胃MALT淋巴瘤的形态特征及诊断

Analysis of endoscopic features and diagnosis of gastric mucosa associated lymphoid tissue lymphoma

目的分析胃黏膜相关淋巴组织淋巴瘤的临床特点及内镜特征。方法收集2009年6月-2010年12月,我院经病理证实的17例胃MALT淋巴瘤患者的病史资料、内镜图像及病理资料进行回顾性分析。结果 17例患者中位年龄58.2岁,男女比例1.4∶1。临床症状无特异性,以上腹疼痛、饱胀不适最为常见。病灶范围较大,常累及胃体、胃窦部,形态上以溃疡样改变最为多见。首次胃镜活检病理检查确诊率为52.9%。幽门螺旋杆菌(H.pylori)感染率为78.6%。结论 MALT淋巴瘤的临床症状及内镜下表现无特异性,内镜下多点多方向活检、应用共聚焦激光显微内镜等导向活检、病理检查除常规HE染色外加做免疫组化或进一步行基因重排检测,有助于胃MALT淋巴瘤诊断。

Objective To assess the clinical and endoscopic features of primary gastric mucosa associated lymphoid tissue lymphoma （MALToma）. Methods A retrospective analysis was done in 17 patients with gastric MALToma from Jun. 2009 to Dec. 2010 in terms of clinical, endoscopic and pathological findings. Results The mean age of the patients was 58.2 years old,and male/female ratio was 1.4： 1. Alarm symptoms were absent in most patients. At endoscopy, the ulcerative type was the most frequent presentation, and the lesions were meanly located in the body and antrum. The rate of accurate diagnosis by initial endoscopic biopsy was 52.9%. Helicobacter pylori infection was present in 78.6% of considered patients. Conclusion The clinical and endoscopic presentation of gastric MALT lymphoma lacks specificity. Multi-directional biopsy or targeted biopsy with confocal laser endomicroscopy （CLE） combined with immunohistochemistry is helpful to the diagnosis of gastric MALT lymphoma.