原发性肠淋巴瘤与克罗恩病的鉴别诊断

背景：原发性肠淋巴瘤的发病率较低，临床表现缺乏特异性，易误诊为其他胃肠道疾病，特别是与克罗恩病（CD）的鉴别诊断较困难。目的：通过分析原发性肠淋巴瘤和CD患者的临床资料，提高原发性肠淋巴瘤与CD的鉴别诊断水平。方法：回顾性分析原发性肠淋巴瘤和CD患者的临床特点、内镜表现和病理检查结果。结果：原发性肠淋巴瘤患者的平均年龄为50岁，CD为35岁。5例（12.2％）CD发生肛周病变，4例（9.8％）内瘘，3例（7.3％）有肠外表现，但仅1例（5.9％）原发性肠淋巴瘤曾有肛瘘。内镜下原发性肠淋巴瘤以回盲部受累多见（41.7％），CD以小肠和结肠均受累多见（48，8％）；原发性肠淋巴瘤以肿块型较多见（41.7％），CD则主要表现为溃疡和铺路石样改变，其中18例伴肠腔狭窄，4例瘘管形成。B细胞性原发性肠淋巴瘤13例，T细胞性4例。12例CD表现为非干酪样坏死性肉芽肿。结论：临床上原发性肠淋巴瘤与CD的鉴别诊断较困难，需综合各种检查手段，特别是内镜检查和内镜下对病变部位多点取活检，以提高诊断率。

Differential Diagnosis between Primary Intestinal Lymphoma and Crohn''''s Disease

Background:The incidence rate of primary intestinal lymphoma is relatively low,and its clinical manifestations are non-specific,which is easy to confuse with other gastrointestinal tract diseases,especially Crohn's disease(CD).Aims:To improve the skill of differential diagnosis between primary intestinal lymphoma and CD by analyzing the clinical characteristics of these two diseases.Methods:The clinical features,endoscopic findings and histopathologic characteristics of patients with primary intestinal lymphoma and CD were reviewed retrospectively.Results:The median ages of primary intestinal lymphoma and CD were 50 and 35 years old,respectively.Perianal lesions were observed in 5(12.2%) patients with CD,internal fistula in 4(9.8%) patients with CD and extraintestinal manifestations in 3(7.3%) patients with CD,while anal fistula was observed in only 1(5.9%) patient with primary intestinal lymphoma.The most frequently involved location was ileocecum in primary intestinal lymphoma(41.7%) and small bowel with colon was affected in 48.8% of patients with CD.Protruding lesions were the most frequently endoscopic features in primary intestinal lymphoma(41.7%),while ulcerative and cobblestoning appearance were found in CD,including complications of intestinal stricture in 18 and fistulization in 4 patients with CD.Of 17 patients with primary intestinal lymphoma,13 were B-cell and 4 T-cell lymphoma.12 patients with CD were noncaseous granuloma.Conclusions:The differential diagnosis between primary intestinal lymphoma and CD is difficult to make clinically.Multiple submucosal biopsies under endoscopy are helpful for the differential diagnosis.