论文部分内容阅读
目的 探讨胃粘膜相关淋巴组织（ＭＡＬＴ）淋巴瘤的内镜和病理特点，以提高其在内镜下的确诊率。方法 回顾性结合部分前瞻性分析２８例患者。结果 胃ＭＡＬＴ淋巴瘤多见于４０～６０岁患者，确诊病程的中位数为８．５月。临床症状无特异性，抗酸剂治疗无效，２５％可引起上消化道出血。Ｈｐ感染率为７８．６％，１０．７％患者的ＣＡ １２５可升高，１７．９％患者的 ＥＳＲ升高。高度恶性者可发生浸润或转移。肿瘤多位于胃体下段和／或胃窦部，占９６．４％，７５％表现为单个或多个浅表性溃疡，质地偏硬，但大部分患者的粘膜尚可稍提起，少见的病变有稍隆起性、糜烂和坏死性病变。胃镜下形态诊断的误诊率为８９．３％。胃镜下常规活检组织病理检查，恶性疾病漏诊率为５７．１％，而胃ＭＡＬＴ淋巴瘤的漏诊率为８２．ｌ％，术后病理检查确诊率达１００％。深而大的活检和免疫组织化学检查有助于确诊。Ｂ细胞淋巴瘤占８８．９％，Ｔ细胞淋巴瘤占１１．ｌ％。结论 胃ＭＡＬＴ淋巴瘤是一类独特的原发性胃淋巴瘤，具有一定的病理和内镜特点。
Objective To investigate the endoscopic and pathological features of gastric mucosa-associated lymphoid tissue (MALT) lymphoma in order to increase its final diagnosis rate. Methods Retrospectively combined partial prospective analysis of 28 patients. Results Gastric MALT lymphoma was more common in patients aged 40-60 years. The median duration of diagnosis was 8.5 months. No specific clinical symptoms, antacid treatment is ineffective, 25% can cause upper gastrointestinal bleeding. The Hp infection rate was 78.6%, CA125 in 10.7% of patients increased, and ESR in 17.9% of patients increased. Highly malignant may have infiltration or metastasis. The tumors were located in the lower part of the stomach and/or gastric antrum, accounting for 96.4%, 75% showed single or multiple superficial ulcers, and the texture was hard, but most of the patients’ mucosa was still slightly lifted. Uncommon lesions Slightly elevated, erosion and necrotic lesions. The misdiagnosis rate of morphological diagnosis under gastroscope was 89.3%. The pathological examination of conventional biopsy under gastroscope showed that the missed diagnosis rate of malignant disease was 57.1%, while the missed diagnosis rate of gastric MALT lymphoma was 82. l%, the pathological examination confirmed the rate of 100%. Deep and large biopsy and immunohistochemical examinations help confirm the diagnosis. B-cell lymphoma accounted for 88.9%, T-cell lymphoma accounted for 11. l%. Conclusion Gastric MALT lymphoma is a unique type of primary gastric lymphoma with certain pathological and endoscopic features.