原发性胃肠道淋巴瘤临床病理特征分析14例

目的:探讨原发性胃肠道淋巴瘤(PGIL)的临床、病理特点、疾病分期、内镜及影像学表现以提高诊治水平.方法:回顾性分析我院1994-01/2008-03经内镜活检或手术病理证实的14例PGIL患者的临床资料.结果:14例PGIL中原发于胃8例, 肠道5例, 1例为混合部位. 临床症状依次为腹痛(92.86%)、消瘦(35.71%)、纳差(28.57%)及腹部包块与贫血(21.42%). 病理类型低度恶性淋巴瘤2例(14.29%), 高度恶性淋巴瘤12例(其中DLBL2例, 伴有MALT成分的DLBL10例). 9例患者临床分期为Ⅰ期, 3例为ⅡE, 2例为Ⅲ期. PIL及混合部位组较PGL组年龄小, 二组之间比较差异有显著性(49.00±13.05 vs 69.12±7.7, P<0.01).结论:PGIL临床症状无特异性, 病理类型以高度恶性淋巴瘤常见, PIL及混合部位淋巴瘤发病年龄小且分期晚, 值得临床高度重视.     

180例原发性胃肠道淋巴瘤的临床特征及预后分析

目的探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphoma,PGIL)的临床特点并分析影响其预后的相关因素。方法收集2006年1月至2016年1月于苏州大学附属第一医院就诊的PGIL患者,分析其临床特征及预后,并进行相关统计学分析。结果共180例患者纳入此研究,男102例,女78例,中位发病年龄为59岁。PGIL临床表现多样,较常见的为:腹痛、腹胀、消化道出血、体质量减轻、大便习惯或性状改变。胃淋巴瘤101例,其最常见的发病部位为胃窦(66例,65.34%),首次胃镜检查活检准确率为43.30%;肠道淋巴瘤79例,其中小肠44例(55.70%),结直肠35例(44.30%),首次结直肠镜检查活检准确率为24.00%。在180例患者中B细胞淋巴瘤为160例,其中以弥漫性大B细胞淋巴瘤(DLBCL)(57.22%)及黏膜相关淋巴组织(MALT)淋巴瘤(19.44%)多见;T细胞淋巴瘤为20例。根据Ann Arbor改良分期,ⅠE期病例49例,ⅡE期48例,Ⅲ期28例,Ⅳ期55例。PGIL的3年生存率为57.39%,其中年龄60岁、病变位于小肠、临床分期处于Ⅲ/Ⅳ期、IPI指数≥3、LDH表达高水平、T细胞源性及单纯手术的患者其预后较差,临床分期为影响PGIL患者预后的独立危险因素。生存分析结果显示,手术联合化疗的预后要优于单纯手术,且与临床分期有关。结论 PGIL好发于中老年男性,以胃淋巴瘤最为常见,其中DLBCL和MALT淋巴瘤是最常见的病理类型。年龄60岁、病变位于小肠、临床分期处于Ⅲ/Ⅳ期、IPI指数≥3、LDH表达高水平、T细胞源性及单纯手术的预后较差。手术联合化疗适用于临床分期处于Ⅲ/Ⅳ期的患者。     

COX-2和PCNA在胃黏膜相关淋巴组织淋巴瘤中的表达

目的:探讨环氧合酶-2(COX-2)在胃黏膜相关淋巴组织(MALT)淋巴瘤中的表达及其与细胞增殖和预后的关系.方法:采用免疫组化SP法检测43例胃MALT淋巴瘤和10例正常胃黏膜中COX-2和增殖细胞核抗原(PCNA)的表达.结果:COX-2在胃MALT淋巴瘤中的阳性表达率为55.8%,明显高于对照组45.8%,差异具有显著性(χ2=5.119,P=0.024).COX-2的表达与胃MALT淋巴瘤的临床分期具有相关性(χ2=4.408,P=0.036).胃MALT淋巴瘤平均增殖指数(MPI)为41.5%±5.1%;COX-2表达阳性组的MPI(43.4%±4.8%)显著高于阴性组(37.5%±2.9%),侵袭性胃MALT淋巴瘤的MPI(44.0%±5.6%)显著高于惰性组(38.9%±4.6%),差异有显著性(t=3.16,P=0.008和t=2.98,P=0.045).COX-2表达阴性患者的5a生存率要高于COX-2表达阳性患者(χ2=6.056,P=0.014).COX-regression模型显示COX-2是一个独立的不良预后指标(P<0.01).结论:胃MALT淋巴瘤中COX-2表达上调.COX-2蛋白可以通过促进淋巴瘤细胞的增殖而参与胃MALT淋巴瘤的发生和发展,并且在胃MALT淋巴瘤中是一个有用的预后指标.     

原发性胃肠道恶性淋巴瘤临床分析

目的 探讨原发性胃肠道恶性淋巴瘤(PGIML)的临床及病理特点。方法 回顾性总 结分析PGIML22例资料,所有病例均经内镜活检或手术后病理组织学所证实。结果 腹痛是PCIML 最常见的症状,达68.2％(15／22);胃是最常见的发生部位,达54.5％(12／22)。黏膜表面呈肿块结节 是PGIML最常见的内镜表现,达71.4％(15／21),内镜活检诊断PGIML的阳性率为52.6％(10／19)。 22例均为非何杰金淋巴瘤,20例为黏膜相关淋巴组织(MALT)淋巴瘤,其中13例为MALT型结外边 缘区B细胞淋巴瘤。结论PGIML以腹痛为主要临床表现,胃的发生率最高,主要病理类型为MALT 型结外边缘区B细胞淋巴瘤,其预后与手术方式和术后化疗有关。     

胃黏膜相关淋巴组织淋巴瘤的临床病理特征及其预后

胃黏膜相关淋巴组织(MALT)淋巴瘤是原发胃淋巴瘤的一种特殊类型,其发生率日趋增长,国外文献报道约占胃原发恶性肿瘤的5%.2000年WHO新分类将MALT淋巴瘤命名为黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤.现将本院1994年1月至2004年6月间经病理诊断为胃MALT淋巴瘤的36例患者的临床、病理和随访资料总结如下.     

38例肠道症状为主要表现的T/NK细胞非霍奇金淋巴瘤的临床分析

目的 分析以肠道症状就诊的T/NK细胞非霍奇金淋巴瘤(NHL)的临床和内镜特点,以提高对该疾病的认识.方法 总结回顾本院38例以肠道症状就诊的T/NK细胞NHL病例临床资料,分析其临床和内镜特点.结果 肠道主要首发症状为单纯腹痛或腹胀/腹部不适(11例)、腹痛伴有便血(12例)、腹痛伴有腹泻(11例)、腹痛伴腹部包块(2例)、黑便(2例).有B症状者30例,IPI评分为高危和高中危的患者33例.约一半患者LDH、ESR、CRP增高.31例患者行手术,主要原因为穿孔(19例).病变累及大肠12例,小肠15例,回盲部7例,小肠和大肠均受累4例.病变类型中多发弥漫溃疡为12例,局限性溃疡10例,肿块/占位11例,黏膜病变4例,其他病变1例.病理类型以周围T细胞淋巴瘤-非特指型(PTCL-U)多见.对于原发肠道T/NK细胞性NHL,病变累及大肠10例,回盲部3例,小肠8例,多部位受累3例;病变类型以多发弥漫溃疡型为主(9例).结论 T/NK细胞淋巴瘤在小肠和大肠均常见,病变类型以多发弥漫溃疡和占位为主.临床工作中对以腹痛为主要表现,伴有B症状、LDH、ESR、CRP增高,病情进展快的患者,应警惕T/NK-NHL的可能,争取早期确诊.     

原发性胃肠淋巴瘤p53基因与13q14染色体缺失与预后的关系

目的 探讨p53基因与13q14染色体缺失在原发性胃肠淋巴瘤(PGIL)预后判断、指导治疗中的作用.方法 采用改良的荧光标记的原位杂交(FISH)技术检测72例PGIL及30例淋巴结反应性增生患者石蜡切片中p53基因及13q14染色体缺失情况,分析其与PGIL预后的关系.结果 ① Ⅰ期～Ⅱ期患者中30.2%(16/53)有p53基因缺失,Ⅲ期～Ⅳ期患者中63.2%(12/19)有p53基因缺失(χ~2=6.397,P=0.011);②黏膜相关组织(MALT)淋巴瘤中28.6%(12/42)有p53基因缺失,非MALT淋巴瘤中53.3%(16/30)有p53基因缺失(χ~2=4.515,P=0.034);③ MALT淋巴瘤中,无基因或单基因改变者平均生存期为(39.25±22.73)个月,2种基因改变的患者平均生存期为(9.11±5.95)个月;Ⅰ期～Ⅱ期患者中,无基因或单基因改变者平均生存期为(40.33±23.18)个月,2种基因改变的患者平均生存期为(20.61±18.90)个月.④单纯 13q14 缺失与肿瘤发生部位、病理类型、临床分期以及平均生存期无关,但同时合并 p53 基因缺失则预后差.结论 p53基因缺失在非MALT淋巴瘤组及Ⅲ期～Ⅳ期患者中发生率较高.p53缺失或p53基因缺失与13q14染色体同时存在缺失的PGIL病例恶性程度高,患者平均生存期短于无基因或单基因改变者.     

原发性胃淋巴瘤与原发性肠道淋巴瘤特征的比较

目的 探讨原发性胃淋巴瘤(PGL)与原发性肠道淋巴瘤(PIL)在临床特征、病理特点、治疗及预后的异同点.方法 回顾性分析48例PGL及15例PIL患者的临床特征、病理特点、治疗、幽门螺杆菌(Hp)检出情况及预后.结果 PGL组和PIL组年龄、性别、腹痛、消化道出血、B症状、临床分期、死亡差异均无统计学意义(P值均>0.05);而病理分型、急腹症急诊手术差异均有统计学意义(P值均<0.05).PGL组黏膜相关淋巴组织(MALT)淋巴瘤Hp阳性12例(12/19),弥漫性大B细胞淋巴瘤(DLBCL)Hp阳性5例(5/20),两种病理类型中Hp检出率差异有统计学意义(P=0.025).PIL组未检测Hp.COX多因素分析显示,Ⅲ、Ⅳ期是影响PGL预后的独立不良因素(P<0.05),Ⅲ、Ⅳ期、B症状及T细胞型是影响PIL预后的独立不良因素(P<0.05).结论 PGL以DLBCL和MALT淋巴瘤为主,PIL则以DLBCL为主.PIL比PGL好发T细胞淋巴瘤,PIL中MALT淋巴瘤少见.PGL及PIL均以Ⅲ、Ⅳ期为主,PIL常因肠套叠或穿孔需急诊手术.PGL预后与分期有关,PIL预后与分期、B症状及T细胞型有关.

Abstract：

Objective To explore the differences and similarities of clinical characteristics,pathological features, treatment and prognosis between primary gastric lymphoma(PGL)and primary intestinal lymphoma (PIL). Methods The clinical characteristics, pathological features, therapeutic results, the detection of Helicobacter pylori (Hp) and prognosis of 48 PGL cases and 15 PIL cases were retrospectively analyzed. Results There was no statistical significance in age, gender, abdominal pain, gastrointestinal bleeding, B symptoms, clinical stage, mortality between PGL and PIL groups (P>0. 05). However, there were significant differences in the pathological type, acute abdomen emergency surgery between these two groups (P<0. 05). There was 12 Hp positive cases in mucosalassociated lymphoid tissue (MALT) lymphoma of PGL group (12/19), and 5 Hp positive cases in diffuse large B-cell lymphoma (DLBCL) (5/20). There was significant difference in Hp detection rate of these two pathological types. Hp was not found in PIL group. The Cox multivariate analysis indicated that stage Ⅲ-Ⅳ was the independent adverse factors affecting PGL prognosis (P<0. 05).Conclusions Mainly histological types are DLBCL and MALT lymphoma in PGL, and DLBCL in PIL.PIL predispose to T-cell lymphoma compared with PGL. MALT lymphoma is rare in PIL group. The mainly clinical stage is Ⅲ-Ⅳ both in PGL group and PIL group. Emergency surgery is often needed in PIL because of intussusception or perforation. The prognosis of PGL is correlated with the stage and the prognosis of PIL are correlated with the stage, B symptoms and T cell phenotype.     

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     

Clinical study of 31 patients with primary gastric mucosa-associated lymphoid tissue lymphoma

BACKGROUND: The purpose of the present paper was to investigate the clinical, endoscopic and histological features of 31 patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma to enable correct, early stage diagnosis. METHODS: A retrospective study was undertaken of 31 patients with gastric MALT lymphoma. The cases were examined immunohistologically with anti-CD(20CY) and CD(45RO) antibodies for further diagnosis. Helicobacter pylori infection was also detected with modified Giemsa staining. RESULTS: Patients with MALT lymphoma were aged between 22 and 73 years (mean, 45.0 years), and the male:female ratio was 11:20. The patients presented with non-specific symptoms, but chronic epigastric pain was the common symptom in a large proportion of the cases. The gastric smaller curvature was involved in 83.9% of cases (26/31) and in 13/31 cases (41.9%) it was confined the antrum. Under endoscopy, large and deep ulcers were similar to cancers in the majority of patients. Only 29.0% of patients were diagnosed by endoscopy on first examination. CD(20CY) were expressed in all cases and CD(45RO) expressed in only one case among 10 cases of indefinite diagnosis. Helicobacter pylori infection was found in 87.1% of patients. CONCLUSIONS: These findings suggest that primary gastric MALT lymphoma has unique clinical, endoscopic and histological features. The diagnosis for primary gastric MALT lymphoma was delayed not only due to the non-specific symptoms but also due to lack of attention to its features. Endoscopy and submucosal multiple biopsy were the principal diagnostic tools in patients with gastric MALT lymphoma. CD(20CY) and CD(45RO) immunological staining are recommended, especially for patients with indefinite diagnosis of gastric MALT lymphoma.     

MALT lymphoma of the small bowel with protein-losing enteropathy

Mucosa-associated lymphoid tissue (MALT) lymphoma usually arises from chronic inflammation. We herein report a case of small intestinal MALT lymphoma with protein-losing enteropathy (PLE). A 73-year-old woman presented with lower leg edema and severe hypoalbuminemia. She had a medical history of pylorus-preserving pancreaticoduodenectomy with Billroth II reconstruction. Oral and anal route double-balloon enteroscopies revealed irregular nodular mucosal lesions with erosion extending from the jejunum to terminal ileum. Histopathological evaluation of the biopsied mucosa showed proliferation of small-to-medium-sized lambda light chain-restricted B cells. Plasmacytic differentiation and lymphoepithelial lesions were present, leading to the diagnosis of MALT lymphoma. Tc-99m albumin scintigraphy indicated tracer exudation in the small bowel, suggesting the presence of PLE. Combination immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen improved both MALT lymphoma and PLE, whereas rituximab monotherapy was not successful. This case is considered to be common type of MALT lymphoma at an uncommon site and is distinct from immunoproliferative small intestinal disease (IPSID). To our knowledge, this is the first case of non-IPSID-type small intestinal MALT lymphoma complicated by PLE. Gastrointestinal reconstruction may be responsible for underlying chronic inflammation via small intestinal bacterial overgrowth.     

Primary non-Hodgkin lymphomas in the small and large intestine: clinicopathological characteristics and management of 40 patients

To investigate the clinicopathological characteristics and optimal treatment modalities of primary non-Hodgkin lymphoma (NHL) in the small and large intestine. Forty patients with primary NHL in the small and large intestine were studied retrospectively. All cases were reclassified according to the World Health Organization (WHO) classification of lymphoma in 2001. Fourteen patients had primary disease in the small intestine, which were all of B-cell origin with diffuse large B-cell lymphoma (DLBCL) diagnosed in 5 of 14 (35.7%) patients and mucosa-associated lymphoid tissue (MALT) lymphoma in 8 of 14 (57.1%) patients. Ileum was the most commonly involved site (8 of 14 patients, 57.1%), followed by jejunum (2 of 14 patients, 14.3%) and duodenum (1 of 14 patients, 7.1%). Twenty-five patients had primary colorectal lymphoma, with B-cell origin accounting for 92.0% and T-cell origin for 8.0% of these patients. The ileocaecal region has the highest involved rate (13 of 25 patients, 52.0%), followed by colon (7 of 25 patients, 28.0%) and rectum (3 of 25 patients, 12.0%). Compared with surgery alone, post-operation chemotherapy or chemoradiotherapy can significantly improve DLBCL patients’ event-free survival (EFS). However, no post-operation treatment modality can improve OS or EFS for patients with MALT lymphoma. B-cell lymphoma is the most common pathological type of intestinal lymphomas. Chemotherapy-containing treatment modality is an effective way to improve intestinal lymphoma patients’ EFS, especially for those with DLBCL subtype.     

35例原发性恶性胃淋巴瘤临床特点分析

原发性恶性胃淋巴瘤（PMGL）临床表现缺乏特异性，内镜和上消化道钡餐检查确诊率低。目的：了解PMGL的临床特点，以期早期诊断，早期治疗，改善预后。方法：回顾性分析上海仁济医院2000年9月～2006年2月收治的PMGL病例的病史资料。结果：共35例PMGL患者人选。主要消化道症状为上腹痛，伴全身症状者较少。内镜下溃疡型、弥漫浸润型和结节肿块型病变分别占67．7％、22．6％和9．7％，病变主要位于胃窦和胃体。内镜活检病理检查确诊率为54．5％。35例PMGL术后病理诊断均为B细胞性非霍奇金淋巴瘤，其中黏膜相关淋巴组织（MALT）淋巴瘤5例，弥漫性大B细胞淋巴瘤（DLBCL）26例，DLBCL合并MALT淋巴瘤（DLBCML）4例。患者预后与肿瘤病理类型、临床分期和血清乳酸脱氢酶（LDH）水平有关（P〈0．05）。术后3年生存率为81．8％。结论：PMGL患者局部表现严重而全身状况良好。内镜下病变大、范围广且多部位侵犯。多点取材或“挖洞式”活检可提高内镜诊断率。治疗方案的选择应根据肿瘤病理类型、临床分期和是否存在幽门螺杆菌感染而定。     

胃黏膜相关淋巴样组织淋巴瘤染色体易位t(11;18)与BCL10的表达

目的　检测胃黏膜相关淋巴样组织 (MALT)淋巴瘤的染色体易位t(11;18) (q2 1;q2 1)和BCL10蛋白表达的情况。方法　采用RT PCR检测胃MALT淋巴瘤和滤泡性胃炎 (FG)中API2 MLT融合及免疫组化检测BCL10蛋白、Ki 6 7表达情况 ,并结合临床病理进行分析。结果　 14例胃MALT淋巴瘤中有 3例 (2例低恶性 ,1例低～高恶性 )检测到API2 MLT融合 ,8例FG无此融合。BCL10在FG淋巴滤泡生发中心细胞胞质中弱表达 ,在胃MALT淋巴瘤中表达明显增强 ,且 4 2 .5 %的病例细胞核阳性。胃低～高恶性及弥漫大细胞淋巴瘤 (DLBCL)的Ki 6 7标记率显著强于低恶性MALT淋巴瘤 (P<0 .0 5 )。BCL10核表达与Ki 6 7阳性表达之间差异无显著性 (P >0 .0 5 ) ,但随Ki 6 7表达增强 ,BCL10核表达的概率增加。结论　API2 MLT融合和BCL10核表达可能与胃MALT淋巴瘤从低恶性向高恶性转化有关。RT PCR检测API2 MLT融合是检测t(11;18) (q2 1;q2 1)的一项重要工具