胃肠道粘膜相关淋巴组织型边缘区B细胞淋巴瘤病理观察

Clinicopathologic Study of Extranodal Marginal Zone B-cell Lymphoma of Mucosa Associated Lymphoid Tissue Type

目的 探讨胃肠道粘膜相关淋巴组织型边缘区B细胞淋巴瘤 (MALT MZL)的临床病理特点。方法 分析30例MALT MZL的临床资料 ,HE光镜特点 ,应用免疫组化S P法标记CD2 0、CD45RO、CD3、CD5、CD10、CD2 3、bcl 2以及bcl 10。结果 患者以中老年居多 ,平均 5 1.2岁。临床症状以腹部胀痛为主 (占 88.9%) ,病变粘膜呈脑回状或结节状 (5 0 %)、溃疡 (43.3%) ,活检弹性差 (93.3%)。组织学特点 :瘤细胞为边缘区B细胞、单核样B细胞 ,多少不等的小淋巴细胞、浆细胞及转化的大细胞 ;淋巴上皮病变 19例 ;滤泡克隆化 14例。 2 2例免疫组化中 ,瘤细胞均表达CD2 0 ,10例bcl 2 +,均不表达CD45RO、CD3、CD5、CD10、CD2 3。 16例bcl 10中 ,5例胞核阳性 ,11例阴性病例中 9例出现胞质着色。 12例获得随访资料 ,1例死于化疗后 4年 ,11例均健在。结论 胃肠道MALT MZL为低度恶性淋巴瘤 ,具有一定临床特征 ,病理以HE形态学为要点 ,结合免疫组化有助于正确诊断和鉴别诊断。

Objective To study the clinicopatholgical characteristics of extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue type(MALT-MZL).Methods Analyze clinical status and characteristics of histopathology of 30 cases with MALT-MZL.22 cases were stained for CD20,CD45RO,CD3,CD5,CD10,CD23,bcl-2 and bcl-10,with immunohistochemical techniques.Results The middle old age was predominant in all of the cases (mean 51.2 years),presenting major complaints such as abdominalgia(88.9%).The lesion mucosa would be like ulcer(43,3%),nodositas(50%),and cyri(50%),with poor elasticity(93.3).The tumor cells are marginal zone B cell,monocytoid B cell,more or less small lymphocyte,plasma cell transformed cell.There were lymphoepithelial lesions in 19 cases and follicular colonnization in 14 cases.Among 22 cases,10 showed immunohistochemistry positive CD20 and bcl 2,while CD45RO,CD3,CD5,CD10,CD23 were negative.Sixteen cases showed a positive bcl-10;nuclear expression was positive in 5 and negative in 11 among which 9 expressed cytoplasm. Twelve cases were followed up.Among them 11 were lived,1 accepted chemiotherapy and died after 4 years.Conclusion MALT-MZL is a kind of low grade malingnant lymphoma,having some clinical characteristics.Combination of HE and immunochemistry attribute to the diagnosis and differential diagnosis.