眼眶原发性MALT淋巴瘤临床病理观察

目的 探讨眼眶原发性黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤)临床病理特点及影响预后因素。方法 复习7例眼眶原发性MALT淋巴瘤临床病理资料及病理切片,并用免疫组化S—P法重新标记瘤细胞。结果 5例位于泪腺及结膜,2例位于眼肌,7例均为IE期。瘤细胞以边缘区B细胞为主,混有少量浆细胞及母细胞化的淋巴细胞。位于泪腺及结膜者可见淋巴上皮病变及生发中心植入现象。瘤细胞表达CD45、CD20、IgM、bcl-2及单一的轻链,CD3、CD5、CD10、cyclin D1、CK均阴性。7例均作手术治疗;1例辅以放疗,2例结合化疗。7例随访4～139个月,均存活。结论 眼眶原发性MALT淋巴瘤好发于泪腺及结膜,预后与临床分期有关,与治疗方法关系不大。     

肺黏膜相关淋巴组织边缘区B细胞淋巴瘤及良性淋巴组织增生性疾病的临床病理分析

目的 研究肺原发性黏膜相关淋巴组织边缘区B细胞(MALT)淋巴瘤及良性淋巴组织增生性疾病的临床病理形态、免疫组织化学表型和B细胞重链基因重排,比较肺MALT淋巴瘤和良性淋巴组织增生性疾病的差异.方法 回顾性的分析原发性肺MALT淋巴瘤13例,7例肺良性淋巴组织增生性疾病资料.对标本行常规HE染色,EnVision免疫组织化学染色(抗体包括AE1/AE3、CD20、CD79α、CD3、CD5、CD10、CD21、bel-2、bcl-6、cyclinD-1)及免疫球蛋白重链IgH基因重排检测.结果 13例肺MALT淋巴瘤,细胞成分多样,分别由不同比例的小淋巴细胞样细胞、中心细胞样细胞、单核样B细胞组成,常伴有浆细胞分化.肿瘤细胞以弥漫性和滤泡边缘区排列为主,常见反应性淋巴滤泡和滤泡中心的植入.肿瘤细胞呈串珠状直接侵犯肺泡间隔和沿支气管血管束向周边及肺膜扩散.MALT淋巴瘤中,均未见坏死.9例可见肿瘤细胞侵犯血管壁,6例可见胸膜累及,2例肺门淋巴结侵犯.9例肺MALT淋巴瘤可见淋巴上皮样病变,免疫组织化学显示上皮细胞内的淋巴细胞CD20阳性,CD3阴性.7例肺良性淋巴组织增生性疾病,2例可见淋巴上皮样病变,免疫组织化学显示,其淋巴上皮样病变内的淋巴细胞,部分CD20阳性,部分CD3阳性.9例肺MALT淋巴瘤进行了免疫球蛋白重链IgH基因重排,8例阳性;7例良性淋巴组织增生性疾病均为阴性.结论 肺MALT淋巴瘤在细胞组成和排列上与其他部位结外MALT淋巴瘤相同,肿瘤细胞呈串珠状直接侵犯肺泡间隔和沿支气管血管束向周边及肺膜扩散.在肺内淋巴上皮样病变常见于MALT淋巴瘤,并有助于诊断,但并非其特异性病变,一些肺的反应性淋巴组织增生也可出现,用免疫组织化学有助于区别两种病变.免疫球蛋白重链IgH基因重排可以帮助鉴别肺MALT淋巴瘤和良性淋巴组织增生性疾病.     

肺霍奇金淋巴瘤1例

患者,女,30岁,顺族,咳嗽伴胸痛4个月、痰中带血2周就诊。X线及CT发现左肺上叶6．3cm×6．5cm的占他性病变,B超发现腹腔有数个肿大的淋巴结,直径0．6～1．2cm。支气管镜检查见左肺上叶前支狭窄,支口有白色结节生长。质脆易出血。取局部组织活检,见纤维组织中有急慢性炎细胞浸润。临床怀疑为肺癌,遂行开胸探查、左肺上叶切除术。[第一段]     

原发性骨非霍奇金淋巴瘤23例临床病理分析

目的探讨原发性骨非霍奇金淋巴瘤的临床病理特点、临床预后指标及Pax-5蛋白表达的诊断价值。方法复习23例骨非霍奇金淋巴瘤患者的临床资料,对血清LDH、国际预后指数及治疗与预后的关系进行分析。并用EnVision两步法标记Pax-5,比较BSAP与CD20及CD79α的表达情况。结果23骨非霍奇金淋巴瘤均为B细胞淋巴瘤,其中22例患者的5年生存率为65．9％,血清LDH升高、国际预后指数高危类对预后不利（两者P值分别为0.02和0.01）。23例中有22例表达Pax-5,Pax-5与CD20及CD79α的表达差异无统计学意义。结论骨非霍奇金淋巴瘤以B细胞淋巴瘤多见,预后较好,血清LDH和国际预后指数是判断预后的指标。Pax-5可应用于原发性骨非霍奇金淋巴瘤的诊断。     

原发性胃肠道非霍奇金淋巴瘤36例临床分析

目的 探讨原发性胃肠道非霍奇金淋巴瘤（PGINHL）的临床特征及治疗策略。方法 收集内镜活检或手术病理组织学证实的PGI NHL 36例临床资料，回顾性分析其临床特点以及影响生存期的因素。结果 PGI NHL发生于胃部者占61．11％（23／38），粘膜表面呈肿块结节是PGI NHL最常见内镜表现，占62．5％（20／32），ⅠE-ⅡE期占67．13％（26／36），B细胞淋巴瘤28例，占89．47％，其中MALT型结外边缘区B细胞淋巴瘤20例。本组采用手术及术后联合化疗，3-5年总生存率分别为84．4％和62．5％，其中ⅠE-ⅡE期患者3-5年总生存率分别为91．3％和70％，显著高于ⅢE-ⅣE期患者（P〈0．01）。B细胞淋巴瘤3-5年总生存率分别为96％和66、7％，显著高于T细胞淋巴瘤（P〈0．05）。其中HP（幽门螺杆菌）根除治疗MALT型结外边缘区B细胞淋巴瘤8例5年全部存活。结论 PGI NHL临床表现无特异性，容易误诊，胃部发生率最高，临床分期以ⅠE-ⅡE为主，病理分型以B细胞性为主，其临床分期和组织病理学类型是影响疗效和预后的重要因素，HP根除治疗有助于胃MALT淋巴瘤临床缓解。     

原发性骨非霍奇金淋巴瘤临床病理预后和病因学分析

目的探讨原发性骨非霍奇金淋巴瘤（PNHLB）的临床病理特征、预后指标及病因学。方法复习17例PNHLB患者的临床资料,同时进行免疫组织化学EnVision法检测免疫标志物、原位杂交检测EBER及PCR检测bcl-2／JH基因重排,并对血清LDH、治疗、国际预后指数（IPI）、免疫标志物与预后的关系进行分析。结果17例PNHLB以弥漫性大B细胞淋巴瘤为主（94．1％）,患者的5年生存率为68．8％,IPI高危类、bcl-2过表达对预后不利（2者的P值分别为0．031和0．028）,治疗方式和CD10、MUM-1、bcl-6的表达对预后的判断差异无统计学意义（P〉0．05）。8例人类B-珠蛋白基因扩增阳性的骨DLBCL患者中1例Bcl-2／JH基因重排扩增阳性。EBER原位杂交仅1例阳性。结论PNHLB预后较好,IPI及免疫组织化学检测bcl-2过表达是判断预后的指标。EB病毒与病因无相关性。     

原发性甲状腺非霍奇金淋巴瘤12例临床病理分析

目的探讨原发性甲状腺非霍奇金淋巴瘤(primary thyroid non-Hodgkin’s lymphoma,PTNHL)的临床病理特征、诊断及鉴别诊断。方法回顾性分析2010～2018年诊断的12例PTNHL的临床病理特征、免疫表型,并复习相关文献。结果所有病例均经术后病理及免疫组化染色确诊,其中男性3例,女性9例,平均发病年龄56. 7岁; 10例伴淋巴细胞性/桥本甲状腺炎背景; 12例均为B细胞淋巴瘤,8例病理类型为弥漫大B细胞淋巴瘤,4例病理类型为黏膜相关淋巴组织结外边缘区淋巴瘤,其中1例伴大细胞转化; 3例浸润甲状腺周围组织,1例伴颈部淋巴结受侵;免疫表型:瘤细胞均表达CD20和CD79a等B细胞标记,不表达CKpan、TG、EMA等甲状腺滤泡上皮标记。结论 PTNHL临床罕见,好发于老年女性,病理类型均为B细胞来源,多伴淋巴细胞性/桥本甲状腺炎背景,临床表现缺乏特异性,确诊依赖术后病理检查及免疫组化染色结果。     

10例子宫原发性非霍奇金淋巴瘤的临床病理分析

目的:探讨子宫原发性非霍奇金淋巴瘤的临床病理表现、免疫表型及对该类肿瘤的诊断及治疗。方法:临床资料回顾性分析。结果:患者平均年龄45.6岁,以无痛性盆腔包块、接触性出血、阴道出血和/或白带增多为其主要临床表现;IE期3例,IIE期2例,IIIE期4例,ⅣE期1例;病理类型上属非霍奇金淋巴瘤,弥漫性大B细胞淋巴瘤8例,非特指外周T细胞淋巴瘤2例;所有患者均接受了手术治疗,2例行手术 化疗、8例手术 放化疗。结论:该类肿瘤的确诊依赖于病理活检,综合治疗为首选治疗方案。     

胃淋巴瘤临床病理分析

目的探讨胃淋巴瘤的临床病理特点及预后相关因素。方法结合2001年版WHO关于淋巴造血组织肿瘤的分类标准,回顾83例胃淋巴瘤临床及病理资料,对其中78例进行随访,随访时间5～192个月。对临床病理特征及治疗方式等多种因素与生存率进行比较分析。结果(1)临床表现：临床症状以腹痛最多见,83例胃淋巴瘤中有60例(72％);39例(47％)有B症状(发热、盗汗、消瘦);21例(25％)有长期慢性胃病史;胃肠黏膜多部位病变13例(16％);淋巴结受累51例(61％)。(2)组织学类型：黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT淋巴瘤)为57例(69％),弥漫大B细胞淋巴瘤合并MALT淋巴瘤23例(28％),弥漫大B细胞淋巴瘤2例(2％),滤泡性淋巴瘤1例(1％)。(3)临床分期与生存率：临床ⅠE期31例,ⅡE期38例,ⅢE期8例,Ⅳ期6例。总5年和10年生存率分别为77．8％和70．1％,平均生存期146个月。MALT淋巴瘤的5、10年生存率分别为77．4％和72．3％,弥漫大B细胞淋巴瘤合并MALT淋巴瘤的5、10年生存率分别为81．8％和68．2％,弥漫大B细胞淋巴瘤的5年生存率为50．0％。结论胃淋巴瘤患者无特异临床症状。MALT淋巴瘤是最常见的病理组织学类型。胃淋巴瘤病变可长期局限,预后较好。患者生存率与淋巴结受累、临床分期密切相关,与发病年龄、性别、有无B症状、病变深度及范围和治疗方式等因素均不相关。     

胸腺原发黏膜相关淋巴组织淋巴瘤及淋巴上皮性涎腺炎样胸腺增生的临床病理分析

目的探讨胸腺原发黏膜相关淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤和淋巴上皮性涎腺炎(lymphoepithelial sialadenitis,LESA)样胸腺增生的临床病理学特征、两者相关性及鉴别诊断。方法分析3例胸腺MALT淋巴瘤和1例LESA样胸腺增生的临床病理学和免疫表型特征,并复习相关文献。结果 3例胸腺MALT淋巴瘤,其中2例伴Sj9gren综合征;镜下胸腺正常结构损毁,增生的淋巴滤泡间可见肿瘤性淋巴样细胞浸润伴明显的淋巴上皮病变,以中心细胞样和单核样B细胞形态为主。瘤细胞表达CD20、PAX-5和BCL-2,其中1例伴显著浆细胞分化者Lambda轻链限制性表达。3例胸腺MALT淋巴瘤免疫球蛋白(immunoglobulin,Ig)基因检测均示单克隆性重排。LESA样胸腺增生镜下胸腺分叶状结构大体尚存,可见包含增生滤泡的丰富淋巴细胞浸润,胸腺上皮增生伴显著淋巴上皮病变,未见有单核样B细胞形态。免疫组化染色示增生淋巴组织由B和T细胞混合;Ig基因重排检测示多克隆性增生。结论 LESA样胸腺增生和胸腺MALT淋巴瘤均是胸腺少见的淋巴增生性病变,两者具有相似的组织学和免疫表型特征;结合基因重排技术详细分析两者的鉴别要点,有助于鉴别。     

From lymphocytic interstitial pneumonia to MALT lymphoma of lung: a case report with a 5-year diagnostic dilemma

Lymphocytic interstitial pneumonia (LIP) and mucosa-associated lymphoid tissue (MALT) lymphoma of lung are all uncommon disorders of respiratory system. MALT lymphoma of lung is a distinct and unique subtype of marginal zone B-cell non-Hodgkin’s lymphoma (NHL) characterized by malignant cells arising from extranodal sites. They are characteristic of exuberant lymphoid infiltration in pathological tissue. Therefore, in some cases, they are too similar in clinical manifestation, chest imaging and pathology to make differential diagnosis. Here, we report a 43-year-old woman who underwent a tough process for the final diagnosis. From this case, we could get a well understanding of difference between LIP and MALT lymphoma of lung.     

Plasmablastic lymphoma following combination treatment with fludarabine and rituximab for nongastric mucosa-associated lymphoid tissue lymphoma: a case report and review of literature

Plasmablastic lymphoma (PBL) is an uncommon malignancy which predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients. Sporadic cases have been published describing PBL in immunocompetent patients as well as in immunodeficient patients following immunosuppressive therapy or transplantation. We hereby reported a case of PBL in a 69-year-old, HIV-negative male subjected to combination treatment with fludarabine and rituximab for nongastric mucosa-associated lymphoid tissue (MALT) lymphoma. The diagnosis of PBL was made with tumor cells of immunoblasts or plasmablasts morphology strongly positive for MUM-1, EMA and CD138, and partly positive for CD38, and negative for CD20, BCL-6, and CD56, and approximately 80% of which were positive for Ki-67. The case presented PBL after MALT, and a history of chemotherapy including fludarabine and rituximab led to the potential immunocompromised state. The patient died 5 months after the diagnosis of PBL.     

A solitary minute thyroid lymphoma of MALT-type without lymphoid thyroiditis

Most of the primary thyroid malignant lymphomas have been considered of mucosa-associated lymphoid tissue (MALT) type and arise from lymphocytic thyroiditis. We report an uncommon case of a 67-yr-old man who underwent total thyroidectomy for multinodular goiter with tracheal compression. At histopathologic examination, we discovered a minute (3-mm diameter) lesion of low-grade thyroid lymphoma of MALT type without any lymphocytic thyroiditis lesion on 33 section levels of the entire thyroid gland. No general inflammatory, autoimmune, or lymphomatous disorder has been evidenced both at staging and after 30 mo of follow-up. MALT-type low-grade lymphoma may, in some instances, develop de novo within the thyroid without an antecedent MALT-type lymphoma.     

Non-Hodgkin's lymphoma arising in adenolymphoma--a report of two cases

Two cases of follicle centre cell lymphoma, apparently arising within adenolymphomas of the parotid gland, are reported. These are discussed in relation to the histogenesis of adenolymphoma and their possible relationship to mucosa-associated lymphoid tissue.     

A reassessment of primary thyroid lymphoma: high-grade MALT-type lymphoma as a distinct subtype of diffuse large B-cell lymphoma

AIMS: Primary lymphoma of the thyroid gland (PTL) is a relatively rare disease. During an 18-year period, 53 cases of primary non-Hodgkin's lymphoma involving this extranodal site were seen at our institutions. The aims of this study were to evaluate the spectrum of PTLs using current lymphoma classification concepts and immunocytochemical markers, determine whether features of MALT-type lymphoma were evident in PTL, and if there was any clinical significance of such a finding. METHODS AND RESULTS: The cases were retrospectively studied clinically, histologically and immunohistochemically. The tumours were classified according to the Revised European-American Lymphoma Classification of lymphoid malignancies (REAL classification). Thirty-eight patients were females, 15 were males and mean age at diagnosis was 66.3 years (range 38-90). Three cases were low-grade marginal zone lymphomas (low-grade MALT-type lymphomas). There were 45 diffuse large B-cell lymphomas (DLBCL) of which there were 27 DLBCL-NOS and 18 high-grade MALT-type lymphomas. Within the diffuse large B-cell lymphoma (DLBCL) category, cases were subdivided into those without (DLBCL-NOS) and those with features of 'high-grade' MALT-type lymphoma based on presence of a low-grade component or large cell lymphoepithelial lesions (HG MALT-type lymphoma). In addition there were three follicle centre lymphomas, one anaplastic large cell lymphoma and one peripheral T-cell lymphoma. Twenty cases were stage IE, 18 stage IIE, and four stage IV. All patients with low-grade MALT-type lymphoma are alive without disease. The 5-year survivals for DLBCL-NOS and HG MALT-type lymphoma were 75% and 25%, respectively. Univariate analysis (log rank) among the DLBCLs showed stage (P < 0.001) and subtype (P = 0.005) were associated with survival. Stage was associated with type of DLBCL, 65% of DLBCL-NOS being stage IE compared to 20% of HG MALT-type lymphomas. CONCLUSIONS: We conclude that primary thyroid lymphomas occur most commonly in elderly women and are frequently present in clinical stage IE and IIE. Low-grade MALT-type lymphomas are relatively uncommon but appear to have a favourable prognosis. DLBCL is the most common lymphoma and features of MALT can be seen in over one-third of cases. As a group, HG MALT-type lymphomas had a worse outcome than DLBCL-NOS, primarily due to higher clinical stage at diagnosis. These two subtypes of DLBCL appear to be distinct clinical and histological entities.     

75例原发性胃肠道淋巴瘤的临床病理分析

目的:探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphoma,PGIL)的临床特点、诊断、病理特征和治疗.方法:收集2011年1月至2017年1月就诊于武汉大学人民医院75例PGIL患者的临床及病理资料,并进行回顾性分析.结果:75例PGIL患者的男女性别比为1.5:1,年龄(56.96±14.51)岁,其中43例(57.33％)患者以腹部隐痛为主要症状.51例(68.00％)患者CEA升高,17例(32.69％)患者行大便隐血试验(+).胃镜/肠镜诊断阳性率为74.58％.9例直肠淋巴瘤患者之中,有5例直肠指诊阳性,直肠指诊的阳性率为55.56％.75例PGIL患者均已行病理检查,45例弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL),13例黏膜组织相关淋巴瘤黏膜组织相关淋巴瘤(mucosa-associated lymphoid tissue,MALT),6例间变性大细胞淋巴瘤(anaplastic large cell lymphoma,ALCL),4例外周T细胞淋巴瘤(peripheral T-cell lymphoma,PTCL),7例为其它病理类型.按照Ann Arbor标准分期,ⅠE期7例(9.33％),ⅡE期25例(33.33％,ⅢE 11例(14.67％),IVE期32例(42.67％).41例患者行CHOP化疗方案,12例患者行R-CHOP化疗方案,3例行手术治疗,19例患者放弃治疗.结论:PGIL好发于中老年男性,临床症状以腹痛为主,确诊主要依靠内镜下活检,内镜下诊断不明确的患者可行腹腔探查术明确诊断.CEA、大便隐血试验对PGIL的辅助诊断有一定价值,而直肠指诊对直肠淋巴瘤的初诊有重要意义.早期PGIL患者以PGL多见,而中晚期PGIL患者以PIL多见.病理类型以DLBCL和MALT为主.DLBCL型PGIL治疗首选CHOP/R-CHOP,MALT型PGIL患者首选HP根除疗法,手术适用于PGIL的并发症治疗.     

Primary malignant lymphoma of the thyroid-a tumour of mucosa-associated lymphoid tissue: review of seventy-six cases

Seventy-six cases of primary thyroid lymphoma have been reviewed employing the Kiel classification. These lymphomas are almost entirely of follicle centre cell origin, occur predominantly in elderly females, and are frequently associated with lymphocytic thyroiditis or Hashimoto's disease. The overall prognosis is variable, with long-term survival in a substantial number of cases following thyroidectomy and radiotherapy. Results of histological examination including immunoperoxidase studies are described. It is proposed that thyroid lymphoma represents a neoplasm of mucosa-associated lymphoid tissue (MALT), and the implications of this are discussed.     

胆囊粘膜相关型淋巴瘤4例临床病理观察及文献复习

目的：探讨胆囊粘膜相关型淋巴瘤的诊断、鉴别诊断及其发病机制。方法：手术切除标本常规石蜡切片和免疫组化ＡＢＣ法标记。结果：４例胆囊ＭＡＬＴ－ＭＬ均 反应性滤泡。免疫表型：４例ＬＣＡ、Ｌ２６均呈阳性ＩｇＭ／ｋ３例,ＩｇＧ／λ１例,ｂｃｌ－２阳性３例。结论：胆囊ＭＡＬＴ－ＭＬ大多为低度恶性,以手术治疗为主。临床应积极控制胆囊慢性炎性病变,防止产生获得性ＭＡＬＴ,进一步发展为ＭＡＬＴ－ＭＬ。     

Primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma with polypoid appearance. Polypoid gastric MALT lymphoma: A clinicopathologic study of eight cases

In the current study, we report eight cases with primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma endoscopically characterized by polypoid lesions in order to highlight their clinicopathologic significance. Four patients were male, their ages ranging from 40 to 78 years old. The resected specimens revealed a histology of low-grade MALT lymphoma characterized by dense lymphocytic infiltration predominantly in the submucosa and a relatively monotonous proliferation of centrocyte-like cells with reactive follicles and infrequent lymphoepithelial lesions. The tumor cells were of CD5-, CD10-, CD20+, BCL2+ and cycline D1- phenotype, and showed a monoclonal rearrangement of immunoglobulin heavy chain genes in the five of six cases examined. Interestingly, Helicobacter pylori (H. pylori) was detected in three (37.5%) of the eight patients, which was significantly lower than previous reports. Two of the H. pylori-positive cases initially underwent H. pylori eradication, but showed no change in their lymphomas after the cure of H. pylori infection. The clinicopathologic findings of the present cases appeared to closely resemble those of colorectal MALT lymphoma with a polypoid appearance and few association of H. pylori infection in their pathogenesis. These gastric polypoid cases may merit separate consideration because of the therapeutic problems they pose.