胃粘膜相关淋巴组织淋巴瘤的内镜和病理特点

目的 探讨胃粘膜相关淋巴组织（MALT）淋巴瘤的内镜和病理特点，以提高其在内镜下的确诊率。方法 回顾性结合部分前瞻性分析28例患者。结果 胃MALT淋巴瘤多见于40－60岁患者，确诊病程的中位数为8．5月。临床症状无特异性，抗酸剂治疗无效，25％可引起上消化道出血。Hp感染率为78．6％，10．7％患者的CA125可升高，17．9％患者的ESR升高。高度恶性者可发生浸润或转移。肿瘤多位于胃体下段和／或胃窦部，占96．4％，75％表现为单个或多人浅表性溃疡，质地偏硬，但大部分患者的粘膜尚可稍提起，少见的病变有稍隆起性、糜烂和坏死性病变。胃镜下形态诊断的误诊率为89．3％。胃镜下常规活检组织病理检查，恶性疾病漏诊率为57．1％，而胃MALT淋巴国漏诊率为82．1％，术后病理检查确诊率达100％。深而大的活检和免疫组织化学检查有助于确诊。B细胞淋巴瘤占88．9％，T细胞淋巴瘤占11．1％。结论 胃MALT淋巴瘤是一类独特的原发性胃淋巴瘤，具有一定的病理和内镜特点。

Analysis of endoscopic and pathological features of patients with gastric mucosa - associated lym-phoid tissue lymphoma

Objective To investigate the endoscopic and pathological features of gastric mucosa associated lymphoid tissue (MALT) lymphoma. Methods Twenty - eight patients were analyzed retro - spectively and/or prospectively. Results MALT were common at the age of 40 -60. Median cource from prespentation of signs to accurate diagnosis was 8. 5 months. No specific clinical presentations and ineffetive in anti - acid drugs treatment The upper gastrointestinal bleeding occurred in 25% of case. Hp infection rate was 78. 6%; CA - 125 increased in 10. 7% of case could, So did ESR of 17. 9% case. High - grade MALT lymphoma could infiltrate or metastasis. In endoscopy, the tumor commonly originated in the lower partion of gastric body and/or antrum in 96.4% of case. 75% of lesion was single ulcer or multiple shallow ulcers, some of them hardened, but most of their mucosa could be drawn up. Less lesions were slightly swollen with erosion and necrosis. The mal diagnosis rate was 89. 3% by endoecopy, and missing diagnosis late of malignant disease was 57. 1%, while of gastric MALT lymphoma 82. 1%. The sure diagnostic rate of postoprative pathological examination was up to 100%. Immunohistochemistry analysis and deep biopsy and large were helpful to diagnosis. B -cell lymphoma and T - cell lymphoma occuned 88. 9% of case and 11, 1% of cases respecively. Conclusions Gastric MALT lymphoma is a special primary gastric lymphoma, and has some specificiries in pathological and endoscopic features.