原发性肠道T细胞淋巴瘤误诊为炎症性肠病的原因分析

Reasons of misdiagnosis of primary T-cell lymphoma to the inflammatory bowel disease

目的原发性肠道T细胞淋巴瘤和炎症性肠病临床表现和影像学表现相似,为了预防误诊误治,我们对被误诊为炎症性肠病的原发性肠道T细胞淋巴瘤的临床特征进行分析。方法收集我院十年来(1994～2004年)所有肠道T细胞淋巴瘤和曾被误诊为炎症性肠病的原发性肠道T细胞淋巴瘤的资料,共6例进行分析。结果肠道T细胞淋巴瘤临床上少见,原发性肠道T细胞淋巴瘤和炎症性肠病在临床表现影像学和内窥镜的大体表现颇为相似,内窥镜下的活检和病理学和免疫组化检查是目前确诊肠道T细胞淋巴瘤的主要依据。结论肠道T细胞淋巴瘤的发病率低使临床医生对此种疾病的认识不足。由于缺乏特异性检测手段,为了避免误诊炎症性肠病,提高肠道T细胞淋巴瘤的诊断,要注意以发热、腹泻、腹痛、腹胀等非特异性症状为主,治疗效果不佳的患者要考虑原发性肠道T细胞淋巴瘤的可能性。内窥镜下大多表现为多形性、多灶性、弥漫性和不规则性溃疡,要在有特征性表现的部位多取组织块,提高活检的阳性率。肠道T细胞淋巴瘤易并发消化道穿孔、肠梗阻、消化道出血,诊断不明确时,必要时尽早剖腹探查以明确诊断。

Objective The clinical manifestations and image examination of primary T-cell lymphomas and inflammatory bowel diseases are similar. So we should pay more attention to differentiate these two diseases, Methods We collected and analysis all the cases of primary T-cell lymphoma including the cases which were misdiagnosed during past ten years（1994 - 2004）. Results Primary T-cell lymphomas were rare in clinic. The clinical manifestations and images examination of primary T-cell lymphomas and inflammatory bowel were similar. The way to confirm the diagnosis of the two diseases depended on the pathologic and immunohistologic examination of the biopsy under the endoscope and tissue of the operation. Conclusion Incidence of primary T-cell lymphomas is low. There is no specific way to diagnose the disease. To avoid the misdiagnosis of two diseases, patient who has fever, abdominal pain, diarrhea, weight loss, intestinal perforation, obstruction or gastrointestinal hemorrhage should be considered as the disease. When we find multiple ulcer in small intestine by endoscope and when the standard therapies are not efficient to patient with inflammatory bowel disease, primary T-cell lymphoma shoulol be noted.