肠道T细胞淋巴瘤的临床病理分析（附13例报告）

Clinicopathologic Characteristics of Intestinal T-Cell Lymphoma：A Report of 13 Cases

目的：分析肠道T细胞淋巴瘤的临床特点及病理特点。方法对2004年1月～2014年4月13例术后病理确诊为肠道T细胞淋巴瘤的病史资料进行回顾性分析。结果该组13例肠道T细胞淋巴瘤男女性别无明显差异，20～30岁、40～50岁及60岁以上发病率较高，中位年龄为49岁，病变多位于空、回肠，结直肠少见。临床表现以腹痛、腹泻、发热、消瘦为主，部分患者并发肠穿孔、肠梗阻、消化道出血。13例肠道T细胞淋巴瘤患者中10例行腹部CT检查，3例行肠镜检查，3例肠镜检查中1例提示肠道肿瘤，2例提示肠道炎性改变或息肉。1例小肠三维重建CT提示小肠淋巴瘤可能。所有患者均接受手术治疗并通过病理确诊，病理分型中外周T细胞型淋巴瘤5例，NK/T细胞型淋巴瘤5例，肠型T细胞淋巴瘤3例。免疫表型13例CD3及CD45-RO均呈阳性表达，Ki-67呈不同程度阳性。结论肠道T细胞淋巴瘤早期诊断困难，误诊和漏诊率高，患者的临床表现以一些非特异性症状为主，内镜活检和手术标本的病理学检查是目前确诊肠道T细胞淋巴瘤的主要依据。

Objective To investigate the clinical and pathologic features of intestinal T-cell lymphoma. Methods 13 patients who were diagnosed with intestinal T-cell lymphoma during January 2004 to April 2014 in our hospital were retrospectively analyzed.Results The incidence of intestinal T-cell lymphoma was not significantly different between male and female, 20~30 and 40~50 years of age and older have a higher prevalence, with a median age of 49 years. The lesions were located in the jejunum and ileum, colorectal rare. The clinical symptoms mainly manifested abdominal pain, diarrhea, fever, weight loss, some with intestinal perforation, intestinal obstruction, gastrointestinal bleeding. Ten of the thirteen patients underwent abdominal CT. One of three patients with routine colonoscopy was diagnosed intestinal cancer; the others were diagnosed infl ammatory bowel diseases or polyps. Especially one case of small bowel intestinal lymphoma were diagnosed by CT reconstruction. All patients underwent surgery and were confi rmed by pathology,fi ve cases of peripheral T-cell lymphoma,fi ve cases of NK/T-cell lymphoma, three cases of intestinal T-cell lymphoma. All the patients showed CD3 and CD45-RO positive-Phenotype, Ki-67-positive with varying degrees.Conclusion For non-specifi c symptoms, diffi culty early diagnosis and highly rate of misdiagnosis and missed diagnosis of intestinal T-cell lymphoma, endoscopic biopsy and surgical pathology specimens are currently pathways to diagnose intestinal T-cell lymphoma.