MALT淋巴瘤胃窦多发性溃疡1例

Case report of antrum multiple gastric ulcer with mucosa-associated lymphoid tissue

胃黏膜相关淋巴组织淋巴瘤临床少见,表现特殊,病因不明。本例患者女性,27岁,胃镜检查胃窦多发溃疡,病理组织检查提示嗜酸细胞浸润并上皮肉芽组织形成。经胃窦组织免疫组织化学染色分析CD20(++),CD3(+),CD45R0(++),CD79a(+),CD68(-),Ki-67(-),CD5(+),CD10(-)。流式细胞仪分析外周血淋巴细胞免疫表型T淋巴细胞占有核细胞的54.39%,高度表达CD7、CD5、CD3、CD38、cCD3;部分表达CD56,CD8;少数表达CD13,无B细胞表达。血液PCR未检出巨细胞病毒,结核菌素试验(-),快速尿素酶试验阳性,经单一抑酸治疗病情无变化;合用丽珠胃三联治疗2个疗程,胃窦溃疡此消彼长,病变范围扩大,最终经剖腹手术确定胃窦淋巴瘤,手术加化疗后患者痊愈。结果显示:埃索美拉唑镁可有效缓解症状,减轻患者痛苦,治愈MALT相关胃窦溃疡,但溃疡此消彼长,向周边扩展。提示:治疗的同时需要进一步明确诊断,关键在于针对淋巴瘤的治疗。

A 27-year-old woman had chronic mucosa-associated lymphoid tissue （MALT） characterized by giant gastric ulcer with nonca- seating epithelioid granulomas including eosinoeyte in the Gastric Antrum. No definite etiologic factors were detected. Immunohistochemistry indicated CD20 ＋＋ , CD3 ＋ , CD45R0 ＋＋ , CD79a ＋ , CD68 - , Ki-67 - - , CD5 ＋ , CD10 - and the rapid urease test indicated that H. pylori was negative in the antrum. T cell 54.39% in nacleated cells in peripheral blood immunophenotypes detected by flow cytometry were strong expression of CD7, CD5, CD3, CD38, cCD3 ; CD56, CD8 in part of them; CD13 and HLA-DR in a few of them. The mueosa-associ- ated lymphoid tissue with giant gastric ulcer improved with a 8-week oral corticosteroid and esomeprazole magnesium for inhibiting gastric acid treatment. Surgery treatment was administrated finally. This case suggests that the multiple gastric ulcer caused by MALT can been improved after inhibiting gastric acid and oral steroid hormone, but surgery of lymphoma in the better choice.