75例原发性胃肠道淋巴瘤的临床病理分析

Clinicopathological analysis of 75 cases of primary gastrointestinal lymphoma

目的:探讨原发性胃肠道淋巴瘤(primary gastrointestinal lymphoma,PGIL)的临床特点、诊断、病理特征和治疗。方法:收集2011年1月至2017年1月就诊于武汉大学人民医院75例PGIL患者的临床及病理资料,并进行回顾性分析。结果:75例PGIL患者的男女性别比为1.5∶1,年龄(56.96±14.51)岁,其中43例(57.33%)患者以腹部隐痛为主要症状。51例(68.00%)患者CEA升高,17例(32.69%)患者行大便隐血试验(+)。胃镜/肠镜诊断阳性率为74.58%。9例直肠淋巴瘤患者之中,有5例直肠指诊阳性,直肠指诊的阳性率为55.56%。75例PGIL患者均已行病理检查,45例弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL),13例黏膜组织相关淋巴瘤黏膜组织相关淋巴瘤(mucosa-associated lymphoid tissue,MALT),6例间变性大细胞淋巴瘤(anaplastic large cell lymphoma,ALCL),4例外周T细胞淋巴瘤(peripheral T-cell lymphoma,PTCL),7例为其它病理类型。按照Ann Arbor标准分期,IE期7例(9.33%),IIE期25例(33.33%),IIIE11例(14.67%),IVE期32例(42.67%)。41例患者行CHOP化疗方案,12例患者行R-CHOP化疗方案,3例行手术治疗,19例患者放弃治疗。结论:PGIL好发于中老年男性,临床症状以腹痛为主,确诊主要依靠内镜下活检,内镜下诊断不明确的患者可行腹腔探查术明确诊断。CEA、大便隐血试验对PGIL的辅助诊断有一定价值,而直肠指诊对直肠淋巴瘤的初诊有重要意义。早期PGIL患者以PGL多见,而中晚期PGIL患者以PIL多见。病理类型以DLBCL和MALT为主。DLBCL型PGIL治疗首选CHOP/R-CHOP,MALT型PGIL患者首选HP根除疗法,手术适用于PGIL的并发症治疗。

Objective： To analyze the clinical and pathological characteristics of patients with primary gastrointestinal lymphoma （PGIL）. Methods： Clinical and pathological information of 75 patients with PGIL admitted to Renmin Hospital of Wuhan University from January 2011 to January 2017 was investigated retrospectively. Results： Of 75 patients with PGIL, 45 were male and 30 were female, with an average age of 56.96± 14.51 years old. Forty-three patients （57.33%） were presented with abdominal pain, 51 patients （68.00%） were detected with high level of CEA and 17 patients （32.69%） patients were detected with OB（＋）. The positive rate of endoscopy was 93.75% and the positive rate of digital rectal examination was 55.56%. There were 45 cases of diffuse large B-cell lymphoma （DLBCL）, 13 cases of mucosa-associated lymphoid tissue （MALT）, 6 cases of anaplastic large cell lymphoma （ALCL）, 4 cases of peripheral T-cell lymphoma （PTCL）, and 7 cases of other pathological types. According to Ann Arbor criteria, there were 7 cases （9.33%） with stage IE, 25 cases （33.33%） with stage IIE, 11 cases （14.67%） with stage IIIE and 32 cases （42.67%） with stage IVE. 41 patients underwent chemotherapy of CHOP regimen and 12 patients received R-CHOP regimen. Three patients accepted surgical treatment, and 19 patients gave up treatment. Conclusion： PGIL is more likely to occur among middle-age and old male patients, and the most common clinical manifestation is abdominal pain. Confirmed diagnosis is made by biopsy under endoscopy and laparoscopic exploration. Tumor makers and OB of stool play a certain role in diagnosing PGIL and digital rectal examination is crucial for rectal lymphoma. PGL is more likely to occur on the early stage of this tumor, while PIL is more likely to occur on the advanced stage. Its most common pathological types are DLBCL and MALT. The therapy of DLBCL is CHOP/R-CHOP, and the treatment of MALT is eradication of liP. Surgery is mainly applied to deal with the complications of PGIL.