原发性胃淋巴瘤内镜表现与病理特征分析

Endoscopic and pathologic characteristics of primary gastric lymphoma

目的探讨原发性胃淋巴瘤(PGL)内镜下表现与病理特征,以提高PGL的诊断水平。方法回顾性分析2011年1月至2019年11月在大连医科大学附属大连市中心医院经内镜活组织检查病理证实的35例PGL,对其内镜下表现和病理特征进行分析。结果 35例PGL患者中,19例(54.3%)内镜下表现为溃疡型,11例(31.4%)为隆起型,5例(14.3%)为平坦型,不同类型间差异有统计学意义(P<0.05)。19例(54.3%)累及胃窦,12例(34.3%)累及胃体和胃底,4例(11.4%)累及胃角,不同部位间差异有统计学意义(P<0.05)。12例行内镜窄带成像术(Narrow Band Imaging,NBI),其中10例(83.3%)镜下观察病灶处微血管呈"树样表现"(tree-like appearance,TLA)。35例PGL患者中病理类型包括弥漫性大B细胞淋巴瘤(DLBCL)23例(65.7%),黏膜相关淋巴组织结外边缘区(MALT)淋巴瘤12例(34.3%)。23例胃原发DLBCL包括非生发中心型(non-GCB)13例,生发中心型(GCB)10例,其中5例(21.7%)为MALT淋巴瘤转化的DLBCL。MALT淋巴瘤患者中胃幽门螺杆菌(Helicobacter pylori,HP)阳性率高于DLBCL患者[83.3%(10/12)比47.8%(11/23)],差异有统计学意义(P<0.05)。结论 PGL内镜下以溃疡型多见,以DLBCL和MALT淋巴瘤为主要病理组织学类型,内镜活检病理可以明确诊断。

Objective To explore the endoscopic(PGL)and to improve the level of diagnosis.Methods Twentyseven patients who were confirmed as PGL with endoscopic biopsy pathology during January 2011 to November 2019 were retrospectively analyzed with respects of endoscopic and pathologic features.Results In 35 PGL patients,there were 19(54.3%)cases with endoscopic performance for ulcers,11(31.4%)cases for protrude type,and 5(14.3%)cases for flat type(P<0.05).19(54.3%)cases involved the gastric stomach antrum,12(34.3%)cases involved gastric body and fundus,4(11.4%)cases involved gastric angle(P<0.05).The positive tree-like apperance(TLA)was found in 10 of 12 cases(83.3%)under Narrow Band Imaging(NBI).35 cases of PGL included 23 diffuse large B cell lymphoma(DLBCL),and 12 mucosa associated lymphoid tissue(MALT)lymphoma cases.Of the 23 the primary gastric DLBCL patients,the germinal center B cell-like(GCB)DLBCL were 10 cases,non-GCB DLBCL were 13 cases.5 cases(21.7%)of 23 DLBCL patients were transformed from gastric MALT lymphoma.The frequency of Helicobacter pylori infection in MALT lymphoma patients was higher than that in patients with DLBCL[83.3%(10/12)VS 47.8%(11/23),P<0.05].Conclusion Ulcerative type is the dominant in endoscopic manifestations of PGL.The types of DLBCL and MALT lymphoma are more commnon in PGL.Endoscopic biopsy together with pathology makes definite diagnosis of PGL.