胃粘膜相关淋巴组织淋巴瘤的内镜和病理特点

Analysis of endoscopic and pathological features of patients with gastric mucosa-associated lymphoid tissue lymphoma

目的 探讨胃粘膜相关淋巴组织（ＭＡＬＴ）淋巴瘤的内镜和病理特点，以提高其在内镜下的确诊率。方法 回顾性结合部分前瞻性分析２８例患者。结果 胃ＭＡＬＴ淋巴瘤多见于４０～６０岁患者，确诊病程的中位数为８．５月。临床症状无特异性，抗酸剂治疗无效，２５％可引起上消化道出血。Ｈｐ感染率为７８．６％，１０．７％患者的ＣＡ １２５可升高，１７．９％患者的 ＥＳＲ升高。高度恶性者可发生浸润或转移。肿瘤多位于胃体下段和／或胃窦部，占９６．４％，７５％表现为单个或多个浅表性溃疡，质地偏硬，但大部分患者的粘膜尚可稍提起，少见的病变有稍隆起性、糜烂和坏死性病变。胃镜下形态诊断的误诊率为８９．３％。胃镜下常规活检组织病理检查，恶性疾病漏诊率为５７．１％，而胃ＭＡＬＴ淋巴瘤的漏诊率为８２．ｌ％，术后病理检查确诊率达１００％。深而大的活检和免疫组织化学检查有助于确诊。Ｂ细胞淋巴瘤占８８．９％，Ｔ细胞淋巴瘤占１１．ｌ％。结论 胃ＭＡＬＴ淋巴瘤是一类独特的原发性胃淋巴瘤，具有一定的病理和内镜特点。

Objective To investigate the endoscopic and pathological features of gastric mucosa associated lymphoid tissue (MALT) lymphoma. Methods Twenty - eight patients were analyzed retro - spectively and/or prospectively. Results MALT were common at the age of 40 -60. Median cource from prespentation of signs to accurate diagnosis was 8. 5 months. No specific clinical presentations and ineffetive in anti - acid drugs treatment The upper gastrointestinal bleeding occurred in 25% of case. Hp infection rate was 78. 6%; CA - 125 increased in 10. 7% of case could, So did ESR of 17. 9% case. High - grade MALT lymphoma could infiltrate or metastasis. In endoscopy, the tumor commonly originated in the lower partion of gastric body and/or antrum in 96.4% of case. 75% of lesion was single ulcer or multiple shallow ulcers, some of them hardened, but most of their mucosa could be drawn up. Less lesions were slightly swollen with erosion and necrosis. The mal diagnosis rate was 89. 3% by endoecopy, and missing diagnosis late of malignant disease was 57. 1%, while of gastric MALT lymphoma 82. 1%. The sure diagnostic rate of postoprative pathological examination was up to 100%. Immunohistochemistry analysis and deep biopsy and large were helpful to diagnosis. B -cell lymphoma and T - cell lymphoma occuned 88. 9% of case and 11, 1% of cases respecively. Conclusions Gastric MALT lymphoma is a special primary gastric lymphoma, and has some specificiries in pathological and endoscopic features.