不同部位原发性胃肠道淋巴瘤的临床特点

目的 研究不同部位原发性胃肠道淋巴瘤(PGIL)的临床特点,以提高对该疾病的诊断水平.方法 回顾性分析武汉地区8家医院1999年1月至2007年6月经病理确诊的PGIL患者,共有202例资料完整的病例用于最后统计,按部位分为胃、小肠、大肠淋巴瘤三组,并比较三组间的临床特点.结果 PGIL发生于胃113例(56.0%)、小肠37例(18.3%)、大肠52例(25.7%);男130例(64.4%),女72例(35.6%),均以男性发病率为高.胃淋巴瘤组比小肠淋巴瘤组的病程长(3个月比1个月,P=0.013).三组PGIL均以腹痛、贫血发生率最高,其中伴有贫血症状者大多为轻度(57.9%).PGIL临床分期均以Ⅰ E期、ⅡE期为主,占71.3%;与胃淋巴瘤组比较,大肠淋巴瘤组的临床分期相对较重(P=0.014);PGIL主要病理类型为黏膜相关淋巴组织(MALT)淋巴瘤、弥漫大B细胞淋巴瘤、T细胞淋巴瘤.胃淋巴瘤组以低度恶性MALT淋巴瘤多见(56.9%),而小肠淋巴瘤组以T细胞淋巴瘤多见(34.4%),大肠淋巴瘤组以高恶性B细胞淋巴瘤多见(51.1%).PGIL病灶类型以隆起肿块型、溃疡型为主,但与胃淋巴瘤组相比,大肠淋巴瘤组以隆起肿块型居多而溃疡型少见(P=0.000).胃、小肠、大肠淋巴瘤组经内镜并活检的确诊率分别为58.7%(61/104)、25.0%(4/16)、48.2%(13/27).结论 不同部位PGIL的临床症状、病理分型,临床分期、病灶类型,内镜检出率各有特点,这些差异有助于临床医师对PGIL的认识及诊断.

The clinical characteristics of primary gastrointestinal lymphoma on the different site of origin

Objective To investigate the clinical characteristics of primary gastrointestinal lymphoma (PGIL) on different origin site in order to improve its diagnosis.Methods The clinical data from 202 patients with PGIL diagnosed by histology from January 1999 to June 2007 were identified from the clinical databases of 8 hospitals in Wuhan area and retrospectively analyzed.The patients were divided into gastric,small intestinal and large intestinal lymphoma groups according to the site of origin and there clinical characteristics were compared.Results The PGIL localization was gastric in 113 (56.0%) cases, small intestine in 37(18.3%) cases and large intestine in 52 (25.7%) cases.One hundred and thirty (64.4%) were males and 72 (35.6%) were females.The male patients were predominant.The median duration of symptoms in gastric lymphoma group was longer than small intestinal lymphoma group (3.0 months vs.1.0 month,P=0.013).The most common symptoms were abdominal pain and anemia. The clinical stage was Ⅰ E and Ⅱ E in 71.3% of cases.The large intestinal lymphoma group presented more advanced-stage disease compared with gastric lymphoma group (P = 0.014).The frequent histological type was mucosa-associated lymphoid tissue lymphoma (MALT),diffuse large B-cell lymphoma and T-cell lymphoma.Gastric,small intestinal and large intestinal lymphomas presented more frequently as low-grade MALT lymphoma (56.9%),T-cell lymphoma (34.4%) and high-grade B-cell lymphoma (51.1%),respectively (all P value ＜0.05).The common macroscopic type of PGIL were nodular protruding and ulcerative type.Compared with gastric lymphoma,nodular protruding type was more common and ulcerative type was less common in large intestinal lymphoma (P = 0.000).The diagnosis confirmed by endoscopic biopsy were 58.7% (61/104),25.0% (4/16),48.2% (13/27) in gastric,small intestinal and large intestinal lymphoma groups,respectively.Conclusions The clinical characteristics are different in patients with different localization of PGIL including patient characters, initial symptoms,histological classification,clinical stage,macroscopic feature,endoscopic findings. Analysis of these clinical characteristics is helpful to improve its diagnosis.