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 appearance...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.展开更多
目的探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。方法回顾性分析四川大学华西医院消化内镜中心2010年1月-2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。结果 38例患者...目的探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。方法回顾性分析四川大学华西医院消化内镜中心2010年1月-2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。结果 38例患者,男18例,女20例,年龄8～80岁;病变下缘距肛门齿状线1～4.0 cm24例,侵及齿状线14例。病变大小(按病变最大径分类):1.5～3.0 cm 12例,3.1～4.0 cm 8例,4.1～5.0 cm4例,5.1～7.0 cm 10例,10 cm 4例。病变直径在5.0 cm以下的24例患者,经首次手术治疗肿瘤完整切除,术后2例灶性癌变,追加外科手术;其余22例2个月复查,病变无残留,6个月复查,2例复发,经再次手术病变完整切除。随访1年,全部未见复发,治愈率为100%,无残留。病变直径5.1～7.0cm的10例患者,经首次手术治疗肿瘤分次切除,2个月复查,6例病变完整切除无残留,6个月复查,其中2例复发,经再次内镜下手术切完病变,随访1年,无复发;另4例有残留,经再次内镜下手术切完病变,6个月复查无复发,随访1年,4例均未见复发。病变直径10 cm的4例患者,经多次手术后复查均有病变残留,无法完全切除,患者拒绝外科手术。5.1 cm以上病变治愈率71.43%,残留率高达57.14%。本组术后出血16例,感染1例,直肠狭窄1例,肛门坠胀3例,无穿孔发生。结论内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效,对5.0 cm以下病变能一次完整切除,5.1 cm以上病变残留率高,需再次内镜下手术,10 cm以上病变切除不完全。应慎重选择病例,术后密切随访。展开更多
文摘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.
文摘目的探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。方法回顾性分析四川大学华西医院消化内镜中心2010年1月-2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。结果 38例患者,男18例,女20例,年龄8～80岁;病变下缘距肛门齿状线1～4.0 cm24例,侵及齿状线14例。病变大小(按病变最大径分类):1.5～3.0 cm 12例,3.1～4.0 cm 8例,4.1～5.0 cm4例,5.1～7.0 cm 10例,10 cm 4例。病变直径在5.0 cm以下的24例患者,经首次手术治疗肿瘤完整切除,术后2例灶性癌变,追加外科手术;其余22例2个月复查,病变无残留,6个月复查,2例复发,经再次手术病变完整切除。随访1年,全部未见复发,治愈率为100%,无残留。病变直径5.1～7.0cm的10例患者,经首次手术治疗肿瘤分次切除,2个月复查,6例病变完整切除无残留,6个月复查,其中2例复发,经再次内镜下手术切完病变,随访1年,无复发;另4例有残留,经再次内镜下手术切完病变,6个月复查无复发,随访1年,4例均未见复发。病变直径10 cm的4例患者,经多次手术后复查均有病变残留,无法完全切除,患者拒绝外科手术。5.1 cm以上病变治愈率71.43%,残留率高达57.14%。本组术后出血16例,感染1例,直肠狭窄1例,肛门坠胀3例,无穿孔发生。结论内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效,对5.0 cm以下病变能一次完整切除,5.1 cm以上病变残留率高,需再次内镜下手术,10 cm以上病变切除不完全。应慎重选择病例,术后密切随访。
