早期未分化型胃癌与胃黏膜相关淋巴组织淋巴瘤的内镜下特征差异

Differences of endoscopic features between undifferentiated-typed early gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma

目的探讨早期未分化型胃癌(undifferentiated-typed early gastric cancer,UD-EGC)与胃黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤在白光内镜以及放大内镜窄带光成像(magnifying endoscopy-narrow band imaging,ME-NBI)下的特征性表现。方法回顾2015年3月-2019年7月上海交通大学附属第一人民医院所有留存白光和ME-NBI完整图像资料的病例,比较26例UD-EGC和7例ⅠE1期胃MALT淋巴瘤患者资料。总结分析不同病变在白光内镜和ME-NBI下的特征差异。结果两组患者在年龄、性别、病灶浸润深度等方面差异无统计学意义。在白光内镜下,UD-EGC多为单一病灶,位于胃的下段,边界常不清晰,而MALT淋巴瘤病灶多为多发病灶,位于胃的中段,边界尚清晰。在ME-NBI下,UD-EGC病灶的微表面特征表现为隐窝间区扩张或消失,微血管表现为螺旋状的病理形态,而MALT淋巴瘤常呈现"阡陌交通征""卵石征"、病灶处残存腺管为幽门螺杆菌相关胃炎表现的微表面特征以及"树样"的微血管特征。幽门螺杆菌根除治疗后,原病灶区域的微表面及微血管形态逐渐恢复正常。结论UD-EGC和胃MALT淋巴瘤在白光内镜下表现为病灶数目、部位和边界特征的不同,在ME-NBI下表现为病灶的微表面和微血管特征的显著差异。对二者内镜特征的识别将有助于减少其在内镜检查中的漏诊和误诊。

Objective To analyze and compare the features of undifferentiated-typed early gatrie cancer(UD-EGC)and gastric mucsa-associated lymphoid isse(MALT)lymphoma under white light endoscopy(WLE)and magnifying endoscopy-narrow band imaging(ME-NBI).Methods Data of patients with complete endoscopic images of WLE and ME-NBI in Shanghai General Hospital,Shanghai Jiao Tong Universily from March 2015 to July 2019 were retrospectively analyzed.Twentysix UD-ECC patients and seven gastric MALT lymphoma patients in IE1 stage were included,and the characteristics of the two diseases under WLE and ME-NBI were compared and summarized.Results There were no signifieant diferences in age,sex or infiltation depth of lesions between the two groups.Under WLE,UD-EGC was often manifested as a single lesion located in the lower part of the stomach,with unclear lesion boundaries.w hile MALT lymphoma lesions were mostly multifocal with clear boundaries,located in the middle of the stomach.Under ME-NBI,the microsurface pattern of UD-ECC showed dilation or disappearance of areas between the reesses,and the spiral microvascular pattern.However,the mierosurface patterm of MALT lymphomas were charaterized by"cros road taffie sign","pebble sign",and the presentation of residual glandular duct at the lesion was similar to that of Helicobocer pylori(HP)-related gastritis.Furthermore,thd microvascular patterm of MALT lymphomas often showed tree like appearance(TLA)".After HF eradication therapy,the morphology of microsurface pattern and microvascular pattern in the original lesion area gradually returned to normal.Conclusion UD-ECC and gastrie MALT lymphoma showed particular features in the number,site and boundary under WLE,and they showed significantly diferent microsurface pattern and microvascular patterm under ME-NBL.Differentiation of the two diseases will help reduce the risk of missed diagnosis and misdiagnosis..