于胃窦部,66.67%表现为单个或多个溃疡,质地偏硬,蠕动性及胃腔形态无明显特异性。结论胃MALT淋巴瘤作为一类特殊的原发性胃淋巴瘤,内镜下多块、深而大的活检有助于提高确诊率。     

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.     

胃粘膜相关淋巴组织淋巴瘤二例

胃粘膜相关淋巴组织淋巴瘤二例施尧萧树东陈晓宇王瑞年胃粘膜相关淋巴样组织（ＭＡＬＴ）淋巴瘤是来源于ＭＡＬＴ的一种胃原发性淋巴瘤，它有特殊组织学表现，以往多被误诊为胃假性淋巴瘤。最近见到２例，都在术后得到确诊。例１女性，４９岁。反复右上腹隐痛至绞痛８个月...     

Treatment outcome of localized Helicobacter pylori-negative low-grade gastric MALT lymphoma

AIM: To investigate treatment outcome of Helicobacter pylori (H.pylori )-negative low-grade gastric mucosaassociated lymphoid tissue (MALT) lymphoma.METHODS: In this study,we retrospectively reviewed the clinical outcome and clinicopathologic factors of stage Ⅰ E H.pylori -negative low-grade gastric MALT lymphoma cases from August 1998 to June 2009.RESULTS: A total of eleven patients with H.pylori -negative low-grade gastric MALT lymphoma were enrolled in the study and received anti-H.pylori eradication tre...     

Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection

AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.     

帽状息肉病临床和内镜特征及内镜下切除治疗效果

为了探讨帽状息肉病的临床、内镜特征,并评价其内镜下切除治疗效果,对2017年6月—2021年2月首都医科大学附属北京友谊医院行内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）或内镜黏膜切除术（endoscopic mucosal resection,EMR）结直肠息肉切除治疗,经术后病理证实为帽状息肉病的14例病例（共56枚息肉）进行了回顾性分析。结果显示：男8例,女6例;年龄14岁～74岁,其中<60岁7例,≥60岁7例;7例（50.0%）伴消化道症状;息肉多发4例,单发10例（71.4%）;息肉位于直肠42枚（75.0%）,乙状结肠13枚（23.2%）,横结肠1枚;山田分型Ⅰ型44枚（78.6%）,Ⅱ型3枚,Ⅲ型5枚,Ⅳ型4枚;内镜下息肉表面可见明显白色帽状覆盖物41枚（73.2%）、明显充血发红23枚,其中两者均可见8枚;2例行ESD治疗、12例行EMR治疗,均完全切除,均未出现出血、穿孔、感染等并发症;7例伴消化道症状者术后临床症状均获得缓解;11例（78.6%）随访期间完成肠镜复查,均未见息肉复发。由此可见,帽状息肉病无性别、年龄发病差异,息肉多单发,直肠及乙状结肠多见,形态以山田Ⅰ型为主,表面多有白色帽状覆盖物,患者可无明显消化道症状,内镜下切除治疗安全、有效。     

Early stage gastric MALT lymphoma with high-grade component cured by Helicobacter pylori eradication

A 68-year-old woman was diagnosed with gastric lymphoma of the mucosa-associated lymphoid tissue (MALT) type with a high-grade component. Surgical treatment was recommended because of the presence of the high-grade component, but she refused surgery. As an alternative, she received Helicobacter pylori eradication treatment, which successfully induced regression of the lymphoma. She shows no sign of recurrence endoscopically and histologically, as of 29 months after the eradication treatment. Moreover, the B-cell monoclonality and Helicobacter pylori infection demonstrated at diagnosis has disappeared. This is one of the rare cases of gastric lymphoma of the MALT type with a high-grade component cured by Helicobacter pylori eradication alone. Received: October 7, 1999 / Accepted: May 26, 2000     

Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum:Clinical experience and endoscopic management

Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.     

原发性胃淋巴瘤临床病理和内镜特点分析

目的探讨原发性胃淋巴瘤（PGL）的临床病理和内镜下表现,提高对PGL的认识。方法对我院1999年1月～2010年3月经内镜检查、组织病理和免疫组化确诊的42例PGL的临床资料并进行分析。结果42例患者从发病到就诊时间平均5.2个月。首发症状为上腹部疼痛,依次有腹部饱胀、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（17例）、多发溃疡型（14例）和隆起糜烂型（11例）。多部位、多种形态且病变范围广为其特征。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38例（90.5%）幽门螺杆菌（Hp）阳性。结论PGL起病较隐匿、病程较长。症状、体征不具特异性。内镜下多点深取组织活检及病理学、免疫组化检查是提高PGL确诊率和早期诊断率的重要方法。Hp感染与PGL有密切相关性。     

Clinical and endoscopic features of Chinese reflux esophagitis patients

AIM： To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis （RE）. METHODS： A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification. RESULTS： Of 18823 patients, 1405 were diagnosed as RE. The ratio of male to female patients was 1.75：1 （P 〈 0.01）. The mean age of male and female patients was significantly different （P = 0.01）. The peak age at onset of the disease was 40-60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D （P 〈 0.01）. Two hundred and seventy-seven patients were infected with H pyiorl, the infection rate was low （P 〈 0.01）. Complication of esophageal hiatal hernia was found to be significantly associated with the severity of esophagitis and age in 195 patients （P 〈 0.01）. Esophageal mucosa damages were mainly located at the right esophageal wall. CONCLUSION： The peak age of onset of RE is 40-60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of Hpylori is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage can occur more often in RE patients.     

Trisomy 3 may predict a poor response of gastric MALT lymphoma to Helicobacter pylori eradication therapy

AIM: To investigate the relation of the response to Helicobacter pylori eradication therapy to the depth of tumor invasion and chromosome abnormalities in patients with mucosa-associated lymphoid tissue (MALT) lymphoma and to determine the clinical value of aneuploidy. METHODS: We studied 13 patients with localized gastric MALT lymphoma of stage E1. Before eradication therapy, the depth of tumor invasion was assessed by endoscopic ultrasonography in 8 patients and by endoscopic examination and gastrointestinal series in the remaining patients. To detect chromosomal abnormalities, paraffin-embedded tissue sections of diagnostic biopsy specimens underwent tissue-fluorescence in situ hybridization (FISH), using chromosome-specific α-satellite DNA probes for chromosomes 3,7,12, and 18 and YAC clones for t(11;18)(q21;q21). RESULTS: Seven of the 13 patients had complete regression (CR) in response to H pylori eradication therapy. No patient with CR had submucosal tumor invasion. Trisomy 18 was seen in 1 patient with CR, and both trisomies 12 and 18 were present in another patient with CR. All patients with no response or progressive disease had deep submucosal tumor invasion and showed t(11;18)(q21;q21) or trisomy 3. Trisomy 7 was not detected in this series of patients. CONCLUSION: The depth of tumor invasion is an accurate predictor of the response of stage E1 MALT lymphoma to H pylori eradication therapy and is closely associated with the presence of chromosomal abnormalities. Trisomy 3 may predict the aggressive development of MALT lymphoma.