原发性胃恶性淋巴瘤胃镜下表现分析

Analysis of endoscopic features of primary malignant gastric lymphoma

目的:探讨原发性胃恶性淋巴瘤(PGML)的胃镜下表现。方法:回顾分析本院2000年9月至2006年2月收治的33例PGML患者的胃镜图像资料。观察病灶形态、分布特征及胃镜活检确诊情况。结果:PGML病变分布广泛,33例患者中15例(45.5%)病灶广泛累及胃内多个部位;19例(57.5%)伴胃窦受累。33例中胃镜下表现为弥漫浸润型13例(39.4%),结节肿块型3例(9.1%),溃疡型17例(51.5%)。5例胃黏膜相关性淋巴组织(MALT)淋巴瘤患者中,4例(80.0%)为弥漫浸润型,1例(20.0%)溃疡型;24例弥漫大B细胞淋巴瘤(DLBCL)患者中,14例(58.3%)为溃疡型,7例(29.2%)弥漫浸润型.3例(12.5%)结节肿块型:4例弥漫大B细胞合并MALT淋巴瘤(DLBCML)病例中弥漫浸润型和溃疡型各2例(50.0%)。33例PGML,胃镜下疑诊为PGML者12例(36.3%),诊断为进展期胃癌20例(60.6%),复合性溃疡1例(3.0%);经胃镜活检确诊PGML 22例,确诊率为66.7%:结论:PGML病灶胃镜下形态多样,易与进展期胃癌混淆,且分布广泛.胃窦最常受累。胃镜活检对PGML确诊率不高,而深部活检结合免疫组化可提高确诊率。

Objective To learn the endoscopic features of primary malignant gastric lymphoma（PGML）. Methods Gastroseopic pictures of 33 cases of PGML admitted from Sept. 2000 to Feb. 2006 were analyzed retrospectively, including lesion morphology, distribution pattern and diagnostic capability of gastric biopsy. Results The distribution of lesion was widespread, involved widely over many gastric sites in 15 cases （45.5%） and involved gastric antrum in 19 cases （57.5%）. The appearance under gastroseopy was diffused infiltration in 13 cases（39.4%）; nodular mass in 3 cases （9.1%）; ulceration in 17 case （51.5%）.Of the 5 eases of gastric mucosa associated lymphoid tissue （MALT） lymphoma, 4（80.0%） were diffuse infiltration type and 1 （20.0%）was ulceration type. Among the 24 cases of diffuse large B cell lymphoma （DLBCL）, 14 （58.3%）were ulceration type, 7 （29.2%）were diffuse infiltration type, and 3 were （12.5%） were nodular mass type. Of the 4 cases of diffuse large B cell associated with MALT lymphoma, 2 （50.0%） and 2 （50.0%） were diffuse infiltrative type and ulceration type, respectively. Under gastroscopic observation, 12 cases （36.3%） were suspected as PGML, 20 （60.6%） diagnosed as advanced gastric cancer, 1 （3.0%） as complex ulcer. Twenty-two case of PGML were accurately diagnosed as PGML by gastric biopsy, and the accurate diagnostic： rate was 66.7%. Conclusions The appearance of PGML under gastroscopy varies and may confuse with advanced gastric cancer; distribution of the lesion could be widespread and gastric antrum is most frequently involved. Tbe diagnostic rate of gastric biopsy might not be high, and deep biopsy combined with immunohistochemistry examination may increase diagnostic rate.