Transformed gastric mucosa-associated lymphoid tissue lymphoma originating in the colon and developing metachronously after Helicobacter pylori eradication:A case report

BACKGROUND Helicobacter pylori(H.pylori)eradication treatment for primary gastric mucosaassociated lymphoid tissue(MALT)lymphoma has already been established.However,t(11;18)(q21;q21)/API2-MALT1 translocation-positive lesions are a type of primary gastric MALT lymphoma in which a response to eradication treatment is difficult to achieve.In addition,trisomy 18 may be associated with diffuse large B-cell lymphoma(DLBCL)transformation of gastric MALT lymphoma.CASE SUMMARY A 66-year-old man was diagnosed with MALT lymphoma in the ascending colon by colonoscopy and biopsy.Two years later,esophagogastroduodenoscopy revealed chronic atrophic gastritis that was positive for H.pylori,and eradication treatment was administered.Two years and nine months later(at the age of 70),a new ulcerative lesion suggestive of MALT lymphoma appeared in the gastric body,and six months later,a similar lesion was also found in the fundus.One year later(4 years and 3 months after H.pylori eradication),at the age of 72,the lesion in the gastric body had become deeper and had propagated.A biopsy revealed a pathological diagnosis of DLBCL.Both MALT lymphoma lesions in the ascending colon and DLBCL lesions in the stomach were positive for the t(11;18)(q21;q21)/API2-MALT1 translocation,and trisomy 18q21 was also detected.After 6 courses of R-CHOP(rituximab,cyclophosphamide,doxorubicin,vincristine and prednisone)chemotherapy,all of the above lesions disappeared[complete remission(CR)],and CR has been maintained for more than 3 years.In addition,both the colonic and gastric lesions were proven to have the same clonality.CONCLUSION Because the patient had a MALT1 translocation with trisomy 18q21,it was thought that this gastric MALT lymphoma developed independently of H.pylori infection and progressed.

Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond

The stomach is the most frequently involved site for extranodal lymphomas,accounting for nearly two-thirds of all gastrointestinal cases.It is widely accepted that gastric B-cell,low-grade mucosal-associated lymphoid tissue(MALT)-lymphoma is caused by Helicobacter pylori(H.pylori)infection.MALT-lymphomas may engender different clinical and endoscopic patterns.Often,diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa.H.pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage(Ⅰ-Ⅱ1).Neoplasia confined to the submucosa,localized in the antral region of the stomach,and without API2-MALT1 translocation,shows a high probability of remission following H.pylori eradication.When both bacterial infection and lymphoma recur,further eradication therapy is generally effective.Radiotherapy,chemotherapy and,in selected cases,surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission,while data on immunotherapy with monoclonal antibodies (rituximab)are still scarce.The 5-year survival rate is higher than 90%,but careful,long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases.

Primary mucosal-associated lymphoid tissue extranodal marginal zone lymphoma of the bladder from an imaging perspective: A case report

BACKGROUND Mucosal-associated lymphoid tissue extranodal marginal zone(MALT)lymphoma is a low-grade tumor that rarely occurs in the urinary bladder.There is currently no consensus on the common imaging findings or most appropriate treatment in MALT lymphoma in the urinary bladder due to the limited number of reports.CASE SUMMARY A 48-year-old woman was admitted to the hospital with a 1-year history of macroscopic hematuria.Imaging showed a large homogeneous mass with an unclear boundary and an irregular morphology in the bladder.The mass had an abundant blood supply.For further diagnosis,transurethral cystoscopic biopsy and bone marrow biopsy was performed,and the patient was finally diagnosed with primary MALT lymphoma of the bladder.R-CHOP chemotherapy was carried out.After three cycles of chemotherapy,the mass disappeared and the bladder wall thickness was only 4 mm,which indicated excellent therapeutic response to the chemotherapy.To date,the patient remains asymptomatic and she visits our hospital regularly for the completion of the remaining chemotherapy cycles.CONCLUSION Primary MALT lymphoma of the bladder is rare,and there are certain characteristics in the ultrasonographic findings.Imaging findings play an important role in evaluating the therapeutic efficacy and are critical during long-term follow-up after therapy.

Primary thymic mucosa-associated lymphoid tissue lymphoma with multiple thin walled lung cysts: case report and literature review

Mucosa-associated lymphoid tissue （MALT） lymphoma of the thymus is rare. We reported a case of a 37-year-old Chinese female with Sjtgren＇s syndrome and hyperglobulinemia. She suffered from chronic cough for 3 weeks. Chest computed tomography （CT） demonstrated a multiloculated cystic mass in mediastinum prevascular space and multiple lung cysts. Laboratory exam of autoimmune markers showed positive of antinuclear antibody （ANA）, Sjtgren＇s syndrome A （SSA）, Sjtgren＇s syndrome B （SSB）, and rheumatoid factors （RF）. Thymectomy with lymph node dissection was performed. The pathology report revealed thymic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Under immunohistochemical stains, CD20 and Bcl-2 were positive. No evidence of recurrence of disease was found.

Clinical features and treatment outcomes of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma: a single center retrospective analysis of 64 patients in China

AIM: To investigate the clinical features, treatment and prognosis of primary ocular adnexal mucosa-associated lymphoid tissue lymphoma(POAML).METHODS: A retrospective analysis was performed on 64 patients with POAML who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2006 to December 2018.RESULTS: With a median follow-up of 61 mo(range, 2-156 mo), estimated overall survival(OS) rate and progressionfree survival(PFS) rate at 10 y reached 94.5% and 61.5%, respectively. Median OS time and PFS time were not reached. During this period, only 3 patients died, but none of them died directly due to disease progression. One patient(1.6%) developed transformation to diffuse large B-cell lymphoma(DLBCL). Of the 56 patients achieved complete remission after first-line treatment, 5(8.9%) developed local and/or systemic relapse eventually. Patients ≥60 y had significantly shorter PFS than younger patients(P=0.01). For patients with early stages(Ann Arbor stage I and stage II), univariate analysis confirmed that radiotherapydose lower than 32 Gy were independently associated with shorter PFS(P=0.04). Other factors including gender, bone marrow involvement, the initial location of the disease, and the laterality were not associated with PFS.CONCLUSION: The data from our center indicate that POAML has a slow clinical progression and has an excellent clinical outcome. Patients with POAML harbor a continual risk of relaps and transformation to aggressive subtype of lymphoma.

Primary renal mucosa-associated lymphoid tissue lymphoma, the result of chronic pyelonephritis?

Objective: To report 2 cases of primary renal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma), and observe the relations between this rare tumor of kidney and chronic pyelonephritis. Methods: 2 renal MALT lymphomas were collected from referral consultation. Detailed clinical information were reviewed, morphological analysis based on the HE section, and immunohistochemistry were performed by CD20, CD79a, CD5, CD10, CD43, CD23, BCL10 and Cyclin D1 antibodies. Results: 2 female patients with age of 48 and 55, respectively, all had a history of chronic pyelonephritis. Under the B ultrasonic and CT scanning a bump in the kidney was found. Renal carcinoma suspected and hereby the whole nephrectomy performed. In the macroscopic, tumors were laid in the renal medulla, with dark red color and ill-defined boundary. In the microscopic, there were mixed lymphoid cells infiltrate which mainly consisted of small lympho- cytes, centrocyte-like cells, lymphoplasmacytoid and plasma cells, reactive follicles and lymphoepithelial lesions also could be seen in the lesion, but follicles colonization was rare. In fact, except changes of lymphoma, basic renal disease also could be seen. Most glomeruli were atrophic, some glomeruli were hyperplastic and hypertrophic. Tubules were dilated or contacted, many dilated tubules contained pink-color glassy-appearing casts that suggest the appearance of thyroid tissue. As a result, those 2 cases showed juxtaposed changes of lymphoma and pyelonephritis. Immunohistochemistry showed that tumor cells were CD20 and CD79a positive, CD43 was weak positive, but CD5, CD10, CD23, BCL10 and Cyclin D1 were all negative. Conclusion: Primary renal MALT lymphoma was very rare disease. According to the clinical manifestation, it’s hard to differentiate from renal cell carcinoma. But the morphological features were consistent with the classic MALT lymphomas in other sites. Immunophenotypic profiles were helpful for diagnosis. Based on the truth that many MALT lymphomas in other sites were connected with chronic inflammations, we suppose that the renal MALT lymphoma may originate from chronic pyelonephritis.

Radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma

Gastric mucosa-associated lymphoid tissue(MALT)lymphoma is a rare disease which is often associated with Helicobacter pylori(H.pylori)infection.First-line treatment of stage IE and IIE localized gastric MALT lymphoma is based on the eradication of H.pylori.The presence of H.pylori resistance factors such as translocation t(11;18),peri-gastric lymph node involvement and the degree of tumor infiltration of the gastric wall;or lack of response to antibiotic therapy are two main indications to treat with definitive radiotherapy(RT).RT is an effective treatment in localized gastric MALT lymphoma.A moderate dose of 30 Gy allows a high cure rate while being well tolerated.After treatment,regular gastric endoscopic follow-up is necessary to detect a potential occurrence of gastric adenocarcinoma.

The clinical significance of CD97, NF-kB and COX-2 ingastric MALT lymphomas

Background and Objectives: Increased expression of the CD97, nuclear factor-kB (NF-kB) and cyclooxygenase-2 (COX-2) has been found to play an important role in development of many cancers, including gastric neoplasm. However, the expression and biological behavior of CD97, NF-kB and COX-2 in gastric MALT (mucosa-associated lymphoid tissue) lymphoma has not been well investigated. Methods: The expressions of CD97, COX-2 and NF-kB in 47 cases of gastric MALT lymphoma were detected immunohistochemically, and the relevance between their expressions and the biological behavior was analyzed retrospectively. Results: 1) The expressions of CD97, NF-kB and COX-2 were 87.2%, 36.2% and 48.9%, respectively;2) The difference of CD97 expression between depth of invasion limited in mucosa and submucosa and beyond muscularis propria was significant (100.0% vs. 71.4%, P < 0.01). Moreover, the expression of nuclear CD97 between stage IIE, III, IV and stage I patients showed significant difference (96.4% vs. 73.7%, P < 0.05);3) The expression of NF-kB was significantly correlated with tumor size, depth of invasion and stage;4) The expression of COX-2 was significantly correlated with Helicobacter pylori infection, clinical stage, depth of invasion and tumor size (P < 0.05). Conclusions: Expressions of CD97, NF-κB and COX-2 were correlated with tumor invasion and metastasis in gastric MALT lymphoma.

综合影像学、组织学和免疫组织化学特点诊断肺MALT淋巴瘤

背景与目的:肺的黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)是原发性肺恶性肿瘤中的少见类型,但在全身各部位所有的MALT淋巴瘤中,肺MALT淋巴瘤并不罕见。由于肺MALT淋巴瘤的临床表现和影像学特点不典型,常与炎症或肺上皮性恶性肿瘤不易鉴别。本研究综合肺MALT淋巴瘤的影像学、大体形态、组织学和免疫组织化学特点,帮助对肺MALT淋巴瘤的认识和诊断。方法:收集15例肺MALT淋巴瘤,根据大体形态和HE图像其组织学特点;并回顾各病例的胸片或(和)CT资料,收集特异性表现;免疫组织化学EnVision法评价BCL10蛋白的表达。结果:在组织学图像上,肺MALT淋巴瘤具有与胃MALT淋巴瘤类似的细胞学特点,但也有肺组织特异性的诊断图像;BCL10免疫组化显示61.5%(8/13)的病例具有核染色;影像学分析显示肺MALT的图像可分为两型:炎症型和肿块型。炎症型表现为单发或多发或弥漫性斑片状模糊影、毛玻璃样影和实变影,内可有支气管充气征;肿块型表现为单发或多发结节或肿块,周围型多见,呈类圆形,边界清楚或模糊,可有分叶及毛刺。结论:肺MALT淋巴瘤有相对特异性的病理形态学特点,BCL10免疫组化能辅助MALT淋巴瘤的诊断,影像特点可能对手术、治疗反应和复发等有作用,但临床病理的关键是与肺"炎性假瘤"及其他非特异性炎症的鉴别诊断。

C反应蛋白/白蛋白比值在胃黏膜相关淋巴组织淋巴瘤中的预后预测价值

目的 探讨C反应蛋白与白蛋白比值(C-creative protein/albumin ratio, CAR)预测胃黏膜相关淋巴组织(MALT)淋巴瘤患者预后的价值。方法 纳入2004年1月至2020年6月在复旦大学附属中山医院初诊的胃MALT淋巴瘤患者,计算其CAR。通过X-tile软件获取最佳CAR临界值,将患者分为低CAR组和高CAR组。收集两组患者的基线数据及生存资料。应用Cox分析和Kaplan-Meier法分析CAR在胃MALT淋巴瘤的预后预测意义。结果 CAR的最佳临界值为0.05。与低CAR组(CAR<0.05,n=66)相比,高CAR组(CAR≥0.05,n=27)中高龄(70岁以上)、贫血患者更多,C反应蛋白水平、β2-微球蛋白水平更高,白蛋白水平更低(P<0.05)。Cox多因素分析示IgG为患者预后的独立预测因素(HR=0.528,95%CI 0.304~0.915, P=0.023)。低CAR组中位总生存期(overall survival,OS)长于高CAR组(172.8个月vs 112.7个月,P=0.020)。不同MALT-IPI评分组患者OS差异无统计学意义;CAR联合MALT-IPI评分2分患者OS明显短于0分和1分患者(P<0.05)。结论 高CAR组患者预后更差,CAR可用于评估胃MALT淋巴瘤患者预后。

眼附属器黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT)临床病理分析

目的:探讨6例眼附属器黏膜相关淋巴组织结外边缘区B细胞淋巴瘤(MALT)患者的临床病理特点及预后。方法:收集2010年01月至2019年01月病理学检查确诊的6例眼附属器MALT患者的临床资料及治疗方案、形态学特点及免疫组化表达,FISH检测MALT1基因断裂,电话随访,分析总结其临床病理特点及预后。结果:临床表现为眼部不适,眼睑肿胀及视物模糊等。镜下可见肿瘤由形态多样的小B细胞组成,包括边缘带细胞(中心细胞样细胞)、单核样细胞、小淋巴细胞,也可见散在的免疫母细胞和中心母细胞样细胞,部分细胞有浆细胞样分化。5例肿瘤细胞CD20(+)、CD3(-)、BCL2(+)、Ki67约10%~25%,3例BCL10及AEG1阳性,1例伴浆细胞分化,免疫组化表现为CD20(-)、CD79α(+)、CD38(+)、CD138(+)、MUM1(+)、Kappa、Lambda呈限制性表达,2例FISH检测结果阳性。结论:眼附属器MALT淋巴瘤常CD20、BCL2、BCL10、AEG1阳性,FISH可作为辅助诊断。

双能量CT在鉴别眼眶炎性假瘤和MALT淋巴瘤中的应用初探

目的:初步探讨双能量CT (DECT)在鉴别特发性眼眶炎性假瘤(IOIP)与黏膜相关淋巴组织(MALT)淋巴瘤中的应用价值,明确可用于鉴别两者的DECT参数。方法:回顾性分析经病理证实的5例IOIP患者及5例MALT淋巴瘤患者的DECT检查资料。对DECT参数进行独立样本t检验,绘制受试者操作特征(ROC)曲线,明确鉴别IOIP与MALT淋巴瘤的最佳DECT参数。结果:眼眶MALT淋巴瘤的碘浓度(IC)、40~100keV (间隔20keV)处虚拟单色图像(VMI) CT值等均显著高于IOIP (P<0.05)。有效原子序数(Zeff)、碘光谱衰减曲线斜率k值及120~180keV (间隔20keV)处的VMI在两者中差异均无统计学意义。60keV处VMI ROC曲线下面积(AUC)最高(AUC=0.96,灵敏度为100%,特异度为80%,准确度为80%)。结论:DECT的定量参数IC及40~100keV (间隔20keV) VMI可用于鉴别诊断眼眶IOIP与MALT淋巴瘤,并且60keV VMI诊断效能最高。

Lacrimal sac lymphoma: a case series and literature review

AIM: To study the clinical and pathological characteristics of the lacrimal sac lymphoma, which is rare but it is the major type of non-epithelial malignant tumor in the lacrimal sac region. METHODS: Sixty-four cases of malignant lacrimal sac tumors in our hospital from 1986 to 2020 were retrospectively reviewed. Eight cases of lacrimal sac lymphoma were carefully reviewed. RESULTS: There were five mucosal-associated lymphoid tissue(MALT) lymphomas, one diffused large B-cell lymphoma, one NK/T cell lymphoma, and one mantle cell lymphoma. All eight patients represented symptoms of epiphora with swelling in the lacrimal sac for a certain period of time and showed no signs of systemic involvement at the first time of clinical visits. They had received either chemotherapy or radiotherapy after surgery. Long-term follow-up(from 11 to 220 mo) showed that, except one patient with MALT lymphoma died for unknown reasons at 104 mo after surgery, the other 7 patients were all alive with no signs of local recurrence, neither in other organs. CONCLUSION: Non-epithelial malignant tumors of the lacrimal sac are rare and lymphoma is the major subtype.

胃黏膜相关淋巴瘤28例临床分析

目的 探讨胃黏膜相关淋巴瘤的临床表现、病理特征及诊治方法。方法 回顾性分析28 例胃黏膜相关淋巴瘤的临床资料。结果 临床表现以消化道症状和/或腹部包块为主,幽门螺旋杆菌阳性率为92.9%。低度恶性B细胞淋巴瘤21例,伴和/或不伴低度恶性成分的高度恶性B细胞淋巴瘤7 例。结论 胃黏膜相关淋巴瘤多为B细胞淋巴瘤,最后诊断依赖于病理学检查;治疗首选抗幽门螺旋杆菌治疗、化疗或放疗,预后较好。

乳腺粘膜相关淋巴瘤的临床病理分析

目的 :为进一步提高对乳腺粘膜相关淋巴瘤本质的认识 ,减少临床上的误诊误治。方法 :对 3例乳腺粘膜相关淋巴瘤的临床和病理特点、组织发生和治疗原则进行探讨。应用免疫组织化学S -P法 ,对肿瘤进行多种免疫学标记。结果 :临床上多发于中年妇女 ,初始为孤立性无痛性肿块。肿瘤组织由小裂样淋巴细胞、单核样B细胞、小淋巴细胞和浆细胞构成 ,浸润生长 ,形成淋巴上皮病变 ,浸润脂肪组织。免疫组织学染色CD4 5( +)、CD2 0 ( +)、CDw75( +)、轻链κ( +)、λ( +)、bcl- 2 ( +)、CD3( - )、CD4 5RO( - )、EMA( - )。证实肿瘤来源于B细胞。治疗以肿块切除后局部放疗和全身化疗为宜。结论 :该肿瘤可发生于正常存在MALT粘膜组织 ,也可发生在正常不存在MALT粘膜器官组织中 ,与感染和自身过度免疫反应性淋巴细胞增生有关。

唾液腺黏膜相关淋巴组织型淋巴瘤的临床特点:1例报告及文献复习

目的:分析总结唾液腺黏膜相关淋巴组织型淋巴瘤的临床特点。方法:报道1例黏膜相关淋巴组织型淋巴瘤,并检索和回顾分析中英文文献。结果:收集临床资料完整的文献16篇,包括成组病例分析5篇,个案报道11篇,共计105例。结论:唾液腺黏膜淋巴组织相关淋巴瘤以腮腺为好发部位,生长缓慢,有长期自限的倾向;治疗包括手术、放疗、化疗等,预后良好;存在局部复发和远处转移的可能。对于唾液腺黏膜相关淋巴组织型淋巴瘤,临床密切随访是十分必要的。

子宫颈粘膜相关淋巴组织淋巴瘤6例临床病理分析

目的 :探讨子宫颈粘膜相关淋巴组织淋巴瘤 (MALT ML)的临床病理特征。方法 :分析 6例临床表现。病理常规染色及ABC法免疫组化染色。结果 :6例均为B细胞性 ;CCL细胞型和淋巴浆细胞型 4例 ,大细胞型 2例。结论 :大多数子宫颈MALT ML为低度恶性 ,手术为首选治疗方法 ;若发生大细胞转化 。

子宫原发性粘膜相关淋巴组织淋巴瘤病例分析

目的探讨子宫体原发性粘膜相关淋巴组织淋巴瘤的临床病理特征及免疫表型特点。方法对2例子宫体原发性粘膜相关淋巴组织淋巴瘤患者进行回顾性研究，包括临床病理观察、免疫组化检测等。结果子宫体原发性粘膜相关淋巴组织淋巴瘤临床诊断困难，镜下病理形态多样，可见子宫内膜和／或肌层内淋巴细胞增生，免疫组化B细胞标记（＋）。结论原发性子宫粘膜相关淋巴组织淋巴瘤是一种罕见惰性淋巴瘤，多为偶然发现子宫体占位性病变，临床易漏诊，因此诊断及鉴别诊断要结合临床、病理形态及免疫组化标记等。

原发性胃恶性淋巴瘤与幽门螺杆菌感染的相关性初探

为了探讨原发性胃恶性淋巴瘤(RGML)与幽门螺杆菌(Hp)感染的相关性,本文收集39例 PGML了以及22例淋巴性胃炎、32例 Hp 无关疾病的胃粘膜行对照研究。结果:PGML 组 Hp 检出率87.18%,显著高于对照的63.64、53.13%(P<0.005)。粘膜相关淋巴样组织(MALT)来源的淋巴瘤占92.31%。Hp 检出率达86.11%,瘤周慢性活动性胃炎及淋巴滤泡检出率分别为84.62、56.41%,且炎症活动程度与 Hp 分布密度相关。组织学研究提示胃 B 细胞 MALT 淋巴瘤与 Hp 感染相关。

甲状腺粘膜相关性淋巴瘤的诊断和治疗

为探讨甲状腺粘膜相关性淋巴瘤的临床规律,治疗特点及预后,回顾性分析我院1988～1997年间收治甲状腺粘膜相关性淋巴瘤12例,男性3例,女性9例,年龄49岁～71岁平均62岁,最常见症状是无痛性快速生长肿块,甲状腺粘膜相关性淋巴瘤与淋巴细胞性甲腺炎密切相关。手术及放、化疗是有效治疗手段。