原发性胃弥漫性大B细胞淋巴瘤临床特点及误诊分析

Clinical Characteristics and Misdiagnosis Analysis of Gastric Diffuse Large B Cell Lymphoma

目的探讨原发性胃弥漫性大B细胞淋巴瘤(primary gastric diffuse large B cell lymphoma,PG-DLBCL)的临床特点,分析误诊原因,以提高临床诊断率。方法回顾性分析武汉大学人民医院2012—2016年收治的PGDLBCL 20例的临床资料。结果本组20例中16例有上腹部疼痛,1例有呕血,1例有上腹部疼痛伴黑便,1例有上腹部胀痛、呕吐、黑便,1例体检发现胃窦溃疡。本组曾误诊7例,2例误诊为胃腺癌,2例误诊为慢性胃炎,1例误诊为慢性胃溃疡,1例考虑黏膜相关淋巴瘤,1例可疑淋巴瘤;误诊时间9~15 d。本组均经病理检查确诊,3例行手术和化疗,1例行手术、化疗和放疗,1例行手术治疗,15例行化疗。12例病情完全缓解,4例病情部分缓解,2例病情进展,1例死亡,1例术后定期复查未见肿瘤复发。结论临床医生需加强对PG-DLBCL认识,对此类患者综合应用多种检查方法能够提高诊断率,减少误诊发生。

Objective To discuss clinical characteristics of primary gastric diffuse large B cell lymphoma （PG- DLBCL） and to analyze misdiagnosis causes in order to improve diagnosis rate. Methods Clinical data of 20 PG-DLBCL patients admitted from 2012 to 2016 was retrospectively analyzed. Results Among the 20 patients, 16 patients had upper ab- dominal pain; 1 patient had hematemesis; 1 patient had upper abdominal pain associated by melena; 1 patient had upper abdominal pain, vomiting and melena; 1 patient was found antral ulcer. A total of 7 patients were misdiagnosed, 2 patients were misdiagnosed as having gastric adenocarcinoma; 2 were misdiagnosed as having chronic gastritis; 1 was misdiagnosed as hav- ing chronic ulcers; 1 was misdiagnosed as having mucous membrane associated lymphoma; 1 was suspected as having lympho ma, and the misdiagnosed time was 9-15 d. After confirming the diagnosis by pathological examination, 3 patients underwent surgery and chemotherapy; 1 underwent surgery, chemotherapy and radiotherapy; 1 underwent surgery; 15 underwent chemotherapy. There were 12 patients with complete remission, 4 patients with partial remission, 2 patients with disease aggravation, I patient with death and 1 patient without recurrence by regular recheck after the surgery. Conclusion Clinicians should improve the understanding of primary gastric diffuse large B cell lymphoma and perform a number of clinical examinations in order to improve diagnosis rate and reduce misdiagnosis rate.