Guiding function of positron emission tomographycomputed tomography examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma

AIM:To explore the role of positron emission tomographycomputed tomography(PET-CT)examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma(OAML).METHODS:The general clinical data,postoperative PET-CT results,treatment regimens,and the prognosis of 21 histopathologically confirmed OAML patients between October 2017 and September 2021 were collected.Among the 21 patients,five patients underwent surgical treatment alone,13 patients underwent surgical treatment combined with radiotherapy,and three patients underwent surgical treatment combined with chemotherapy.RESULTS:The follow-up period ranged from 8 to 79mo,with four cases of recurrence and no deaths.Through PETCT examination,two patients exhibited both local ocular metabolic elevation and systemic metastasis,and one of these patients had cervical lymph node metastasis,while the other had submandibular and parotid gland metastasis.Nine patients showed only local ocular metabolic elevation,while 10 patients had no abnormal metabolic activity locally.CONCLUSION:PET-CT examination plays a crucial role in detecting residual lesions and recurrence following tumor resection,aiding in precise disease staging,and facilitating the development of personalized treatment plans,ultimately improving patient prognosis.

A case of mucosa-associated lymphoid tissue lymphoma of the gastrointestinal tract showing extensive plasma cell differentiation with prominent Russell bodies

A 73-year-old Japanese woman was hospitalized for detailed examination of nausea, diarrhea and loss of appetite. Atypical erosion in the ileum was found on endoscopy. Biopsy of this erosion showed proliferation of cells containing numerous Russell bodies. Differential diagnoses considered were Russell body enteritis, crystal-storing histiocytosis, Mott cell tumor, immunoproliferative small intestinal disease(IPSID) and mucosaassociated lymphoid tissue(MALT) lymphoma. The cells containing prominent Russell bodies showed diffuse positivity for CD79 a and CD138, but negative results for CD20, CD3, UCHL-1, CD38 and CD68. Russell bodies were diffusely positive for lambda light chain, but negative for kappa light chain, and immunoglobulin(Ig)G, Ig A and Ig M. Based on these findings, Russell body enteritis, crystal-storing histiocytosis and IPSID were ruled out. As the tumor formed no mass lesions and was restricted to the gastrointestinal tract, MALT lymphoma with extensive plasma cell differentiation was finally diagnosed. The patient showed an unexpectedly aggressive clinical course. The number of atypical lymphocytes in peripheral blood gradually increased and T-prolymphocytic leukemia(T-PLL) emerged. The patient died of T-PLL 7 mo after admission. Autopsy was not permitted.

Impact of the microenvironment on the pathogenesis of mucosaassociated lymphoid tissue lymphomas

Approximately 8%of all non-Hodgkin lymphomas are extranodal marginal zone B cell lymphomas of mucosa-associated lymphoid tissue(MALT),also known as MALT lymphomas.These arise at a wide range of different extranodal sites,with most cases affecting the stomach,the lung,the ocular adnexa and the thyroid.The small intestine is involved in a lower percentage of cases.Lymphoma growth in the early stages is associated with long-lasting chronic inflammation provoked by bacterial infections(e.g.,Helicobacter pylori or Chlamydia psittaci infections)or autoimmune conditions(e.g.,Sjögren’s syndrome or Hashimoto thyroiditis).While these inflammatory processes trigger lymphoma cell proliferation and/or survival,they also shape the microenvironment.Thus,activated immune cells are actively recruited to the lymphoma,resulting in either direct lymphoma cell stimulation via surface receptor interactions and/or indirect lymphoma cell stimulation via secretion of soluble factors like cytokines.In addition,chronic inflammatory conditions cause the acquisition of genetic alterations resulting in autonomous lymphoma cell growth.Recently,novel agents targeting the microenvironment have been developed and clinically tested in MALT lymphomas as well as other lymphoid malignancies.In this review,we aim to describe the composition of the microenvironment of MALT lymphoma,the interaction of activated immune cells with lymphoma cells and novel therapeutic approaches in MALT lymphomas using immunomodulatory and/or microenvironmenttargeting agents.

Laterally spreading tumor-like primary rectal mucosa-associated lymphoid tissue lymphoma:A case report

BACKGROUND Colorectal mucosa-associated lymphoid tissue(MALT)lymphoma is a rare disease,and only a few cases have been reported to date.It has no specific clinical presentations and shows various endoscopic appearances.There is no uniform consensus on its treatment.With the advancement of endoscopic technology,endoscopic treatment has achieved better results in individual case reports of early-stage patients.CASE SUMMARY We report a case of rectal MALT in a 57-year-old Chinese man with no symptoms who received endoscopy as part of a routine physical examination,which incidentally found a 25 mm×20 mm,laterally spreading tumor(LST)-like elevated lesion in the rectum.Therefore,he was referred to our hospital for further endoscopic treatment.Complete and curable removal of the tumor was performed by endoscopic submucosal dissection.We observed enlarged and dilated branch-like vessels similar to those of gastric MALT lymphoma on magnifying endoscopy with narrow-band imaging.And immunopathological staining showed hyperplastic capillaries in the mucosa.Histopathological findings revealed diffusely hyperplastic lymphoid tissue in the lamina propria,with a visible lymphoid follicle structure surrounded by a large number of diffusely infiltrated lymphoid cells that had a relatively simple morphology and clear cytoplasm.In addition,immunohistochemical analysis suggested strongly positive expression for CD20 and Bcl-2.Gene rearrangement results showed positivity for IGH-A,IGH-C,IGK-B,and IGL.Taking all the above findings together,we arrived at a diagnosis of extranodal marginal zone B-cell lymphoma of MALT lymphoma. Positron emission tomography-computed tomographyexamination showed no other lesions involved. The patient will be followed byperiodic endoscopic observation.CONCLUSIONIn conclusion, we report a case of rectal MALT with an LST-like appearancetreated by endoscopic submucosal dissection. Further studies will be needed toexplore the clinical behavior, endoscopic appearance, and treatment of rectalMALT.

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.

胃粘膜相关淋巴组织型淋巴瘤形态学研究

目的：研究胃粘膜相关淋巴组织（ＭＡＬＴ）型淋巴瘤及其与胃粘膜套细胞淋巴瘤和滤泡性淋巴瘤的鉴别诊断。方法：应用ＨＥ染色和免疫组化ＡＢＣ法检测胃ＭＡＬＴ型淋巴瘤，内镜作幽门螺杆菌（ＨＰ）培养或尿素试验检测ＨＰ感染。结果：３１例胃ＭＡＬＴ型淋巴瘤中低度恶性２７例，高度恶性４例。细胞类型以ＣＣＬ型最常见。免疫表型以ＩｇＭ为主，缺乏ＩｇＤ。３１例中２８例有ＨＰ感染（占９０．５２％）。结论：①低恶ＭＡＬＴ型淋巴瘤常见到淋巴上皮病变，滤泡性克隆化和反应性滤泡，具有诊断和鉴别诊断价值。②高恶ＭＡＬＴ型淋巴瘤伴有低恶成分。

胃癌组织内三级淋巴结构及其临床意义

目的检测三级淋巴结构(tertiary lymphoid structure,TLS)在胃癌组织内的形成及其与临床病理特征和患者预后的关系。方法回顾性分析苏州大学附属第三医院2006～2008年存档的163例胃癌标本。经常规HE染色判读TLS组织学评分,分析其与胃癌临床病理特征和患者预后的关系。随机选取63例为验证组进行MECA-79免疫组化染色,分析其与TLS评分的一致性。结果 MECA-79与TLS评分具有相关性(P=0. 002)及一致性(P=0. 024)。TLS的形成与胃癌临床病理特征的关系差异无统计学意义。高密度TLS的胃癌患者中位生存期为48. 54个月,预后良好(P=0. 025)。多因素Cox回归模型中TLS是独立性预后因素(P=0. 031)。结论 TLS组织学评分准确可行。胃癌组织内TLS形成是提示患者预后良好的重要指标,反映肿瘤微环境(tumor microenvironment,TME)内抗肿瘤免疫功能良好,具有成为免疫治疗靶点的潜在可能。

透明质酸对CNE-2Z裸鼠移植瘤毛细淋巴管形成的影响

目的：研究透明质酸（ｈｙａｌｕｒｏｎｉｃａｃｉｄ，ＨＡ）对ＣＮＥ－２Ｚ裸鼠移植瘤组织内毛细淋巴管形成的影响。方法：将ＣＮＥ－２Ｚ接种到裸鼠皮下并注射ＨＡ（每次３００μｇ／周，共１８００μｇ），取移植瘤作冰冻切片、组织化学染色和常规ＨＥ染色，光镜下观察癌组织内毛细淋巴管的形态和分布，并用图像分析技术对癌间质面积进行定量测量。结果：实验组部分癌组织内见毛细淋巴管存在，其余部分癌组织及对照组所有癌组织切片均未见毛细淋巴管；癌组织坏死明显，甚至在毛细血管旁的癌组织，坏死亦明显；两组间癌间质面积差异无显著性（Ｐ＞０．０５）。结论：透明质酸可促进鼻咽癌组织内毛细淋巴管形成，癌组织坏死与癌组织缺乏淋巴循环有关，透明质酸对癌间质形成无明显促进作用。

次级淋巴组织趋化因子浓度梯度抑制肿瘤细胞免疫逃逸

目的探讨人次级淋巴组织趋化因子(SLC)浓度梯度对肿瘤细胞免疫逃逸的影响。方法根据SLC浓度梯度,实验分6组;流式细胞术检测肿瘤细胞HLA-Ⅰ类分子的表达、肿瘤细胞凋亡,Western blot检测肿瘤细胞胞内BCL-2表达,ELISA检测肿瘤细胞培养上清中生长转化因子β(TGF-β)水平。结果在一定浓度范围内,随SLC浓度增加,肿瘤细胞的HLA-Ⅰ类分子表达增高,肿瘤细胞凋亡增多;BCL-2表达增高,而肿瘤细胞TGF-β分泌水平降低。结论SLC具有抑制肿瘤细胞免疫逃逸的作用。

骨髓淋巴造血组织肿瘤的形态学和免疫表型分析

目的探讨骨髓活检(BMB)中淋巴造血组织肿瘤的临床病理特征和免疫表型特点,提高诊断水平。方法 19例骨髓的淋巴造血组织肿瘤行苏木精-伊红染色法(HE)染色、过碘酸雪夫氏染色法(PAS)染色、网状纤维染色及免疫组化PV9000法系列抗体标记。结果 4例骨髓增生异常综合征(MDS)均显示造血组织增生,有小巨核细胞和原始细胞异常定位;2例急性髓系白血病(AML)有显著原始粒细胞或原始红细胞增生;2例慢性粒细胞白血病(CML)显示粒系细胞增生为主,各阶段粒细胞均可见到;3例浆细胞性骨髓瘤(PCM)和8例非霍奇金淋巴瘤(NHL)均系骨髓肿瘤性增生,两者的HE形态结合免疫组化标记能够诊断和鉴别诊断。结论 MDS诊断主要依赖病理形态学,免疫组化标记没有太大帮助;对AML、CML、PCM和NHL的诊断而言,除病理形态学观察外,各类肿瘤组织免疫组化表型分析有重要参考价值。

lncRNAs在淋巴造血系统肿瘤中的研究进展

长链非编码RNAs(long noncoding RNAs,lnc RNAs)是长度≥200个核苷酸的非蛋白编码转录子。多数lnc RNAs在肿瘤组织中显示致癌基因的作用,通过影响肿瘤细胞的增生、迁移、浸润和转移促进肿瘤的发生发展;部分lnc RNAs已成为特定肿瘤的诊断及预后标志物。对其表达、功能及机制的研究成为当前肿瘤研究的热点,但多集中于上皮源性肿瘤。本文旨在对lnc RNAs在淋巴造血系统肿瘤中的研究进展进行综述。

三级淋巴样组织在肿瘤微环境中的形成及作用

实体肿瘤微环境中免疫细胞的招募和浸润因肿瘤原发器官、疾病分期等存在明显的异质性,并在肿瘤的发生、发展、转移及治疗耐药中发挥重要作用。三级淋巴样组织(TLS)是形成于慢性炎症、感染及肿瘤组织中的异常淋巴样结构。TLS的形成与肿瘤患者的临床预后密切相关,并对肿瘤微环境中T淋巴细胞的招募及局部免疫细胞的活化极为重要。深入分析肿瘤微环境中的TLS不仅可为阐明肿瘤免疫治疗的具体机制发挥作用,还可为患者的预后提供依据,从而为肿瘤患者的精准治疗奠定基础。

造血和淋巴组织肿瘤WHO分类形态学诊断——附571例应用体会

目的介绍造血和淋巴组织肿瘤WHO分类的应用体会,促进在我国的应用和普及。方法用血片,骨髓涂片、印片和切片(简称四片联检)加细胞免疫化学染色进行形态学诊断。结果按WHO的基本要求,近四年来诊断髓系肿瘤370例,淋系肿瘤201例。应用体会之一,开展四片联检,可显著提高WHO的形态学诊断水平,尤其是慢性骨髓增殖性疾病(MPD)和骨髓增生异常-MPD(MD-MPD)及伴骨髓纤维化的造血和淋巴组织肿瘤。体会之二,WHO的AML五分类中,第一类重现性染色体异常AML,形态学典型的M3、M2(原始细胞较大伴成熟特征或M2b)、M4Eo和M5,可提示这一类型并建议(分子)遗传学检查;第二类伴多系病态造血和第三类治疗相关AML,结合临床可以作出诊断;第四类不另作分类AML(M0、M1、M6和M7,以及不包括前述三类的M2、M4和M5),即仍按FAB诊断,还有形态学诊断的急性嗜碱粒细胞白血病、全髓增殖症伴骨髓纤维化和髓系肉瘤;第五类系列未明或双系AML,为形态学结合免疫表型诊断。体会之三,WHO分类的MDS八型,除5q-综合征外,以形态学为主要诊断,有核细胞量、原始细胞量和病态造血程度的评估是诊断和鉴别的根本指标。体会之四,WHO分类的MPD和MD-MPD,主要为形态学诊断,外周血细胞增多和骨髓增殖是MPD评估的最重要异常,骨髓增殖加病态造血是诊断MD-MPD的最有力证据。体会之五,ALL形态学诊断(尤其L1和L2)中,需要开展免疫化学染色,以区分B、T细胞;成熟B细胞肿瘤主要是形态学诊断。结论以WHO理念,摆正形态学与其他检查在诊断中的位置,按条件应用WHO分类的深度和广度,提高诊断水平以及对治疗和预后的评估力。

淋巴造血组织疾病专题网站的建设和应用

专题网站是围绕某一项或多项学习专题进行深入研究的资源学习型网站。联合病理科、口腔科、血液内科和放射科等多学科,共同进行淋巴造血组织疾病专题网站建设,包括专业医学版块、大众医学版块、网络教学版块和微信平台,为学生和患者提供丰富的最新资源,使学生可以不受时空限制、实现个性化学习,并对患者进行相应知识的普及。

皮肤以浆细胞为主的淋巴组织瘤样增生临床病理学分析

目的探讨皮肤以浆细胞为主的淋巴组织瘤样增生的临床病理特征。方法对1例皮肤以浆细胞为主的淋巴组织瘤样增生的临床表现,组织学特征,免疫表型进行分析。结果患者,女,18岁,右手腕部皮肤包块十年,显微镜下皮肤鳞状上皮角向下延伸,真皮层及皮肤附属器周围由小到中等大小淋巴样细胞和浆细胞浸润,免疫标记:LCA(+++),CD3、CD38,CD138、MUM-1(++),CD20散在阳性,CD30阴性,kappa、lambda均为散在阳性,呈多克隆表达,Ki-67增值指数<20%。结论皮肤以浆细胞为主的淋巴组织瘤样增生少见,良性,易误诊,应与皮肤性真淋巴瘤相鉴别,完整切除可治愈。

肿瘤内三级淋巴组织免疫治疗研究进展

三级淋巴组织常见于慢性炎症、自身免疫性疾病和肿瘤的病变组织局部。对疾病状态下机体的免疫调节发挥着重要作用。最近发现,肿瘤组织中成熟的三级淋巴结构能够募集T细胞并激活其抗肿瘤效应,但在三级淋巴组织形成的不同阶段,其对肿瘤的免疫抑制或耐受作用并不一致。因此,对肿瘤浸润的三级淋巴组织的发展阶段及其内部的免疫细胞群的动态变化进行分析、评估,可为免疫治疗策略提供一种有益借鉴。本文综述三级淋巴组织的免疫学特征、形成过程及临床相关性。

多脏器恶性肿瘤术后肝黏膜相关淋巴组织淋巴瘤

目的 探讨肝黏膜相关淋巴组织淋巴瘤的临床病理特征。方法 对 1例罕见多脏器恶性肿瘤术后肝黏膜相关淋巴瘤病例结合文献进行临床、病理和免疫组化分析。结果 患者于 8年和 3年前先后发生胃恶性间质瘤、阴囊阴茎皮肤湿疹样癌 ,有长期化疗史。肿瘤组织学以单核样B细胞为主 ,并有淋巴滤泡和淋巴上皮病变形成。免疫表型示瘤细胞CD4 5、CD79α、CD2 0阳性 ,CD5、CD10、ALK、TdT阴性 ,bcl 2、Ki 6 7少数肿瘤细胞阳性。结论 肝黏膜相关淋巴瘤可以发生于多脏器恶性肿瘤术后 ,其发病可能与长期使用免疫抑制剂有关 。

宫颈癌细胞接种后小鼠淋巴组织的免疫形态学研究

在小鼠接种小鼠宫颈未分化鳞状细胞癌14号(U_(14)细胞)后的25 d时间中,动态地观察了宿主淋巴组织的重量、组织学和组织化学变化。结果发现,5～15 d细胞免疫增强,10 d最强,20d减弱。体液免疫增强从10 d后开始并持续到实验结束,20 d反应最强。提示U_(14)细胞能诱导宿主产生免疫应答,早期以细胞免疫为主,后期以体液免疫为主。

儿童恶性血液病合并医院获得性肺炎的抗生素疗效分析

目的:探讨美罗培南和哌拉西林/他唑巴坦在治疗恶性血液病患儿合并医院获得性肺炎抗生素的疗效,并对其进行安全性分析,为临床用药提供参考。方法:采用回顾性调查分析自2017年1月至2019年9月期间共60例恶性血液病患儿合并医院获得性肺炎的临床资料,根据所用抗生素种类不同分为观察组和对照组。观察组应用美罗培南,共34例;对照组应用哌拉西林/他唑巴坦,共26例;观察两种抗生素的临床疗效及不良反应。结果:两组患儿治疗总有效率观察组为75.3%、对照组为53.8%,两组差异无统计学意义。结论:美罗培南及哌拉西林/他唑巴坦治疗恶性血液病合并医院获得性肺炎在疗效上没有明显差异,均在临床治疗中不良反应较少。

PAX-5在非淋巴造血系统肿瘤中的研究进展

PAX-5基因是PAX基因(paired box gene)家族的一员,其编码的蛋白被称为B细胞特异性激活蛋白(B cell specif ic activator protein,BSAP),在B细胞的生长和发育过程中具有重要的作用。PAX-5在B淋巴细胞及其来源的肿瘤中可高表达,尤其是B淋巴母细胞淋巴瘤,是一种用于淋巴造血系统肿瘤诊断与鉴别诊断的可靠标志物。近年来研究发现PAX-5可在淋巴造血系统外的恶性肿瘤中异常表达,例如神经内分泌肿瘤(Merkel细胞癌、小细胞癌和大细胞神经内分泌癌、胃肠道神经内分泌肿瘤)、乳腺癌、肝细胞癌、膀胱癌、星形细胞瘤、髓母细胞瘤、口腔鳞状细胞癌等,造成某些淋巴造血系统肿瘤诊断及鉴别诊断的困难,而且PAX-5与某些恶性肿瘤的进展、转移及预后有关。因此,研究PAX-5在非淋巴造血系统肿瘤中的表达具有重要意义。