胃肠道原发恶性淋巴瘤的内镜诊断探讨

本文报告经手术及病理检查证实的胃肠道原发恶性淋巴瘤２０例，对其中１３例行内镜检查者作了较细致观察与记录。肿瘤形态呈隆起型４例，溃疡型５例，局部浸润型１例，弥漫型３例。内镜确诊率为１５．４％，确诊加疑诊率为５３．８％。文中重点讨论了本病胃镜、肠镜的表现特点及活检取材的方法，提出了早期诊断的必要性和可能性。     

原发皮肤T细胞淋巴瘤治疗的最新进展

原发皮肤T细胞淋巴瘤(PCTCL)是指原发于皮肤并以T淋巴细胞单克隆扩增为特征的一组非霍奇金淋巴瘤,为原发性皮肤淋巴瘤(PCL)中最常见的类型,约占PCL的75%。PCTCL诊断标准为:诊断皮肤T细胞淋巴瘤6个月以内未发现皮肤以外组织的淋巴瘤。在早期,PCTCL主要指蕈样霉菌病     

胃原发性恶性淋巴瘤的内镜诊断探讨

本文分析了我院１９９１的３月至１９９５年８月经手术病理证实的１６例胃恶性淋巴瘤的内镜下特点。点镜所见以溃疡型多见，共８例。病灶多为不规则巨大溃疡，呈放射状或地图状，形态各异。息肉样型５例，表现为息肉或结节样隆起。浸润型３例，呈广泛性浅表溃疡。     

原发纵隔的大B细胞淋巴瘤研究进展

<正>原发纵隔大B细胞淋巴瘤(PMBL)的概念是二十世纪80年代提出的〔1〕,后在欧洲及美国淋巴瘤分类中认为是弥漫大B细胞淋巴瘤(DLBCL)的一个特殊亚型。PMBL大约占DLBCL的10%,特点为原发于前上纵隔,超过10 cm的大肿块较常见,常伴有肺部、胸膜及心包的浸润〔2,3〕。PMBL与结节硬化型霍奇金淋巴瘤(HL)在临床特征和生物学特征上相似〔4〕,目前仍没有标准的治疗方案。1病理类型形态学上,PMBL表现为大体积的肿瘤细胞弥漫增生,胞质灰白或透亮,细胞核为圆形或卵圆形。有时可见肿瘤细胞有     

原发性甲状腺恶性淋巴瘤的诊断与治疗(附6例报告)

原发性甲状腺恶性淋巴瘤 ( Primary malignantlymphoma of thyroid,PMLT)是一种非常少见的恶性肿瘤 ,因其临床表现缺乏特异性 ,术前常易和慢性淋巴性甲状腺炎、结节性甲状腺肿、甲状腺癌等疾病混淆而误诊。 1 985～ 2 0 0 0年 ,我院共收治 6例患者。现报告如下。1　资料与方法1     

弥漫大B细胞淋巴瘤的分子诊断及治疗进展

弥漫大B细胞淋巴瘤（diffuse large B-cell lym-phoma,DLBCL）是最常见的非霍奇金淋巴瘤（non hodgkin lymphoma,NHL）,约占全部NHL的30%～40%。它可原发于淋巴结或结外器官和组织,也可从惰性淋巴瘤转化而来,比如慢性淋巴细胞性白血病/小淋巴细胞性淋巴瘤、滤泡性淋巴瘤、边缘区B     

原发性消化道恶性淋巴瘤诊断及治疗结果分析

我院自１９８４年１月至１９９７年６月,经内镜及病理检查确诊为原发性消化道恶性淋巴瘤２０例,现将诊断及治疗结果分析如下：临床资料一、一般资料：本组２０例,其中男性１２例,女性８例。年龄最大７８岁,最小２－５岁,平均年龄３６－４岁。发生部位：食管１例,胃１２例,回肠４例,结肠２例,胃回肠同时受侵１例。二、临床表现：病程最长１年,最短一周。主要症状：腹部疼痛１３例,上腹部胀满不适１０例,黑便３例,腹部包块６例,贫血３例,发热１例。三、诊断：１４例进行胃镜检查,２例经肠镜检查,１６例内镜检查中,镜下诊断…     

恶性淋巴瘤病理学检查对治疗和预后的意义

恶性淋巴瘤的正确诊断和分型是临床治疗和预后判断的重要依据。传统的恶性淋巴瘤分类仅依据肿瘤的形态学特征进行组织学分型,但2001年新的WHO恶性淋巴瘤分类将每种类型淋巴瘤视为一个独立病种（disease entity）,依据形态学、免疫表型、遗传学和临床特征四个方面来定义每一种类型淋巴瘤。     

Flow cytometric DNA analysis of malignant lymphomas with primary bone manifestation

Summary Malignant lymphomas with primary skeletal manifestation have received controversial evaluation with regard to histological classification and histogenesis. Recent histological and immunohistological studies on the rare bone lymphomas conducted by our team, have shown that they do not differ from primary nodal lymphomas with regard to the spectrum of histological subtypes. The present flow cytometric DNA analysis of paraffin-embedded material from 17 lymphomas documented in the Bone Tumor Registry of Westfalia yielded the following distribution pattern of DNA ploidy: among 12 non-Hodgkin's lymphomas (NHL) (according to the Kiel classification) there was only 1 case of low grade malignancy; this centroblastic-centrocytic lymphoma showed a unimodal diploid DNA histogram. Of 11 highly malignant NHL, 6 were DNA hyperdiploid. Among the 5 cases of Hodgkin's lymphoma, 4 were DNA diploid, (1 nodular sclerosing, 3 mixed types) and one DNA tetraploid (lymphocytic depletion type). Comparison with data from the literature reveals that even with regard to DNA ploidy, malignant lymphomas primarily manifesting in bone do not differ from those of exclusively nodal manifestation.     

Incidence and histological features of bone marrow involvement in malignant lymphomas

Summary Bone marrow biopsy (BMB) is a routine investigation in the diagnosis and staging of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL), and there is evidence supporting its prognostic importance in some histological varieties. The histological characteristics of BMB in 433 NHL and 155 HD patients were reviewed for clinicopathological correlations; 36 of these cases were also studied by means of immunohistochemistry. BM infiltrates were discovered in 171 NHL patients. In 36 cases, the diagnosis of NHL was directly established by BMB; a discordance between lymph node and BM histology was observed in 38 of the other 135 cases. BM-positive centroblastic and immunoblastic NHL were significantly associated with larger infiltrates, BM fibrosis, and megakaryocytic hyperplasia. Leukemization at diagnosis was more frequent in low-malignancy NHL. No correlation was found between histology and prognosis, although immunohistochemistry revealed a B-cell phenotype in all but two cases. BMB was positive in 18 of the 155 HD patients and directly diagnostic in two; Reed-Sternberg and Hodgkin cells were CD-30 positive and surrounded by T-cell infiltration. The concordance between BM and lymph node histology was fairly satisfactory, although the relationships between BM infiltration and other histological parameters may reflect peculiar interactions with BM microenvironmental factors. The usefulness of BMB in the diagnosis of malignant lymphomas has been demonstrated, and further progress can be expected from the availability of reliable immunohistochemical markers of clonality reacting on paraffin-embedded BM sections.     

Lymphomatous involvement of gastrointestinal tract： Evaluation by positron emission tomography with ^18F-fluorodeoxyglucose

AIM: To demonstrate the 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) findings in patients with non-Hodgkin's lymphoma (NHL) involving the gastrointestinal (GI) tract and the clinical utility of modality despite of the known normal uptake of FDG in the GI tract. METHODS: Thirty-three patients with biopsy-proven gastrointestinal NHL who had undergone FDG-PET scan were inducted. All the patients were injected with 10-15 mCi FDG and scanned approximately 60 min later with a CTI/ Siemens HR (+) PET scanner. PET scans were reviewed and the maximum standard uptake value (SUVmax) of the lesions was measured before and after the treatment, if data were available and compared with histologic diagnoses. RESULTS: Twenty-five patients had a high-grade lymphoma and eight had a low-grade lymphoma. The stomach was the most common site of the involvement (20 patients). In high-grade lymphoma, PET showed focal nodular or diffuse hypermetabolic activity. The average SUVmax±SD was 11.58±5.83. After the therapy, the patients whose biopsies showed no evidence of lymphoma had a lower uptake without focal lesions. The SUVmax±SD decreased from 11.58±5.83 to 2.21± 0.78. In patients whose post-treatment biopsies showed lymphoma, the SUVmax±SD was 9.42±6.27. Low-grade follicular lymphomas of the colon and stomach showed diffuse hypermetabolic activity in the bowel wall (SUVmax 8.2 and 10.3, respectively). The SUVmax was 2.02-3.8 (mean 3.02) in the stomach lesions of patients with MALT lymphoma. CONCLUSION: 18F-FDG PET contributes to the diagnosis of high-grade gastrointestinal non-Hodgkin's lymphoma, even when there is the normal background FDG activity. Furthermore, the SUV plays a role in evaluating treatment response. Low-grade NHL demonstrates FDG uptake but at a lesser intensity than seen in high-grade NHL     

Diagnosis and surgical treatment of primary hepatic lymphoma

AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnos...     

Alternating mini-BEAM/ESHAP as salvage therapy for refractory non-Hodgkin's lymphomas

 Mini-BEAM and ESHAP are two non-cross-resistant salvage regimens that have been used separately in patients with lymphoma. The aim of the present study was to investigate the efficacy of the combination of these two regimens, administered in alternating cycles, as salvage therapy for refractory non-Hodgkin's lymphoma (NHL) patients. A total of 28 patients were included in the study: 14 patients were primary refractory, seven were partial responders, and seven were in relapse. The alternating cycles of mini-BEAM and ESHAP were given until there was maximum response or progression. The overall response rate to mini-BEAM/ESHAP was 39%; 25% of patients achieved a complete response and 14% a partial response. Nevertheless, it should be noted that none of the primary refractory patients responded to this protocol. Nine of the 11 patients who responded to mini-BEAM/ESHAP were consolidated with autologous transplantation using BEAM as a conditioning regimen. The survival at 3 years in this group of 11 patients who responded to the salvage regimen is 64%, with a disease-free survival of 67% at 2 years. No major toxic effects were observed with mini-BEAM/ESHAP. Myelosuppression was the most frequent complication, especially with the mini-BEAM cycles. Other toxicities were infrequent and no treatment-related deaths were observed. These results suggest that alternating mini-BEAM/ESHAP chemotherapy is a safe regimen that is effective in partial responders or relapsing patients with NHL who have sensitive disease, but not in primary refractory patients. Moreover, although this therapy has a potential advantage, combining as it does two non-cross-resistant regimens, it does not seem superior to ESHAP alone. Received: 16 July 1996 / Accepted: 31 October 1996     

Primary cardiac lymphoma presenting as atrial flutter and total heart block

Primary cardiac lymphoma is extremely rare. We present the case of a 70-year-old man with primary cardiac lymphoma involving interatrial septum, presenting as atrial flutter and total heart block. The diagnosis was obtained by echocardiography-guided transvenous endocardial biopsy which revealed diffuse large B-cell non-Hodgkin's lymphoma, CD 20+. After six courses of immunochemotherapy the patient achieved complete remission. After 2 months he developed a series of epileptic attacks. Intracerebral lymphoma extension was diagnosed. Two cycles of high-dose methotrexate and cranial irradiation were applied, resulting in a second complete remission.     

Treatment of primary orbital lymphomas

We present an overview of the treatment and clinical outcome of 15 orbital lymphomas, carried out in our center from 1993 to 2002. The surgical approach was determined by the location, and type of the lesion. Lateral orbitotomy was performed in five laterally located lesions, a transconjunctival approach in five medial, basal, extra-, intraconal lesions. Pterional intradural and extradural and intradural approaches (three) were used in case of intracranial involvement or location in the apex and optic canal. Two lesions of the lid or extraconal space were operated via eyebrow incision. Ten patients were diagnosed as extranodal marginal zone lymphoma. Diffuse large B-cell lymphoma (DLCL) was encountered in two patients, follicular lymphoma (FCL) in two patients, and diffuse lymphoplasmacytic/lymphoplasmacytoid lymphoma in one patient. All patients except one failed to reveal systemic disease and had a localized orbital lymphoma. Twelve of the patients responded to radiation therapy with usually 40 Gy. Cyclophosphamide, doxorubicin, vincristine, prednisone chemotherapy was applied in two patients, once in combination with radiotherapy. Local recurrence was seen in one patient with FCL. Systemic manifestation occurred in one patient with DLCL, undergoing ifosfamide, carboplatin, etoposide chemotherapy with complete remission. The course of orbital non-Hodgkin's lymphoma is variable and requires a multidisciplinary treatment. Therapeutic options include surgical biopsy, radiation therapy, and chemotherapy.     

Demonstration of C3 receptors on frozen sections of normal lymphoid tissue and malignant lymphomas using various EAC complexes

Summary The occurrence and distribution of complement receptors (C3R) were investigated on frozen sections from normal lymphoid tissue and from 185 cases of malignant lymphoma. Various EAC complexes were used: vital EA or glutaraldehyde-fixed EA coated with mouse complement (EAC mouse and Glu-EAC mouse, respectively), human complement (EAC human and Glu-EAC human), or complement from C6-deficient rabbits (EAC_ra-C6-def, Glu-EAC_ra-C6-def). The different EAC complexes showed varying affinity for C3R: Glu-EAC human > EAC mouse = EAC_ra-C6-def > Glu-EAC mouse = Glu-EAC_ra-C6-def > EAC human. The EAC complexes differed not only in their receptor affinity but also in their pattern of binding. On frozen sections of tonsils, EAC mouse, EAC human and EAC_ra-C6-def adhered exclusively to germinal centers and the follicular mantle, whereas Glu-EAC mouse, Glu-EAC human and Glu-EAC_ra-C6-def adhered not only to germinal centers and the follicular mantle but also to parafollicular areas and sometimes to interfollicular regions. The various EAC complexes were also assayed for reactivity to C3b receptors of human erythrocytes and C3R of human tonsil cells. Human erythrocytes (C3b receptor⁺ and C3d receptor^– did not react with EAC mouse, EAC human or EAC_ra-C6-def whereas tonsil cells (C3b and C3d receptor⁺) showed positive reactions with these complexes. In contrast, Glu-EAC mouse, Glu-EAC human and Glu-EAC_ra-C6-def displayed marked affinity for both the C3b receptors of human erythrocytes and the C3Rof tonsil cells. In connection with previously reported data, these findings indicate that (a) EAC mouse, EAC human and EAC_ra-C6-def react only with receptors for C3d, whereas Glu-EAC human, Glu-EAC mouse and Glu-EAC_ra-C6-def are bound by C3b receptors and probably by C3d receptors as well, and (b) germinal center cells and follicular mantle lymphocytes express C3b and C3d receptors whereas cells in parafollicular areas and those in the interfollicular zone bear only C3b receptors.On frozen sections from a fetal thymus C3R could be clearly demonstrated with Glu-EAC human. The demonstration of C3R on frozen sections from malignant lymphomas with the Glu-EAC human complex revealed C3R on cells from all types of lymphoma except mycosis fungoides, although there were variations in the number of positive cells and in the density of the reaction. C3R were most common and were expressed most densely in two types of germinal center cell tumors, viz. centroblastic/centrocytic lymphoma and centrocytic lymphoma. Combined with the investigation of acid phosphatase activity and the sheep erythrocyte rosette test, analysis of C3R in lymphoblastic lymphomas of the T type led to the distinction of three subtypes, viz. a prethymocytic, a prothymocytic, and a mature thymocytic subtype. In none of the cases of Hodgkin's disease tested could C3R be demonstrated unequivocally on Hodgkin or Sternberg-Reed cells.This study was supported by the Deutsche Forschungsgemeinschaft SFB 111, Project CL1     

A case of primary isolated non-Hodgkin's lymphoma of the esophagus in an immunocompetent patient

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. A case of primary isolated non- Hodgkin's lymphoma of the esophagus in a 77-yearold man without acquired immunodeficiency syndrome is presented. We describe the clinical features and the imaging findings (barium swallow, endoscopic ultrasonography and CT) of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall, which was discovered incidentally. We also briefly review the literature.