如何通过内镜活检提高大肠淋巴瘤的诊断水平

How to improve diagnostic accuracy of colorectal lymphoma by endoscopic biopsy

大肠淋巴瘤临床表现并无特异性,肠镜检查虽多能发现黏膜病变,但由于组织病理学上多有明显的炎症背景,与炎症浸润的淋巴细胞难以区分。肠镜下溃疡病变为淋巴瘤的常见表现,但由于内镜活检取材局限,常常误诊为克罗恩病或肠结核,不易获得明确诊断。本文从肠道淋巴瘤发生的病理学基础入手,介绍了肠道淋巴瘤内镜下的常见表现和临床诊断线索,强调可疑病变需要大块黏膜剥离活检,借助淋巴瘤的单克隆起源特性,通过病理形态和免疫组化的结合,正确诊断肠道淋巴瘤,从而提高内镜诊断大肠淋巴瘤的水平。

In spite of wide variability in clinical behavior,most patients with colorectal lymphoma are characteristic of mucosal lesions found by colonoscopy.However,it is still histopathologically difficult in identifying infiltration of lymphocytes under the common condition of strong inflammatory background.Moreover,owing to the one sidedness of sampling by endoscopic biopsy,colonic lymphoma is often misdiagnosed as Crohn＇s disease or intestinal tuberculosis,making it even more difficult for doctors to make a clear diagnosis.This article is aiming to introduce the common endoscopic manifestations and diagnosis clues of colorectal lymphoma basing on the knowledge of the pathologic alterations at the very beginning stage of this illness.The author also highly emphasizes the importance of massive mucosal-stripping biopsy of suspicious lesions,since due to the monoclonal origin of colorectal lymphoma,its pathomorphological features together with relevant immunohistochemistry results will assist us in getting correct diagnosis and in turn improving the clinical diagnosis efficacy of endoscopy.