胃黏膜相关淋巴组织淋巴瘤的内镜和病理诊断

Analysis of endoscopic and pathological diagnosis of patients with gastric mucosa-associated lymphoid tissue lymphoma

目的探讨胃黏膜相关淋巴组织(MALT)淋巴瘤的内镜和病理特征,以减少误诊、漏诊,提高诊断正确率.方法对1986～2003年该院经病理证实的32例胃MALT淋巴瘤的临床、内镜和病理资料进行回顾性分析.结果 32例患者平均57.1岁,男女比例1:3,临床症状无特殊性.肿瘤多位于胃体下部和/或胃窦部,占90.6%;侵犯全层者,占44.0%;区域淋巴结转移,占32.0%.病理形态学改变肿瘤组织由中心细胞样细胞组成、淋巴上皮病变及反应性淋巴滤泡.该组病例内镜活检确诊率达15.6%,内镜病理诊断正确率达40.6%,术后病理确诊率达100%.免疫组织化学证实为B细胞淋巴瘤.结论内镜下多块取检、深取检,结合以上病理特点和免疫组织化学,有助于诊断胃MALT淋巴瘤.

To study the endoscopic and pathological features of gastric mucosa associated lymphoid tissue (MALT) lymphoma, reduce the rates of misdiagnosis and missed diagnosis, and improve accurate rate of diagnosis. The clinical, endoscopic and pathological datum of 32 patients with gastric MALT lymphoma diagnosed pathologically were analyzed retrospectively. Patients with gastric MALT lymphoma had a median age of 57.1 years with female predominance. The symptoms were not characteristic. The tumor commonly originated in the lower portion of gastric body and/or antrum in 90.6% of cases. After operation infiltrate serosa in 44.0% and range lymphatic metastasis in 32.0%. The tumors consisted of centrocyte-like cells, frequently accompanying with lymphoepithelial lesions and reactive lymph follicle. The correct diagnostic rate were 15.6% and 40.6% by endoscopy and pathology respectively. The correct diagnostic rate of postoperative pathological examination was up to 100%. Immunohistochemistry analysis showed B-cell lymphoma. [Conclusions] It is suggested that multiple deep biopsy, special pathological change and immunohistochemistry are helpful to correct diagnosis of gastric MALT lymphoma.