NK细胞淋巴瘤样胃病一例报告并文献复习

Lymphomatoid gastropathy： one case report and literatures review

目的 报道国内首例NK细胞淋巴瘤样胃病（lymphomatoid gastropathy），阐述其临床特征、诊疗方法、治疗选择及转归。方法 收集并分析北京协和医院诊断的一例NK细胞淋巴瘤样胃病患者的临床表现、实验室检查、治疗及转归情况。结果 患者为51岁女性，因上腹不适行胃镜检查发现胃内多发溃疡，病理发现黏膜内异型淋巴细胞浸润，免疫组化：CD3（＋）、CD56（＋）、CD20（-）、CD8（-）、TIA（＋）、Granzyme B（-）、Ki-67（75%）。原位杂交：EBER（-）。诊断为NK细胞淋巴瘤样胃病，未行放化疗，密切随访。4个月后多次复查胃镜发现溃疡自发愈合。结论 NK细胞淋巴瘤样胃病作为一种独立的疾病类型，虽然病理表现与胃肠道NK/T细胞淋巴瘤相似，但临床表现、预后完全不同。对于有这种病理改变的患者，需仔细评估其临床表现、胃镜特点，避免过度治疗。

Objective To report the first case of lymphomatoid gastropathy in China, and to demonstrate the clinical characteristics, diagnostic approach, treatment and prognosis in this kind of patients.Methods One patient was diagnosed as lymphomatoid gastropathy at Peking Union Medical College Hospital, and her clinical characteristics, lab data, treatment and follow-up outcomes were reviewed.Results A case of a 51-year-old female was presented, who underwent esophagogastroduodenoscopy （EGD） due to slight epigastric discomfort. EGD revealed multiple ulcers and erosions. Biopsies showed atypical lymphocytes infiltration with CD3（＋）, CD56（＋）, CD20（-）, CD8（-）, TIA（＋）, Granzyme B（-） and Ki-67 （75%）. Epstein-Barr virus-encoded RNA in situ hybridization was negative. Four months later, repeated EGD examination showed regression of the lesions without specific treatment.Conclusion Lymphomatoid gastropathy was a unique disease entity mimicking NK/T-cell lymphomas in pathology, with the quite different profile of treatment and prognosis. It’s important to consider this issue during the differential diagnosis to avoid any excessive treatment.