不同淋巴细胞起源的原发性结直肠恶性淋巴瘤临床特点差异分析

The difference of clinical features between primary colorectal malignant T cell lymphoma and primary colorectal malignant B cell lymphoma

目的探讨T细胞与B细胞起源的原发性结直肠恶性淋巴瘤（PCML）临床特征的差异。方法回顾性分析1999年1月至2008年5月南昌大学第一附属医院经病理确诊的40例PCML患者的临床、内镜及病理资料。结果40例PCML患者平均年龄为（41．0±11．2）岁，T淋巴细胞起源者占32．5％（13／40），B淋巴细胞起源者占67．5％（27／40）。T淋巴细胞起源的PCML患者多见发热、盗汗、便血症状，易并发肠穿孔。内镜下T淋巴细胞起源的PCML患者多见多发或全结肠溃疡型病灶，B淋巴细胞起源者多见右半结肠隆起型单发病灶。B淋巴细胞起源的PCML确诊时临床分期较早，手术切除机会更多。结论PCML内镜下肉眼观察诊断率较低，T淋巴细胞起源的PCML多为全结肠多发性溃疡型病灶，B淋巴细胞起源的PCML多为右半结肠隆起型单发病灶。B淋巴细胞起源的PCML确诊时临床分期较早。

Objective To investigate the difference of clinical features between primary colorectal malignant T cell lymphoma and primary colorectal malignant B cell lymphoma. Methods Forty cases diagnosed as primary eolorectal malignant lymphoma （PCML） between Jan 1999 and May 2008 were studied retrospectively. Results The average age of 40 patients with PCML was （41.0± 11.2） years old. Twenty-seven cases （67. 5%） were diagnosed as B-cell lymphoma. Thirteen cases （32. 5%） were diagnosed as T-cell lymphoma. Patients with T-cell lymphoma in PCML had more symptoms such as fever, night sweat and hematochezia, and was easier to perforate than those with B- cell lymphoma. Protrude type and single-focus and right-colon type were common in B-cell lymphoma under colonoscopy, but ulcerative type and multi-focus and full-colon were common in T-cell lymphoma. B-cell lymphoma had an earlier diagnosis, and more opportunities for surgery than T-cell lymphoma. Conclusions The misdiagnostic rate for PCML was high. Protrude type and single-focus and right-colon type were common in B cell lymphoma under colonoseopy, but ulcerative type and multi-focus and full-colon were common in T-cell lymphoma. B-cell lymphoma could be diagnosed earlier.