Nomogram model predicting the overall survival for patients with primary gastric mucosa-associated lymphoid tissue lymphoma

BACKGROUND Increasingly extranodal marginal B-cell lymphoma of mucosa-associated lymphoid tissue,known as mucosa-associated lymphoid tissue(MALT)lymphoma,is a type of non-Hodgkin’s lymphoma.The prognosis of primary gastric MALT(GML)patients can be affected by many factors.Clinical risk factors,including age,type of therapy,sex,stage and family hematologic malignancy history,also have significant effects on the development of the disease.The available data are mainly focused on epidemiology;in contrast,few studies have investigated the prognostic variables for overall survival(OS)in patients with primary GML.Based on the realities above,we searched a large amount of data on patients diagnosed with primary GML in the Surveillance,Epidemiology and End Results(SEER)database.The aim was to develop and verify a survival nomogram model that can predict the overall survival prognosis of primary GML by com-bining prognostic and determinant variables.AIM To create an effective survival nomogram for patients with primary gastric GML.METHODS All data of patients with primary GML from 2004 to 2015 were collected from the SEER database.The primary endpoint was OS.Based on the LASSO and COX regression,we created and further verified the accuracy and effectiveness of the survival nomogram model by the concordance index(C-index),calibration curve and timedependent receiver operating characteristic(td-ROC)curves.RESULTS A total of 2604 patients diagnosed with primary GML were selected for this study.A total of 1823 and 781 people were randomly distributed into the training and testing sets at a ratio of 7:3.The median follow-up of all patients was 71 mo,and the 3-and 5-year OS rates were 87.2%and 79.8%,respectively.Age,sex,race,Ann Arbor stage and radiation were independent risk factors for OS of primary GML(all P<0.05).The C-index values of the nomogram were 0.751(95%CI:0.729-0.773)and 0.718(95%CI:0.680-0.757)in the training and testing cohorts,respectively,showing the good discrimination ability of the nomogram model.Td-ROC curves and calibration plots also indicated satisfactory predictive power and good agreement of the model.Overall,the nomogram shows favorable performance in discriminating and predicting the OS of patients with primary GML.CONCLUSION A nomogram was developed and validated to have good survival predictive performance based on five clinical independent risk factors for OS for patients with primary GML.Nomograms are a low-cost and convenient clinical tool in assessing individualized prognosis and treatment for patients with primary GML.

The Value of Multiple Imaging Methods in Primary Gastric Lymphoma

Primary gastric lymphoma (PGL) is the most common type of extranodal lymphoma that originates from the lymphatic tissue within the gastric submucosa. In the past two decades, the treatment of PGL has been overturned from surgery to non-surgical individualized treatment, and its treatment and prognosis are different from those of other malignant lesions in the stomach, so early diagnosis, accurate staging, and timely monitoring of outcome are extremely important. Unlike intra-nodal lymphoma, PGL can be evaluated by endoscopy, endoscopic ultrasound and gastric ultrasound, in addition to conventional imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT), which are specific to the gastrointestinal tract. This article introduces the application of various imaging modalities in the management of primary gastric lymphoma. .

Helicobacter pylori eradication treatment for primary gastric diffuse large B-cell lymphoma:A single-center analysis

BACKGROUND Unlike the already established effect of Helicobacter pylori(H.pylori)eradication on gastric mucosa-associated lymphoid tissue(MALT)lymphoma,its therapeutic effect on primary gastric diffuse large B-cell lymphoma(DLBCL)is still unclear.AIM To clarify the efficacy of H.pylori eradication treatment for primary gastric DLBCL.METHODS We reported on 3 new cases,and added them to 3 previously reported cases.We analyzed the usefulness of H.pylori eradication treatment for gastric DLBCL for a total of 6 cases at our center.RESULTS Of the 6 patients(27-90 years old,3 males and 3 females),all 3 patients with single lesions(one transformed from MALT lymphoma)achieved complete remission(CR)after H.pylori eradication.Regarding the 2 newly reported cases,CR was maintained for more than 6 years with eradication treatment alone.In contrast,none of the 3 patients with 2 lesions achieved CR.In 1 newly reported case,endoscopic CR was achieved in one lesion,while stable disease was obtained in the other lesion.Two patients with progressive disease responded to standard chemo therapy±radiation and remained in CR for more than 6 years.CONCLUSION We believe it is worthwhile to attempt H.pylori eradication for elderly patients with primary gastric DLBCL in a single lesion with a small tumor burden.

Clonal immunoglobulin heavy chain and T-cell receptor γ gene rearrangements in primary gastric lymphoma

AIM:To study the diagnostic value of immunoglobulin heavy chain(IgH)and T-cell receptorγ (TCR-γ)gene monoclonal rearrangements in primary gastric lymphoma(PGL).METHODS:A total of 48 patients with suspected PGL at our hospital were prospectively enrolled in this study from January 2009 to December 2011.The patients were divided into three groups(a PGL group,a gastric linitis plastica group,and a benign gastric ulcer group)based on the pathological results(gastric mucosal specimens obtained by endoscopy or surgery)and follow-up.Endoscopic ultrasonography(EUS)and EUSguided biopsy were performed in all the patients.The tissue specimens were used for histopathological examination and for IgH and TCR-γ gene rearrangement polymerase chain reaction analyses.RESULTS:EUS and EUS-guided biopsy were successfully performed in all 48 patients.In the PGL group(n=21),monoclonal IgH gene rearrangements were detected in 14(66.7%)patients.A positive result for each set of primers was found in 12(57.1%),8(38.1%),and 4(19.0%)cases using FR1/JH,FR2/JH,and FR3/JH primers,respectively.Overall,12(75%)patients with mucosal-associated lymphoid tissue lymphoma(n=16)and 2(40%)patients with diffuse large B-cell lymphoma(n=5)were positive for monoclonal IgH gene rearrangements.No patients in the gastric linitis plastica group(n=17)and only one(10%)patient in the benign gastric ulcer group(n=10)were positive for a monoclonal IgH gene rearrangement.No TCRgene monoclonal rearrangements were detected.The sensitivity of monoclonal IgH gene rearrangements was 66.7%for a PGL diagnosis,and the specificity was96.4%.In the PGL group,8(100%)patients with stage IIE PGL(n=8)and 6(46.1%)patients with stage IE PGL(n=13)were positive for monoclonal IgH gene rearrangements.CONCLUSION:IgH gene rearrangements may be associated with PGL staging and may be useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica.

Primary gastric non-Hodgkin lymphomas:Recent advances regarding disease pathogenesis and treatment

Primary gastric lymphomas(PGLs)are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly.Their main histological types are diffuse large B-cell lymphoma(DLBCL)or mucosaassociated lymphoma tissue.PGL has been one of the main fields of clinical research of our group in recent years.Although gastric DLBCLs are frequent,sufficient data to guide optimal care are scarce.Until today,a multidisciplinary approach has been applied,including chemotherapy,surgery,radiotherapy or a combination of these treatments.In this minireview article,we provide an overview of the clinical manifestations,diagnosis and staging of these diseases,along with their molecular pathogenesis and the most important related clinical published series.We then discuss the scientific gaps,perils and pitfalls that exist regarding the aforementioned studies,in parallel with the unmet need for future research and comment on the proper methodology for such retrospective studies.Aiming to fill this gap,we retrospectively evaluated the trends in clinical presentation,management and outcome among 165 patients with DLBCL PGL who were seen in our institutions in 1980-2014.The study cohort was divided into two subgroups,comparing the main 2 therapeutic options[cyclophosphamide doxorubicin vincristine prednisone(CHOP)vs rituximab-CHOP(R-CHOP)].A better outcome with immunochemotherapy(R-CHOP)was observed.In the next 2 mo,we will present the update of our study with the same basic conclusion.

EXPRESSION OF PTEN AND CASPASE-3 AND THEIR CLINICOPATHOLOGICAL SIGNIFICANCE IN PRIMARY GASTRIC MALIGNANT LYMPHOMA

Objective To investigate the expression of PTEN and Caspase-3 in malignant lymphoma of the stomach and explore their role in progression of primary gastric malignant lymphoma. Methods Formalin-fixed paraffin embedded tissues from 56 cases of primary gastric malignant lymphoma and their adjacent non-tumor mucosa were evaluated for PTEN and Caspase-3 protein ex-pression by streptavidin-biotin-complex (SABC) immunohistochemistry. Their expression was compared with clinical tumor parameters with the relationship between PTEN and Caspase-3 expression concerned as well. Results The positive rate of PTEN expression in primary gastric lymphomas(50.0%, 28/56) was significantly lower than that in adjacent non-tumor gastric mucosa(96.4%, 27/28)(P < 0.05). Meanwhile,43 of 56(76.8%)gastric lymphomas indicated Caspase-3 expression, less than that in adjacent non-tumor mucosa (93.5%, 29/31) (P < 0.05). The expression of PTEN was negatively correlated with invasion and lymph node metastasis of gastric lymphoma(P < 0.05), while the Caspase-3 expression was negatively associated with the latter one(P < 0.05). Additionally, the PTEN expression was posi-tively correlated with Caspase-3 expression in the primary gastric malignant lymphoma(P < 0.05). Conclusions The down-regulated expression of PTEN and Caspase-3 played an important role in progression of primary malignant gastric lymphoma. PTEN, as a molecular marker of pathobiological behaviors of tumor, contributes to tumor progression by increasing cell mobility and angiogenesis, as well as decreasing cell adhesion and apoptosis.

Laparoscopic resection of synchronous gastric cancer and primary small intestinal lymphoma: A case report

Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchronous cancer. During hospitalization, the patient underwent laparoscopic distal gastrectomy + resection of bilateral ovaries + partial resection of both small intestine and descending colon. Pathological examination revealed a synchronous cancer consisting of early gastric cancer with poorly differentiated adenocarcinoma located in mucosa, with lymph node metastasis (3+/29) (T1N1M0, stage IB); and diffuse large B cell lymphoma of small intestine involving descending colon and bilateral ovaries, with lymph node metastasis (2+/5) (Ann Arbor IIE). The patient recovered well, without any obvious complications and was discharged on post-operative day 7. The patient received six cycles of chemotherapy after operation. She has been doing well with no evidence of recurrence for 13 mo.

Individualized Treatment and Palliative Care for A90-Year-Old Patient with Primary Gastric Diffuse Large-B Cell Lymphoma:4 Year Follow-up and Inspiration

A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.

Current Treatment and Controversy of Primary Gastric Lymphoma

Primary gastric lymphoma (PGL) is not a common cancer and account for 10% of malignant lymphoma and 5% of gastric cancer. The correlation with Helicobacter pylori (H. pylori) infection with mucosa associated lymphoepithelial tumor (MALT) is now well documented and some of the low grade MALT can be cured sorely by triple agent eradication therapy. The most common type of PGL is diffuse large B cell lymphoma which now can be successfully treated with chemotherapy alone. There is still no consensus on the optimal treatment for PGL. In the recent 10 years chemotherapy combined with anti-CD 20 monoclonal antibody such as rituximab, achieved higher complete response rate and more than 80% are long-term survival. The so-called R-CHOP (rituximab, cyclophosphamide, vincristin, prednisolone) now become the new gold standard therapy. The role of surgical resection prior to chemotherapy is controversial and not commonly applied in recent publications. Yet some cases of suboptimal response to R-CHOP or patient is too fragile to tolerate the immuno-chemotherapy will be feasible to surgical resection as a salvage or alternative therapy. The radiotherapy as an adjuvant therapy is less commonly considered. Patients with advanced PGL with high international prognostic index risk and along with co-morbidity diseases are prone to get treatment related complications from above-mentioned modality of treatment, such as GI perforation, neutropenic septicemia, pulmonary infection, fulminate heaptitis B reactivation, respiratory and cardiac impairment can be seen.

原发性胃淋巴瘤的诊断难点及治疗进展

原发性胃淋巴瘤(PGL)是除胃癌外最常见的胃恶性肿瘤,大多无特异临床症状,所以通常不能被准确诊断,易出现误诊和漏诊。主要治疗方法包括手术、放射治疗、化学药物治疗和靶向治疗,免疫治疗有望成为其潜在治疗方式。了解其诊断过程中存在的难点是准确诊断的保障,也是后续精准治疗的基础。

原发胃弥漫大B细胞淋巴瘤的特点与预后研究

目的开展原发胃弥漫大B细胞淋巴瘤(PG-DLBCL)的临床及病理特征的回顾性队列研究,探究影响其疗效及预后的临床因素,特别是炎症及营养指标。方法纳入2010年1月至2021年1月于空军军医大学西京医院诊疗的PG-DLBCL患者,分析其病理和临床特征对无进展生存时间(PFS)和总生存时间(OS)的影响。采用Kaplan-Meier生存曲线进行单因素生存分析,以及Cox比例风险模型进行多因素生存分析。结果本研究共纳入84例PG-DLBCL患者,其中位PFS为39.5个月,5年PFS率为59.6%;中位OS为48个月,10年OS率为70.1%。单因素生存分析显现出PG-DLBCL病患的PFS预后影响因素包括病理分型、大体类型、淋巴结外病灶数目、Ann Arbor分期、Lugano分期、体力活动状态(PS)评分、淋巴瘤的国际预后(IPI)评分、血清乳酸脱氢酶(LDH)、β2微球蛋白(β2-MG)、衍生中性粒细胞/淋巴细胞比值(dNLR)、系统炎症反应指数(SIRI)、β2微球蛋白/淋巴细胞比值(βLR)、乳酸脱氢酶/淋巴细胞比值(LLR)及预后营养指数(PNI);OS的预后因素包括大体类型、淋巴结外病灶的数目、Lugano分期、Ann Arbor分期、PS评分、IPI评分、LDH、淋巴细胞/单核细胞比值(LMR)、SIRI、βLR、LLR、PNI及营养控制状态(CONUT)评分。多因素生存分析提示患者PFS的独立危险因素包括Lugano分期、PS评分、IPI评分、β2-MG升高及SIRI,OS的独立危险因素包括Lugano分期、PS评分、IPI评分及SIRI。结论Lugano分期能更好地预测PG-DLBCL病患的预后;治疗应以化疗为主;dNLR、LMR、SIRI、PNI、βLR、LLR及CONUT评分为PG-DLBCL患者的简便且有意义的炎症及营养预后指标,其中SIRI对预后的预测价值更高,可能是一种新型预后指标。

原发性胃淋巴瘤的内镜超声检查影像特征分析

目的分析、总结原发性胃淋巴瘤(PGL)的内镜超声检查术(EUS)的影像特征,提高对PGL的诊断水平。方法分析诊断明确的PGL患者在内镜和超声影像学方面的图像,以及在治疗和随访过程中内镜和超声影像学方面动态变化,总结其在诊断和鉴别诊断方面的影像特征。结果经EUS并且病理明确诊断为PGL者24例。病变表现为溃疡型14例,结节型5例,浸润型3例和糜烂型2例。病灶位于胃窦5例,胃窦体7例,胃体8例,胃体底4例。病变浸润至黏膜下层12例,浸润至肌层7例,全层浸润5例。胃周淋巴结浸润5例。治疗后其中15例患者进行了EUS的复查和随访。结论掌握EUS的内镜和超声影像特征可以提高对PGL的诊断和鉴别诊断水平;EUS对PGL的疗效评估和复发随访具有不可替代的作用。

50例胃原发性恶性淋巴瘤临床特点分析

目的：探讨原发性胃淋巴瘤的临床特点，提高原发性胃淋巴瘤的诊治水平。方法：回顾性分析中南大学湘雅医院肿瘤科2005年9月至2009年9月收治的50例胃原发性恶性淋巴瘤。结果：原发性胃恶性淋巴瘤临床表现包括腹痛、上腹部不适、呕吐、黑便、食欲减退、发热、乏力、消瘦等，其中最主要临床表现为腹痛。50例胃原发性恶性淋巴瘤中，1例为外周T细胞性淋巴瘤；49例为B细胞性淋巴瘤，其中弥漫大B细胞性淋巴瘤（diffuse largeBcelllymphoma，DLBCL）34例，黏膜相关淋巴组织淋巴瘤（mucosaassociatedlymphoidtissuelymphoma，MALT）13例，DLBCL合并MAIT淋巴瘤2例。50例胃原发淋巴瘤患者中共12例接受手术治疗，所有患者均接受化学治疗。49例DLBCL患者中14例接受利妥昔单抗联合化学治疗，3s例单纯化学治疗，利妥昔单抗联合化学治疗患者的2年总生存率优于单纯化学治疗患者（85．7％vs77．1％，P〈0．05）。临床分期Ⅰ-Ⅱ期的患者2年总生存率优于临床分期Ⅲ～Ⅳ期的患者（90．9％VS71．4％，P〈0．05）。结论：原发性胃恶性淋巴瘤患者临床表现以消化道症状为主，但无特异性，腹痛是最常见的表现。临床以组织病理检查为金标准，最常见病理类型为DLBCL。治疗选择以化学治疗为主的综合治疗，患者预后与临床分期、是否联合美罗华化学治疗相关。治疗后s0例患者的2年总生存率达80．0％。

126例原发胃弥漫大B细胞淋巴瘤的临床特点及预后分析

目的：分析胃弥漫大B细胞淋巴瘤（DLBCL）的临床特点和预后,以期更好的指导治疗。方法：回顾性收集1999年1月至2012年3月中国医学科学院肿瘤医院收治的初治、胃原发DLBCL患者的临床资料,分析其人口学特点、分期、病理诊断、并发症、治疗和预后等特征。结果：共计纳入研究患者126例,中位年龄49（16~81）岁,男女比例为68：58。病理诊断为单纯DLBCL 96例、MALT伴大B细胞转化27例、伴浆样细胞分化3例。早期患者114例（90.5%）,其治疗方式包括单纯化疗37例、化疗＋放疗39例、手术＋化疗±放疗38例。中位随访48个月,全组患者PFS和OS分别为75.6%和82.7%,早期和晚期患者的PFS分别为77%和41.7%（P=0.005）。早期患者采用单纯化疗、化放疗联合和含手术治疗的PFS分别为67.3%、77.8%和77.8%（P=0.588）。国际预后指数（IPI）评分为0分、1分和〉1分患者的PFS分别为85.4%,74.4%和55.6%（P=0.011）。Ⅰ期和Ⅱ期患者的PFS分别为81.2%和66.1%（P=0.018）。LDH正常和升高患者的PFS分别为86.6%和63.3%（P=0.006）。病理类型为单纯DLBCL和含有MALT成分、生发中心（GCB）和非生发中心（non-GCB）、年龄〉60岁等与预后无关。结论：早期病变比例占胃原发DLBCL患者的绝大多数。早期患者预后良好,手术切除并不能提高疗效。早期患者中IPI〉1分、LDH升高和临床分期Ⅱ期提示预后不良。

胃淋巴瘤的^(18)F-FDG PET/CT表现与鉴别诊断-与胃癌比较

目的通过比较分析原发性胃淋巴瘤与胃癌的18F-FDG PET/CT影像学特点,分析其对二者的诊断和鉴别诊断价值。方法回顾性分析经胃镜活检病理证实的13例胃淋巴瘤患者和43例胃癌患者的PET-CT图像,对病灶的最大厚度Suvmax值,CT值及肝脏CT值进行统计学对比分析。结果胃淋巴瘤及胃癌的PET/CT均可表现以不同形式的胃壁增厚和显著增高的FDG代谢为主要特征,13例胃淋巴瘤患者中,4例(30.8%)呈Ⅰ型表现(胃壁弥漫性增厚伴FDG代谢显著增高),8例(61.5%)呈Ⅱ型表现(胃壁节段性增厚伴FDG代谢显著增高),1例(7.7%)呈Ⅲ型表现(胃壁局限性增厚伴FDG代谢增高);SUVmax范围2.3～53.5,平均SUVmax=16.0;PET/CT评价:6例仅累及胃壁,4例累及胃壁和淋巴结,3例累及胃壁、淋巴结和其它脏器。43例胃癌患者中,2例(4.7%)呈Ⅰ型表现(胃壁弥漫性增厚伴FDG代谢显著增高),26例(60.5%)呈Ⅱ型表现(胃壁节段性增厚伴FDG代谢显著增高),15例(34.8%)呈Ⅲ型表现(胃壁局限性增厚伴FDG代谢增高);SUVmax范围2.6～34.6,平均SUVmax=8.9,与胃淋巴瘤比较,两者SUVmax有显著统计学差异(P<0.05)。PET/CT评价:16例仅累及胃壁,14例累及胃壁和淋巴结,13例累及胃壁、淋巴结和其它脏器。结论胃淋巴瘤的18F-FDG PET/CT表现以Ⅰ型和Ⅱ型更为多见,而胃癌则以Ⅱ型和Ⅲ型多见,且胃淋巴瘤SUVmax显著大于胃癌。因此,结合形态学和SUVmax有助于淋巴瘤与胃癌的诊断和鉴别诊断。

^(18)F-FDG PET/CT显像对胃部恶性肿瘤的鉴别诊断价值

目的探讨18F-FDG PET/CT显像对胃癌及原发性胃淋巴瘤(PGL)的鉴别诊断价值。方法选取2012年6月至2015年6月收治的93例胃癌(23例黏液腺癌及70例非黏液腺癌)及58例PGL[31例弥漫性大B细胞淋巴瘤(DLBCL)及27例黏膜相关组织淋巴瘤(MALT)]患者为研究对象,比较他们的临床资料、胃壁病灶的最大标准摄取值(SUVmax)、病灶最大厚度、CT值、病灶形态、合并脾肿大及肾门下淋巴结转移状况。采用Pearson相关分析SUVmax与病灶最大厚度的关系。结果胃癌组的平均年龄、病灶累及贲门的比例明显高于PGL组(P<0.05)。胃癌组的SUVmax及脾肿大发生率均显著低于PGL组(P<0.05)。病灶形态方面,胃癌组以Ⅱ型及Ⅲ型多见,而PGL组以Ⅰ型及Ⅱ型多见,两组比较有显著差异(P<0.05)。进一步分析表明DLBCL的SUVmax明显高于其他类型(P<0.05),病灶最大厚度明显大于胃黏液腺癌及MALT(P<0.05)。Pearson相关分析结果表明不同病理类型患者的SUVmax与病灶最大厚度之间均无显著相关(P>0.05)。结论 18F-FDG PET/CT检查在胃恶性肿瘤的鉴别诊断方面有重要意义,不同肿瘤、不同病理亚型患者在SUVmax、病灶最大厚度、病灶形态等方面有所不同。

42例原发性胃淋巴瘤的临床特点分析

目的:探讨原发性胃淋巴瘤(PGL)的临床特点,以期提高该病的诊治水平。方法:回顾性分析湖北医药学院附属太和医院2003年01月至2013年01月收治的42例原发性胃淋巴瘤患者的临床病理资料。结果:患者多以消化道症状为主要表现,腹痛最常见,占83.3%,其次为恶心、呕吐、黑便和腹部包块。胃镜诊断阳性率为46.1%,高于钡餐及CT,超声胃镜可以协助诊断。DLBCL是其最常见的病理类型。ⅠE期23例、ⅡE期11例、ⅢE期5例、ⅣE期3例。MALToma的预后与DLBCL无显著差异。LDH升高者预后较正常水平者差;ⅠE期、ⅡE期患者预后较ⅢE期、ⅣE期好。结论:PGL临床表现以消化道症状为主,胃镜检查有利于诊断,治疗手段包括手术、化疗及放疗,选用CHOP化疗方案的患者联合美罗华预后较仅行CHOP方案好。

原发性胃淋巴瘤内镜下表现及误诊分析

目的:对内镜下原发性胃淋巴瘤的形态进行分析,以期提高内镜对胃淋巴瘤的诊断率.方法:收集近两年我院通过胃镜活检确诊的原发性胃淋巴瘤51例及内镜拟诊的"胃淋巴瘤"27例,比较其内镜特点,并采用Mann- Whitney U秩和检验进行比较.结果:51例确诊的原发性胃淋巴瘤以溃疡型33例(65%)和结节型12(23.5%)为主.27例拟诊组患者以结节型13例(48%)和黏膜粗大型10例(37%)为主,内镜下病变形态有显著性差异(P<0.001).而在病变的蠕动性及活检质地方面没有显著性差异(P>0.05).结论:原发性胃淋巴瘤的内镜下形态具有多型性,提高对其内镜下表现的认识并结合多取及深取活检对原发性胃淋巴瘤的术前确诊具有重要的意义.

多排螺旋CT在T3/T4期胃癌与胃淋巴瘤诊断中的应用价值

目的:分析探讨T3/T4进展期胃癌与胃淋巴瘤的CT增强扫描表现差异,提高胃部肿瘤、特别是进展期胃癌与胃原发性淋巴瘤的诊断水平。方法:回顾性分析经病理证实的46例进展期T3/T4胃癌和23例胃淋巴瘤的增强CT扫描资料。术前均采用多排螺旋CT平扫加多期增强扫描,图像行容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)后处理,并测量病变区域各期CT值,分析TNM分期以及肿瘤性质,并做统计学研究。结果:胃癌多发生于胃窦部,以溃疡型多见,其中以单发溃疡多见;而原发性胃淋巴瘤多发生于胃体、胃窦区,贲门及胃底比较少见,病变区常伴有多发溃疡或巨大结节。MSCT增强扫描胃癌强化程度高于胃原发性淋巴瘤,进展期胃癌及胃淋巴瘤的CT的三期强化值均存在显著统计学差异(P<0.01),术前二者鉴别的准确率为91.3%(63/69)。46例进展期胃癌的CT分期与TNM分期符合率为87.0%(40/46),进展期T3、T4胃癌TNM分期的CT三期强化值中,平扫及动脉期时无显著统计学差异(P>0.05),实质期存在显著统计学差异(P<0.05)。结论:MSCT能够全面细致地显示胃部病变的位置及范围,多期动态增强能较好地为临床提供诊断及治疗依据。

原发性胃恶性淋巴瘤的胃镜诊断

目的总结分析原发性胃恶性淋巴瘤(PGML)胃镜下特征及诊断要点,以提高胃镜对该病的诊断率。方法对24例经病理确诊的PGML临床、胃镜及病理资料进行分析。结果该组PGML患者临床症状无特异性。胃镜下主要表现为溃疡型15例,肿块型7例,弥漫浸润型2例,病变累及胃体14例,胃窦10例,多部位者8例。术前胃镜活检确诊者19例(79%)。结论PGML胃镜下具有病变范围广、病灶多发、形态多样的特点。胃镜活检是确诊PGML的主要手段,提高对该病的警惕和认识,掌握胃镜下活检技巧,可提高胃镜对PGML的诊断率。