原发性肺黏膜相关淋巴组织淋巴瘤4例临床病例分析

目的 总结原发性肺黏膜相关淋巴组织(MALT)淋巴瘤的临床表现、影像学特点、诊断手段、治疗方法及预后,提高临床诊治水平.方法 回顾性分析4例经病理确诊的原发性肺MALT淋巴瘤的临床资料并随诊分析预后.结果 4例原发性肺MALT淋巴瘤患者均为老年女性,为原发性肺非霍奇金淋巴瘤的最常见类型.其中3例为查体发现,1例因咳嗽、咳痰和痰中带血就诊.发病时间为7个月至5年.肺部体征无特异性.血炎症指标和肿瘤相关指标多为正常.影像学以肿块影和结节为主要表现.患者肺通气和弥散功能正常.经胸腔镜、CT引导下肺穿刺、开胸手术获取病变组织而确诊.病理表现为弥漫浸润生长的小淋巴细胞,可见淋巴上皮增生.治疗主要是化疗和手术.随访1～8.8年,1例随访4.5年时可疑复发,其余3例均病情稳定.结论 肺原发性MALT淋巴瘤为少见病,好发于老年女性,起病隐匿,临床表现不典型.诊断须靠有经验的病理专家作出.治疗尚无指南,无症状者可采取“观察等待”策略,待肿瘤进展或出现症状时,首选苯丁酸氮芥化疗,联合利妥昔单抗与否均可.预后良好,但复发率高.     

肺黏膜相关淋巴组织淋巴瘤临床特征分析

目的：提高肺黏膜相关淋巴组织淋巴瘤诊治水平。方法回顾性分析江西省人民医院及南昌大学第二附属医院自2005年1月至2015年1月确诊的8例肺黏膜相关淋巴组织淋巴瘤的临床表现、影像学特点、诊断手段、误诊情况、治疗及预后。结果8例肺黏膜相关淋巴组织淋巴瘤中男6例,女2例,年龄38~75岁,中位年龄65岁。主要症状：咳嗽(5例)、咳痰(4例)、发热(2例)、胸闷(4例)、乏力(3例)、消瘦(3例),无症状2例。胸部 CT 表现：双肺分布5例,单肺分布3例,实变影5例,肿块及结节影4例,斑片状浸润影3例,支气管充气征5例,钙化1例,空洞2例。确诊方法：经气管镜活检1例,CT 引导下经皮肺穿刺5例,外科手术2例。误诊分析：5例误诊为细菌性肺炎,1例误诊为肺真菌病,1例误诊为肺癌,1例误诊为肺转移癌。治疗及预后：2例外科手术患者术后未行放化疗,4例转入血液内科行化疗(CHOP 方案),2例放弃治疗。8例患者随访时间2~105个月,2例死亡,6例存活。结论肺黏膜相关淋巴组织淋巴瘤临床表现不典型,容易误诊,诊断需要组织病理活检。     

肺原发性黏膜相关淋巴组织淋巴瘤12例诊断与治疗

目的探讨肺原发性黏膜相关淋巴组织淋巴瘤的临床诊断与治疗方法。方法对1992年8月至2005年5月收集的12例肺原发性黏膜相关淋巴组织淋巴瘤（MALT lymphoma）患者的临床资料、治疗、随访结果进行总结。结果随访6～164个月（平均70．3个月），12例目前均存活。手术治疗6例，术后化疗4例。单纯化疗4例，2例为完全缓解，2例为部分缓解。临床观察2例，带病生存。1例术后12．7年复发，随访8个月生存良好。结论肺原发性黏膜相关淋巴组织淋巴瘤临床表现无特异性，但其胸部放射线检查较为特异，表现为边缘模糊，内有充气支气管征的肿块。该病主要依靠病理组织学及免疫组化诊断。手术治疗结合化疗或者单纯化疗，疗效均较满意，是一种预后相对良好的恶性肿瘤。     

原发性肝黏膜相关淋巴组织淋巴瘤临床病理特征

目的：探讨原发性肝黏膜相关淋巴组织(MALT)淋巴瘤的临床病理特征及治疗方法。方法：对1例原发性肝MALT淋巴瘤的发病因素、临床表现、病理特征及治疗结果进行分析。结果：腹部B超检查发现肝左叶低回声区。腹部MRI检查示肝脏恶性占位性病变，行肝左叶切除术，病理检查示正常肝小叶结构破坏，被弥漫分布的肿瘤细胞替代，瘤细胞以单核样细胞为主，伴有淋巴上皮病变形成，免疫组化示，CD45、CD20、CD79a阳性，CD5、CD10、ALK、TdT阴性，HCV、HBV和EBV阴性。结论：原发性肝MALT淋巴瘤属低度恶性B细胞淋巴瘤，有独特的临床、组织病理学和免疫表型特点。治疗上多采取手术局部切除治疗，部分需加用联合化疗。     

支气管相关淋巴组织研究进展

支气管相关淋巴组织(bronchus-associated lymphoid tissue,BALT)是支气管内能够对吸入的抗原发生B细胞和T细胞免疫应答的淋巴细胞集合体.大部分BALT位于人或动物支气管分叉处,具有相对特异的组织特征.BALT 从胎儿期即开始出现,抗原刺激可以加速BALT的发育.BALT引发的体液免疫应答主要是局部B细胞的应答和免疫球蛋白IgA的应答,是黏膜免疫系统的组成部分.     

肺黏膜相关淋巴组织淋巴瘤二例

原发于肺的黏膜相关淋巴组织淋巴瘤（mucosaassociated lymphoid tissue lymphoma，MALTLoma）较少见，现结合有关文献对我院收治的2例患者的临床资料分析报告如下。     

肺粘膜相关淋巴组织淋巴瘤一例

患者男性 ,6 2岁。 1993年因咳嗽、咳少许白痰 ,于外院摄片诊为“右肺肺炎” ,经抗感染、抗结核治疗 1年 ,症状消失 ,但肺部阴影无好转 (图 1～ 3)。 2 0 0 0年 3月 7日因突发右胸痛 ,伴干咳、气促 ,收住我院。 40年前曾误吸汽油、柴油。近 30年反复上腹饥饿性疼痛 ,3年前于外院因“幽门梗阻” ,行“胃大部切除术”。术后诊为“胃恶性淋巴瘤”。 1999年 9月于我院行胃镜检查 ,示“吻合口周围炎 ,毕Ⅱ式术后胃” ,病理诊断 :粘膜慢性炎症伴淋巴组织增生。体检 :体温 36 7℃ ,ＢＰ 10 0 / 6 0ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ,脉搏 72次 /…     

15例黏膜相关淋巴组织淋巴瘤临床分析

目的:探讨黏膜相关淋巴组织淋巴瘤(MucosaAssociatedLymphoidTissueLymphoma,MALToma)的诊断、治疗及预后。方法:分析总结经病理证实的15例MALToma的临床病理资料、治疗结果和预后因素。结果:本组病例平均随访28.73±12.92月(7~50月),死亡3例,均为IVEB期。MALToma以低度恶性多见,临床表现无特异性,有特征性的病理学表现和临床生物学行为。结论:临床病理分期是决定MALToma预后的主要因素,正确诊断对估计患者预后及指导临床治疗具有重要意义。     

肺黏膜相关淋巴组织淋巴瘤1例并文献复习

正华中科技大学同济医学院附属同济医院张勇施静黄伟刘先胜*,武汉430030     

Development of bronchus-associated lymphoid tissue in goats

Development of bronchus-associated lymphoid tissue (BALT) was studied in clinically healthy and diseased Assam local goats. Animals were sacrificed before term as well as at different postnatal periods to screen lung sections for the presence of BALT. In a retrospective study sections prepared from pneumonic lungs were examined for any alteration of BALT. No BALT-like structure was found in neonatal goats. Bronchial lymphoid structures appeared in half of the animals from 1 month of age onward. The frequency of the BALT/4.5 cm² of lung section ranged from one to two in 1-month-old and three to six in 1-year-old goats. In pneumonic lungs BALT became hyperplastic, and the size was also increased. The incidence of BALT was increased in lungs with fibrotic pneumonia. The number of BALT/section was high (five to eight/4.5-cm² area) in mesenchymal cell proliferation. The present study shows that BALT did not develop in prenatal periods. But in the presence of potent antigens lymphoid aggregates appeared in the bronchial lamina propria of normal and diseased lungs. Offprint requests to: N. N. Barman.     

Extremely rare case of primary esophageal mucous associated lymphoid tissue lymphoma

SJ is a 37-year-old male who presented with one year history of dysphagia, odynophagia and 15 pounds weight loss. He underwent endoscopic evaluation which showed mid esophageal ulcers. It was thought that the cause of the ulcer was the multivitamins and the patient was asked to stop them. Furthermore Esomeprazole therapy was also initiated. Patient’s symptoms persisted but he did not seek any medical attention until about one year later. Meanwhile the patient reported additional 15 pounds of weight loss. We repeated upper endoscopy again which showed evidence of two chronic non bleeding irregular friable ulcerations seen in the mid esophagus, 31 cm from the incisors. Biopsies and frozen section were taken and sent for assessment to the Pathology lab. Immunoperoxidase studies on frozen sections showed the presence of IgM and for most plasma cells IgG. The microscopic and histologic findings were consistent with mucous associated lymphoid tissue lymphoma with plasmocytic differentiation. Computed tomographic scan done showed no evidence of spread to adjacent structures. The patient was referred to oncology and several cycles of radiation and Rituximab therapy were initiated which cured the disease. Subsequent endoscopies with blind biopsies were done which were negative for any neoplastic process.     

肺黏膜相关淋巴组织淋巴瘤的多层螺旋CT表现

目的分析肺黏膜相关淋巴组织(mucosa-associated lymphoid tissue, MALT)淋巴瘤多层螺旋电脑断层扫瞄(multilayer spiral computed tomography, MSCT)影像表现及特征，提高对该病的认识及诊断准确性。 方法回顾性分析16例经病理证实肺MALT淋巴瘤患者的MSCT表现。 结果16例肺MALT淋巴瘤患者中单发6例，多发10例。根据MSCT病变形态分布，将16例MALT病变分为三类：结节/肿块型(7例)，渗出/实变型(6例)，混合型(3例)。病变周围血管支气管束增粗14例，8例病灶可见钙化。空气支气管征11例，其中9例支气管扩张。4例结节/肿块型呈"钻缝"样生长。16例中有13例行增强扫描，其中11例均匀强化，11例可见血管造影征。3例纵隔淋巴结增大，8例合并胸水。 结论肺MALT淋巴瘤MSCT影像学表现具有一定特征性，结合临床惰性生长表现，可提示肺MALT淋巴瘤的诊断。     

Gastroendoscopic biopsy diagnosis of mucosa-associated lymphoid tissue lymphoma

AIM: To differentially diagnose gastric lymphoma by gastroendoscopic biopsy and clinicopathology. METHODS: A retrospective review of 38 lymphoma cases diagnosed by gastroendoscopic biopsy in the period between 1984 and 1994 from gastroendoscopy files in the Department of Gastroenterology. The histology slides were examined retrospectively. Diagnostic criteria were discussed according to the new classification of non-Hodgkin’s lymphoma. RESULTS: Of 53400 gastroendoscopy, 1672 were malignant neoplasms of which 38 were cases of the primary gastric lymphoma as diagnosed by both endoscopic findings and histological examination. A total of 22 men and 16 women, age 16 to 82 year, with a median of 47.7 year, were included in the study. The endoscopic evaluation found 12 cases of ulcerative, 11 cases of diffusely infiltrating, six cases of massive, four cases of large mucosal fold, and five cases of mixed type. The histological evaluation resulted in 34 cases of mucosa-associated lymphoid tissue lymphoma (89.5%), two cases with lymphoblastic type and two cases unclassified due to the crushed neoplastic cells. CONCLUSION: These findings are present in about 90% of endoscopic biopsy specimens of low-grade gastric lymphoma. The majority of the cases of the primary low-grade gastric lymphoma have morphologic and clinical features that justify their inclusion in the category of low-grade lymphoma of mucosa-associated lymphoid tissue.