肺黏膜相关淋巴组织淋巴瘤4例报道并文献复习

黏膜相关淋巴组织淋巴瘤（mucosa associated lymphoid tissue type lymphoma，MALT淋巴瘤）为来源于胃肠道及其他黏膜组织的低度恶性的B细胞淋巴瘤，多见于胃肠道，仅肺受累较少见。本文总结了北京协和医院1990年至今的肺MALT淋巴瘤的病例。     

肺黏膜相关淋巴组织淋巴瘤1例报告

黏膜相关淋巴组织(mucosa-associated lymphoid tissue MALT)淋巴瘤是属低度恶性B细胞性淋巴瘤,WHO将其确定为来自边缘区B细胞淋巴瘤.其临床表现、组织学特征、免疫表型、治疗及预后均与结内淋巴瘤不同,病变好发于淋巴组织丰富部位,多见于鼻腔及消化道,而原发于肺者很少见,极易误诊,现将我院诊治的肺黏膜相关淋巴组织淋巴瘤1例报告如下.     

肺原发性黏膜相关淋巴组织淋巴瘤一例并文献复习

肺原发性非霍奇金淋巴瘤是一种罕见恶性肿瘤,仅占所有恶性淋巴瘤的0.4%。黏膜相关淋巴组织（Mucosa-associated lymphoid tissue,MALT）淋巴瘤是肺非霍奇金淋巴瘤的主要类型,占70%-80%,因该病发病率低,临床表现不典型,易误诊为肺癌、肺结核、肺炎等延误治疗,即便得到确诊,亦缺乏标准治疗方案。     

脑膜原发黏膜相关淋巴组织淋巴瘤1例

1临床资料 患者,男性,56岁。2010年5月初无明显诱因出现间歇性头痛,6月3日凌晨4时患者头痛加重伴左侧手指麻木,随后出现四肢抽搐及意识障碍,并不慎跌倒,擦伤右额部,昏迷时间持续5 min,清醒后对当时情况记忆不清。     

气管黏膜相关淋巴组织淋巴瘤1例

<正>1病例资料患者,女性,62岁,反复闷喘近9个月,一直未进行任何检查及治疗。2016年10月开始逐渐加重,伴有渐进性呼吸困难,当地医院予对症处理,于2016年11月14日转诊至我院。该患者无发热、盗汗,无痰血、咯血等症状。体质量、食欲未出现明显下降。无合并其他基础疾病,无肿瘤家族史。常规血检未见明显异常,体格检查喘鸣音明显,听诊两肺无湿性啰音。胸部CT提示气管内软组织影,病变局限在上段气管,两肺和纵膈淋巴结未见异常。排除禁忌后,我院在局麻下急诊行气管镜检查,镜下见气管上段新生物沿膜部生长致管腔狭窄(狭窄约90%),瘤体基底部宽大,见图1。为了避免患者窒息,气管镜未     

原发性肺黏膜相关淋巴组织B细胞淋巴瘤临床病理分析

目的:研究肺原发性黏膜相关淋巴组织(MALT)B细胞淋巴瘤的临床病理特征、免疫组化及鉴别诊断。方法:对1例原发性肺黏膜相关淋巴组织结外边缘带B细胞型淋巴瘤进行组织病理学观察、免疫组化检测及文献复习。结果:镜下幼稚淋巴细胞弥漫性增生,主要由中心细胞样淋巴细胞组成,部分像小淋巴细胞,散在转化的中心母细胞及浆样细胞和成熟的浆细胞。瘤细胞浸润肺泡壁和支气管上皮形成淋巴上皮病变,并见反应性淋巴滤泡及瘤细胞侵蚀生发中心(滤泡植入)。免疫组化:CD20(+),CD5(-),CD45RO(-),CD10(-),CyclinD1(-),Cytoker-atin上皮(+),CD21(+)。结论肺原发性黏膜相关淋巴组织B细胞淋巴瘤是一种少见的低度恶性肿瘤,缺乏特异的临床表现,确诊有赖于组织病理学、免疫学检测,应与肺假性淋巴瘤、小淋巴细胞性淋巴瘤(SLL)、套细胞淋巴瘤(MCL)、淋巴浆细胞性淋巴瘤(LPL)等进行鉴别。     

非胃肠道的黏膜相关淋巴组织淋巴瘤48例临床分析

目的分析非胃肠道黏膜相关淋巴组织（MALT）淋巴瘤患者的临床特点,以提高临床诊断及治疗水平。方法回顾性分析北京协和医院2000年1月至2011年7月经病理证实明确诊断为非胃肠道MALT淋巴瘤的48例患者的资料。结果48例患者中男16例,女32例;诊断时的年龄为21～76岁,平均55．4岁。发病部位为肺23例,涎腺9例,甲状腺8例,眼及附属器3例,其他部位5例,同时发生于两个部位的5例。临床表现为无症状者27例,有非特异性全身症状者13例。实验室检查中,8例低中度贫血,6例乳酸脱氢酶水平升高,19例血沉加快。影像学检查提示20例淋巴结肿大。6例患者合并自身免性疫疾病,其中3例为涎腺病例。肺部受累患者确诊经支气管活检获得病理诊断3例,CT引导下经皮肺穿刺11例,外科肺活检9例。肺外受累患者确诊均经外科活检。23例肺部受累患者中,有1例未经处理,其余22例接受各种组合治疗（单纯手术3例,手术联合化疗6例,单纯化疗13例）;25例肺外受累患者中,11例患者接受单纯手术治疗,10例患者接受手术＋化疗联合治疗,3例接受单独的化疗,此外还有1例患者予以手术＋化疗＋放疗联合治疗。随访4—133个月。平均46．7个月,肺部受累患者1例死于肺部感染,1例死因不详,其余患者均病情平稳。结论非胃肠道MALT淋巴瘤常见于中老年女性,肺、涎腺和甲状腺为其好发部位,临床上多无明显症状或仅限于非特异性全身症状,部分合并自身免疫性疾病。CT引导下经皮穿刺肺活检和手术活检获取病理组织有助于明确诊断。本淋巴瘤的预后较好,部分患者可经外科手术治愈。     

黏膜相关淋巴样组织淋巴瘤与幽门螺杆菌

黏膜相关淋巴样组织(MALT)淋巴瘤是1983年Isaacson等首先提出的一种原发于淋巴结外的淋巴样组织恶性淋巴瘤，当时主要是指胃黏膜低度恶性的淋巴瘤。此后有直肠、肺、涎腺、甲状腺、眼眶等诸多部位MALT淋巴瘤的报道。     

肺黏膜相关淋巴组织型淋巴瘤5例误诊原因分析

目的探讨肺黏膜相关淋巴组织型淋巴瘤（PMALT型淋巴瘤）的误诊原因。方法回顾性分析5例经皮肺穿刺活检证实的PMALT型淋巴瘤的临床资料、影像学表现及误诊情况等,并结合文献复习进行误诊原因分析。结果5例临床表现无特异性,2例无症状为体检发现,另3例有咳嗽、胸闷、发热、胸痛。影像学表现多样,分为肿块型、肺实变型、结节型,病灶中可见空气支气管征。诊断需结合组织病理学、免疫组化和遗传学检测及生物学特性进行综合诊断。5例均误诊,误诊时间14d至5年不等。结论提高对该病的认识,及早获取组织病理标本,并结合临床作出综合诊断,可减少误诊。     

肾黏膜相关淋巴组织淋巴瘤大B细胞转化1例报告

黏膜相关淋巴组织（mucosa—associated lymphoid tissue,MALT）淋巴瘤是发生在淋巴结外的低度恶性B细胞淋巴瘤,可以转化为恶性度较高的淋巴瘤,其最常见原发部位为胃肠道,肾脏是MALT淋巴瘤极少发生的一个器官,本文对2010-03—15日收治的1例肾黏膜相关淋巴组织淋巴瘤大B细胞转化病例进行报告。     

Diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue lymphoma

Background Primary non-Hodgkin＇s lymphoma in lung is very rare, and the most common among them is mucosa-associated lymphoid tissue lymphoma （MALToma）, whose clinical features and laboratory characteristics are poorly defined, making diagnosis difficult. The purpose of this study was to study the diagnosis and treatment of pulmonary MALToma. Methods The clinical data of 12 patients treated for MALToma between August 1992 and December 2005 were analyzed. Results No specific symptoms or signs, or results of bronchoscopy, ultrasonagraphy or bone marrow examination could be found in the 12 patients. Only radiography was useful in diagnosis, though the final diagnosis of all the patients was based on histology and immunohistochemistry. Two patients also had gastric MALToma. Operations were performed on 6 patients, including 5 radical operations and 1 partial resection： 4 patients also received adjuvant chemotherapy. One patient experienced recurrence 152 months after the operation, while the other 5 patients have survived disease-free. Four patients were treated with chemotherapy alone, two of whom experienced complete remission and the others partial remission. The final 2 patients received no treatment and had survived for 7 and 27 months respectively. All the patients were still alive at the most recent follow-up, 7 to 160 months （mean 71.3 months）. Conclusions Except radiography, no specific clinical manifestations could be identified for pulmonary MALToma. The final diagnosis should be based on histology and immunohistochemistry. Several treatment methods can be used to achieve good outcomes.     

Cystic changes in mucosa-associated lymphoid tissue lymphoma of lung: a case report

Mucosa-associated lymphoid tissue （MALT） is a term .that describes lymphoid tissue in various sites of the body, such as the gastrointestinal tract, thyroid, breast, lung, salivary glands, eye, and skin. MALT lymphoma of the lung is a subset of primary pulmonary lymphomas which originates from the MALT. Previously reported computed tomographic （CT） features of MALT lymphoma are the presence of consolidation or nodules in the lungs. To our knowledge, however, there have been rare reports of MALT lymphoma of the lung which are manifested on CT as multifocal cystic structures. The purpose of this report is to present a case of MALT lymphoma which, on high resolution CT （HRCT） scan, manifested as bilateral multifocal cystic structures, and to correlate these findings with the histological findings.     

胃黏膜相关淋巴组织淋巴瘤20例临床分析

目的:提高临床医生对胃黏膜相关淋巴组织淋巴瘤诊治的认识。方法:回顾性分析20例胃黏膜相关淋巴组织淋巴瘤患者的临床症状、内镜检查、免疫学检查、病理组织学检查、治疗过程及随访结果等资料。结果:本组病例临床主要表现为上腹部不适、上腹痛、消化道出血、体重下降和食欲下降等;胃镜检查明确病灶位于胃窦部13例,胃体4例,胃底体3例;镜下观察呈黏膜隆起表面糜烂或溃疡(单个或多个)16例,弥漫浸润型3例,1例表现为巨大包块;16例患者采用手术治疗,1例未行手术或者放化疗,3例行单纯放化疗和抗幽门螺杆菌(Hp)治疗;随访1～10年,手术患者5年生存率为81.25%,未手术患者5年生存率为25.00%。结论:对于具备手术条件的胃黏膜相关淋巴组织淋巴瘤患者应尽早行手术治疗,可提高患者的生存率。     

胃肠道黏膜相关淋巴瘤27 例临床病理分析

目的探讨胃肠道黏膜相关淋巴瘤临床病理特点,为其诊断及治疗提供依据。方法分析27例淋巴瘤患者肿瘤组织标本的形态学特点,采用免疫组织化学SP法标记白细胞共同抗原(LCA)、CD20、CD79α、CD45RO、CD3、CD23、CD43、CK以及Ki-67。结果 27例淋巴瘤中胃17例(62.96%),回盲部5例(18.52%),乙状结肠3例(11.11%),空肠2例(7.40%)。组织学特点:瘤细胞为边缘区B细胞、单核样B细胞、多少不等的小淋巴细胞、浆细胞及转化的大细胞。淋巴上皮病变18例(66.67%),滤泡克隆化9例(33.33%)。LCA(+)、CD20(+)、CD79α(+)27例,Ki-67(+)25例,CD43(+)9例,CK腺上皮(+)27例,CD45RO(-)、CD3(-)、CD23(-)27例。结论胃肠道黏膜相关淋巴瘤为低度恶性淋巴瘤,病理诊断主要基于形态学,结合免疫组织化学有助于正确诊断和鉴别诊断。     

Clinical and prognostic characteristice of pulmonary mucosa-associated lymphoid tissue lymphoma:a retrospective analysis of 23 cases in a chinese population

Background Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is the most frequent type of non-Hodgkin's lymphoma (NHL) that primarily involves the lungs. It represents a rare entity accounting for less than 1%of all NHLs and the clinical features have yet to be clearly elucidated.Methods The clinicopathological features and radiological data of 23 patients with pulmonary MALT lymphoma confirmed by biopsy in Peking Union Medical College Hospital from January 2001 to December 2010 were retrospectively analyzed.Results At diagnosis,there were 15 women and 8 men. The median age was 55.1 years (range,37-73 years). One patient had a history of primary Sjoren's syndrome,another patient had a history of systemic lupus erythematosus (SLE)and secondary Sjoren's syndrome. One patient had a history of previous hematological malignancy (lymphomatoid papulosis in complete remission). In addition,one patient had simultaneous gastric and pulmonary involvement and one patient had simultaneous parotid gland and pulmonary involvement. The other 21 patients had disease localized within the lungs at the initial diagnosis. Among them,10 patients were asymptomatic while two had non-specific pulmonary symptoms. There were six patients with fever,four patients had low grade fever and two patients had moderate-high fever.The most common manifestations were cough (n=10),expectoration (n=8),exertional dyspnea (n=8),fatigue (n=7),body weight loss (n=6) and crackles (n=6). Blood tests showed low to moderate anemia in six cases,elevated erythrocyte semimentation rate (ESR) in 10 cases and only one patient had elevated lactate dehydrogenase (LDH). High resolution computed tomography (HRCT) of the chest revealed bilateral disease in 13 patients,air space consolidation with or without air bronchogram in 15 patients,lung nodules in 15 patients,patchy opacities in eight patients,lung mass in three patients and pleural effusion in five patients. Flexible fiberoptic bronchoscopy showed multiple nodules in five patients and almost normal morphology in 18 patients. Pathological diagnosis was obtained by bronchial biopsies in three cases,by CT-guided percutaneous lung biopsies in 11 cases and by surgical biopsies in nine cases. Of the 23 patients,one remained untreated,while 22 received various combinations of treatment (surgery alone in three patients,surgery plus chemotherapy in six patients,and chemotherapy alone in 13 patients). Twenty-one patients remained alive during the median follow-up of 23 (0.25-84) months,while one patient died from unknown causes,one patient died from lung infection.Conclusions Pulmonary MALT lymphoma tends to occur in old-aged females and to be limited to the lungs on the initial diagnosis and LDH's level was normal in most patients. Lung nodules,patchy opacities and air space consolidation     

Tracheal stenting for primary tracheal mucosa-associated lymphoid tissue lymphoma

Primary tracheal mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a 49-year-old female patient with the complaint of dyspnea. Fiberoptic bronchoscopy showed polypoid, variable-sized and irregular nodules causing narrowing of the tracheal lumen from the proximal trachea to the left main bronchus. Because of severe stenosis in the airway and the severity of symptoms, this case was unresectable. The patient was then treated successfully with placement of an endobronchial stent through bronchofibroscopy. After the placement of the stent, bronchoscopic biopsy was performed. Pathological analysis confirms a diagnosis of MALT-associated malignant lymphoma. We performed systemic chemotherapy on the patient. The temporary stent was removed after the reduction of the stenosis. This is the first case in which tracheal MALT lymphoma was treated successfully following tracheal stent insertion guided by bronchofibroscopy. Temporary tracheal stenting can be a favorable choice for a patient with tracheal stenosis caused by primary tracheal MALT lymphoma.     

胃黏膜相关淋巴组织淋巴瘤40例内镜下表现分析

[目的]探讨胃黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤内镜下表现特征,以提高早期诊断水平.[方法]总结40例经内镜及手术病理确诊的胃MALT淋巴瘤患者的内镜下表现资料.[结果]病变多位于胃窦部、胃体部,累及多部位者25例(62.5%),表现为溃疡型、隆起型、...     

涎腺淋巴瘤临床与病理研究

目的　探讨涎腺粘膜淋巴瘤的病理诊断特征及发病机理。方法　分析临床资料 ,利用HE染色 ,白细胞共同抗原、CD2 0、CD4 5RO、上皮膜抗原的SP法免疫组化及电镜观察32例涎腺粘膜淋巴瘤。结果　男性 2 7例 ,女性 5例 ,平均年龄 54 76岁 ,其中腮腺 17例 ,颌下腺 15例。涎腺粘膜淋巴瘤是由弥漫性中心细胞样 (CCL)细胞组成 ,并有“淋巴上皮病变”。免疫组化 :CCL细胞CD2 0阳性、CD4 5RO阴性。电镜下瘤细胞圆形 ,高核浆比 ,胞浆内少量溶酶体和免疫球蛋白的颗粒 ,无胞质丝 ,无细胞外基膜 ,无细胞间连接。随访 :存活 5年以上者 9例 ,3～ 4年者 5例 ,不足 1年 6例 ,3例死亡。结论　大多数涎腺粘膜淋巴瘤为低度恶性 ,瘤细胞有“回归”现象 ,治疗以手术加化疗为主 ,少数可转变为高度恶性 ,预后差。自身免疫性疾病和 或感染可导致机体产生获得性涎腺粘膜淋巴瘤 ,并在持续性刺激下发展为涎腺肌上皮炎 ,进而转变为涎腺粘膜淋巴瘤。     

Clinicopathologic study of mucosa-associated lymphoid tissue lymphoma of the salivary gland

Objective　To study the histopathologic features and pathogenesis of mucosa-associated lymphoid tissue lymphoma (MALT-oma) of salivary glands. Methods　Clinical data, paraffin-embedded sections, immunohistochemical slides (SP method) and electron microscopic features of surgical specimens of 32 cases of salivary gland MALT-oma were studied. Results　The patients were 27 males and 5 females, with a mean age of 54.76 years. The lesions were located in the parotid area in 17 cases, and in the submandibular gland in the remaining 15 cases. Much of the MALT-oma was replaced by infiltration of a great amount of centrocyte-like cells (CCL) as background and occasional large cells (centroblast- or immunoblast-like). In MALT-omas “lymphoepithelial lesions' were present. Immunohistochemically, CD20 expression was found to be positive and CD45RO expression was negative in all MALT-omas. Conclusion　Most of the MALT-omas are low grade malignant tumors and have a “homing back' phenomenon. The cases were managed by surgery and chemotherapy. In a few MALT- omas which turned into high grade malignant tumors, the prognosis was poor. Acquired MALT may develop as a reaction to autoimmune disease and infection. Hyper-immune reaction and MALT hyperplasia under stimulation may result in myoepithelial sialadenitis and lead to MALT-oma of the salivary gland.     

胃黏膜相关淋巴组织淋巴瘤的临床治疗观察

目的:提高对胃黏膜相关淋巴组织(MALT)淋巴瘤的认识和诊疗水平,提高治愈率。方法:回顾性总结我院10年间115例胃黏膜相关淋巴组织淋巴瘤资料,手术标本重新病理诊断,明确分期诊断,并进行追踪随访。结果:98例经手术治疗,17例内科非手术治疗,患者胃MALT淋巴瘤的病变累计范围较广,胃窦、胃体、小弯侧多见形态多样,腹腔淋巴结易受累。病理属低度恶性,预后良好。结论:胃MALT淋巴瘤是一类新型淋巴瘤,与幽门螺旋菌感染有关,预后较好,生存期可延长。