重视对胃黏膜相关淋巴组织淋巴瘤的研究

近 2 0年来 ,胃肠道非霍奇金淋巴瘤 (ＧＩ ＮＨＬ)的发病率显著增长 ,这一点已经引起人们的关注。其中胃黏膜相关淋巴组织 (ＭＡＬＴ)淋巴瘤占胃内淋巴瘤的 50 %以上。在正常胃黏膜内并无ＭＡＬＴ存在 ,而其免疫监视系统主要由散在Ｔ淋巴系统组成 ,其中以分布在上皮细胞内的ＣＤ 8Ｔ细胞为主 ,另外在固有膜内尚有少量ＣＤ 4 Ｔ细胞及ＣＤ 1Ｔ细胞。当黏膜表面存在某种抗原性刺激时 ,可引起ＣＤ 2 2 Ｂ淋巴细胞及ＫｉＭ 4滤泡树突细胞的聚集 ,因而形成黏膜内淋巴滤泡 ,称为获得性ＭＡＬＴ。而在扁桃体内、肠道Ｐｅｙｅｒ小结则为生理性ＭＡＬ…     

根除幽门螺杆菌对胃黏膜相关淋巴组织淋巴瘤疗效研究进展

胃黏膜相关淋巴组织(mucosa associated lymphoid tis-sue,MALT)淋巴瘤是原发于胃黏膜相关淋巴组织的一种B细胞淋巴瘤,由Isaacson和Wright首先于1983年提出,其组织学与小肠黏膜下淋巴集结(peyer s patch,PP)相似,而与外周淋巴结不同。1994年经修订后的欧美淋巴瘤分类法及1997年     

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。     

胃黏膜相关淋巴组织淋巴瘤的临床研究进展

胃黏膜相关淋巴组织淋巴瘤,即胃MALT(mucosa-associated lymphoid tissue,MALT)淋巴瘤是一种较为少见的胃恶性肿瘤,发病率约占恶性肿瘤的1%-5%.组织学类型主要是非霍奇金淋巴瘤(NHL),霍奇金淋巴瘤(HD)很少见.长期以来对其治疗问题一直存在很多争议.传统观点认为手术是治愈的最主要手段,但随着对幽门螺旋杆菌(H pylori)感染与该病发病机制的认识的提高,这一观念受到了不断冲击.本文对胃MALT淋巴瘤的治疗现状和进展作一综述.     

黏膜相关淋巴组织淋巴瘤61例临床分析

黏膜相关淋巴组织淋巴瘤 (简称ＭＡＬＴＬ)属淋巴结以外与黏膜组织相关的一种肿瘤性疾病。早期易误诊 ,其发病率有增高趋势 ,且临床缺乏特征性表现 ,与其他恶性肿瘤难以鉴别。为提高对该病的诊断和治疗的认识 ,我院自 1984年 1月至 1999年 6月期间收住的 6 1例ＭＡＬＴＬ的诊断和治疗及随访资料作回顾性分析。一、临床资料1 对象 :6 1例中男 41例 ,女 2 0例。年龄 7～ 84岁 ,中位年龄 6 1岁 ,均经病理确诊 ,其中 2 3例做了免疫组化检测。中位确诊时间 3 5个月。发病到确诊时间为 2 8ｄ至 30个月。2 肿瘤生长部位 :胃 17例 ,肠道 2 1例。鼻…     

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。     

早期胃黏膜相关淋巴组织淋巴瘤患者52例的临床分析

目的 探讨早期胃黏膜相关淋巴组织（MALT）淋巴瘤患者的临床特点及抗幽门螺旋杆菌（Hp）治疗和抗肿瘤治疗的疗效。方法 收集2003年4月至2013年5月在天津医科大学附属肿瘤医院确诊并治疗的早期胃MALT淋巴瘤患者52例的病例资料。对Hp感染的患者进行抗Hp治疗。对抗Hp治疗失败的患者进行抗肿瘤治疗。结果 52例早期胃MALT淋巴瘤患者中,Hp感染率为88.4%。抗Hp治疗的有效率为91.3%。18例患者进行抗肿瘤治疗,有效率为66.7%。52例患者5年的总生存率为92.3%,5年无疾病进展生存率为83.1%。结论 对于早期胃MALT淋巴瘤患者,抗Hp治疗是合理和有效的治疗方法。抗Hp治疗失败的患者应进行抗肿瘤治疗,从而使患者得到长久的获益。     

胃黏膜相关淋巴组织淋巴瘤1例

胃黏膜相关淋巴组织淋巴瘤临床表现不典型,诊断主要依靠病理活检,但因其内镜下表现不典型,易漏诊、误诊,临床工作中对于多发溃疡、糜烂灶需多点、深凿,必要时内镜下黏膜剥离切除,病理活检时需同时免疫组织化学,避免漏诊、误诊.     

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.     

Therapy of gastric mucosa associated lymphoid tissue lymphoma

Gastric mucosa associated lymphoid tissue （MALT） lymphoma has recently been incorporated into the World Health Organization （WHO） lymphoma classification, termed as extranodal marginal zone B-cell lymphoma of MALT-type. In about 90% of cases this lymphoma is associated with H pylori infection which has been dearly shown to play a causative role in lymphomagenesis. Although much knowledge has been gained in defining the clinical features, natural history, pathology, and molecular genetics of the disease in the last decade, the optimal treatment approach for gastric MALT lymphomas, especially locally advanced cases, is still evolving. In this review we focus on data for the therapeutic, stage dependent management of gastric MALT lymphoma. Hence, the role of eradication therapy, surgery, chemotherapy and radiotherapy is critically analyzed. Based on these data, we suggest a therapeutic algorithm that might help to better stratify patients for optimal treatment success.     

胃黏膜相关淋巴样组织瘤与幽门螺杆菌感染的相关性研究

目的 回顾分析胃黏膜相关淋巴组织（MALT）瘤与幽门螺杆菌（Hp)感染的相关性。方法 收集手术和病理理诊的消化道原发性非霍奇金淋巴瘤35例，行常规病理和免疫组化染色（CD3，CD5，CD10，CD20，CD23，CD45RO，Kappa,Lamda,Cyclinl,Ki67,TUNEL)重新作出病理学评价。同时观察Hp感染情况。结果 （1）MALT瘤共21例，其中胃MALT瘤16例，小肠1例，结肠4例。（2）胃MALT瘤中，除3例因切片均为癌组织无法判定有无Hp感染以外，余13例Hp均为阳性。（3）胃MALT瘤中，Ⅰ1期2例，Ⅱ1期5例，ⅡE期9例，（4）内镜误判为胃癌者3例，误判为巨大肥厚性胃炎者1例，误判为萎缩性胃炎者1例，诊断为慢性胃炎者5例，6例患者系胃镜活检确诊。（5）1例经3个疗程抗Hp治疗，病变完全消退，Hp转阴，经内镜及病理检查随访3年未见复发。结论 （1）胃MALT瘤与Hp感染关系密切，（2）抗Hp治疗可治愈早期MALT瘤。     

胃MALT淋巴瘤的形态特征及诊断

目的分析胃黏膜相关淋巴组织淋巴瘤的临床特点及内镜特征。方法收集2009年6月-2010年12月,我院经病理证实的17例胃MALT淋巴瘤患者的病史资料、内镜图像及病理资料进行回顾性分析。结果 17例患者中位年龄58.2岁,男女比例1.4∶1。临床症状无特异性,以上腹疼痛、饱胀不适最为常见。病灶范围较大,常累及胃体、胃窦部,形态上以溃疡样改变最为多见。首次胃镜活检病理检查确诊率为52.9%。幽门螺旋杆菌(H.pylori)感染率为78.6%。结论 MALT淋巴瘤的临床症状及内镜下表现无特异性,内镜下多点多方向活检、应用共聚焦激光显微内镜等导向活检、病理检查除常规HE染色外加做免疫组化或进一步行基因重排检测,有助于胃MALT淋巴瘤诊断。     

Primary gastric mucosa associated lymphoid tissue lymphoma： Clinical data predicted treatment outcome

AIM： To determine clinical characteristics and treatment outcome of gastric lymphoma after chemotherapy and immuno-chemotherapy. METHODS： Thirty four patients with primary gastric mucosa associated lymphoid tissue （MALT） lymphoma （Ann Arbor stages Ⅰ to Ⅳ） were enrolled. All had upper gastric endoscopy, abdominal ultrasonography, CT and H pylori status assessment （histology and serology）. After anti-H pylori treatment and initial chemotherapy, patients were re-examined every 4 mo. RESULTS： Histological regression of the lymphoma was complete in 22/34 （64.7%） and partial in 9 （26.5%） patients. Median follow up time for these 31 responders was 60 mo （range 48-120）. No regression was noted in 3 patients. Among the 25 （73.5%） H pylori positive patients, the eradication rate was 100%.CONCLUSION： Using univariate analysis, predictive factors for overall survival were international prognostic index （IPI） score, hemoglobin level, erythrocyte sedimentation rate （ESR）, and platelet numbers （P 〈 0.005）. In addition to this, Cox proportion hazard model differentiate IPI score, ESR, and platelets as predictors of survival.     

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     

Regression of idiopathic thrombocytopenic purpura after endoscopic mucosal resection of gastric mucosa associated lymphoid tissue lymphoma

Recent reports have suggested an association between Helicobacter pylori infection and both gastric mucosa associated lymphoid tissue (MALT) lymphoma and thrombocytopenic purpura. Although treatments eradicating H pylori lead to regression of these diseases in some cases, the exact mechanisms are still controversial. This case report describes a patient with thrombocytopenic purpura accompanied by an early stage gastric MALT lymphoma. Endoscopic mucosal resection of the lesion in this patient led to dramatic regression of thrombocytopenic purpura, and t(11;18)(q21;q21), which means resistance more likely to H pylori eradication therapy, was confirmed by fluorescence in situ hybridisation. There is no evidence of recurrence and his platelet count is within normal limits after 24 months of follow up. This is the first case report describing regression of thrombocytopenic purpura after mucosal resection of a gastric MALT lymphoma. We suggest that while some cases of thrombocytopenic purpura may be induced by H pylori, others may be due to an autoreactive antibody produced by MALT lymphoma B cells.     

Low grade gastric mucosa associated lymphoid tissue lymphoma：Treatment strategies based on 10 year follow-up

AIM: To deduce strategic guidelines of gastric mucosa associated lymphoid tissue lymphoma (MALTOMA) by evaluating the long-term outcome of patients in respect to various treatment modalities. METHODS: A total of 55 patients with MALTOMA from May 1992 to August 2002 were retrospectively reviewed. RESULTS: Complete remission was obtained in 24 (82.8%) of 29 patients treated with anti Helicobacter pylori (H pylori) regimen only. The duration to reach complete remission was 12 months (85 percentile, 2-33 months). Five patients showed complete remission with radiation therapy (26-86 months). Two of them were H pylori treatment failure cases. CONCLUSION: H pylori eradication is an effective primary treatment option for low grade MALTOMA and radiation therapy could be considered in patients with no evidence of H pylori infection or who do not respond to H pylori eradication therapy 12 months after successful eradication.     

Regression of gastric high grade mucosa associated lymphoid tissue (MALT) lymphoma after Helicobacter pylori eradication

BACKGROUND: Most low grade gastric lymphomas arising from the mucosa associated lymphoid tissue (MALT) are related to Helicobacter pylori colonisation. Cases with disease limited to the stomach can be cured after H pylori eradication and remain in remission for years. In contrast, high grade lymphomas of the stomach, although also related to H pylori, do not usually respond to eradication treatment. CASE REPORT: A 36 year old patient was referred from another hospital with a diagnosis of a low grade gastric MALT lymphoma associated with H pylori. The patient was in stage I and while waiting for the biopsies to be reviewed H pylori eradication therapy was given as the first step of treatment. Review of the biopsies showed a high grade immunoblastic lymphoma with areas of low grade gastric MALT lymphoma (high grade gastric MALT lymphoma or diffuse large B cell lymphoma with areas of MALT type lymphoma of the WHO classification). The patient received no further treatment but has been closely followed up for 32 months with sequential endoscopies to obtain biopsies for histological studies, H pylori cultures, and polymerase chain reaction analysis of the IgH gene. RESULTS: After H pylori eradication the patient had a complete histological response that has been maintained for 32 months. Monoclonal IgH gene rearrangement persisted for 32 months. CONCLUSION: The response of this patient indicates the possibility that some cases of high grade gastric MALT lymphoma (possibly patients in stage I with a superficial or limited disease) may still be responsive to H pylori antigenic drive and may be cured with eradication therapy. Prospective studies should be performed to identify patients with high grade gastric MALT lymphomas that may respond to eradication therapy and be spared of other more aggressive treatments.     

肺黏膜相关淋巴组织型淋巴瘤的临床诊断与分析

目的提高对肺黏膜相关淋巴组织型淋巴瘤（PMALT型淋巴瘤）的临床诊断水平。方法1998年6月至2006年6月经气管镜、经皮胸腔镜肺、胸膜及开胸肺活检证实的PMALT型淋巴瘤13例，对其临床表现、影像学等资料进行分析，并结合文献复习。结果13例中男9例，女4例；病程1．5．108个月，平均14个月；平均年龄55岁；临床症状相对较轻且缺乏特异性，部分病例仅在体检时发现，临床症状包括咳嗽、胸痛、胸闷、血痰、发热、体重减轻等；胸部影像学表现为多发性病变，以双侧多见（7／13）；病变形态多样，表现为块状影（2／13）及结节状影（2／13），致密的实变影内可见支气管充气征（9／13），可伴胸腔积液（4／13），气管镜下可见支气管狭窄和炎症（6／13）。结论PMALT型淋巴瘤发病率低，好发于中、老年男性，病情发展相对缓慢，临床症状相对较轻且缺乏特异性，胸部CT示致密的实变影，可见支气管充气征，尤其双侧病变，气管镜下可见支气管狭窄和炎症。经抗感染治疗后病灶未见吸收者应警惕本病的可能，尽可能行组织病理学检查。     

肺粘膜相关型淋巴瘤8例报告

目的　肺粘膜相关型淋巴瘤 (MALT型淋巴瘤 )虽是相对少见且临床诊断困难的肺部肿瘤 ,但老年人发病率较高 ,本文旨在引起临床医师对本病的重视。　 方法　利用 8例完整的临床、病理资料 ,结合文献 ,探讨肺MALT型淋巴瘤的诊断、病理特征、预后及治疗等问题。　 结果　①本组 8例均为肺低度恶性MALT型淋巴瘤。②临床上 8例病人均有吸烟、反复肺部感染等超常慢性免疫系统刺激因素存在。③肺MALT型淋巴瘤与肺炎性假瘤关系密切 ,需通过免疫组化等方法加以鉴别。　 结论 　①肺MALT型淋巴瘤的临床症状和影像学表现缺乏特异性 ,极易误诊 ,病理检查是该病确诊的金指标。②临床上凡遇肺部病灶诊断不明或炎性假瘤只要病人能承受手术 ,建议尽早手术切除。