原发性胃肠道淋巴瘤的临床、内镜及组织病理学特点分析（附41例报告）

Analysis of clinical, endoscopic and pathological features of primary gastrointestinal lymphoma (41 cases)

摘要:

目的 探讨原发性胃肠道淋巴瘤（PGIL）的临床、内镜及组织病理学特点，以提高其诊治水平。方法 回顾性分析2008年1月－2019年12月该院经内镜或手术活组织病理检查确诊的41例PGIL患者的临床、内镜及组织病理学特点。结果 病变部位依次为胃（73.2%）、小肠（12.2%）、结肠（9.8%）和直肠（4.8%）。患者临床表现无特异性，主要症状为腹痛、腹胀、食欲减退和消瘦等。最常见的病理类型为弥漫性大B细胞淋巴瘤（DLBCL）（61.0%），其次为黏膜相关淋巴组织（MALT）淋巴瘤（34.2%）。胃淋巴瘤肉眼形态以溃决型最多（36.7%），其次为隆起型、表层型和溃疡型等；小肠淋巴瘤肉眼形态以溃疡型最多（60.0%），其次为隆起型和多发性淋巴瘤性息肉病（MLP）型；大肠淋巴瘤肉眼形态以隆起型最多（83.3%）。结论 PGIL好发于老年患者，女性略多于男性，临床表现缺乏特异性，腹痛和腹胀为最常见症状。内镜下病灶形态多样，肉眼形态和病变部位与病理类型相关。其中，DLBCL为最常见的病理类型。

Abstract:

Objective To explore the clinical, endoscopic, and pathological characteristics of primary gastrointestinal lymphoma (PGIL), and improve the level of diagnosis and treatment.Methods Forty-one patients who were confirmed as primary gastrointestinal lymphoma with endoscopic biopsy or operation pathology from January 2008 to December 2019 were retrospectively analyzed with respects of clinical, endoscopic and pathological features.Results The lesion sites of PGIL were stomach (73.2%), small intestine (12.2%), colon (9.8%) and rectum (4.8%). The clinical manifestations of the disease are non-specific, and the main symptoms are abdominal pain, bloating, loss of appetite, and weight loss. The most common pathological type is diffuse large B-cell lymphoma (DLBCL) (61.0%), followed by mucosal associated lymphoid tissue (MALT) lymphoma (34.2%). The most common gross morphology of gastric lymphoma is breaching type (36.7%), followed by protuberance, superficial and ulcer type. The most common gross morphology of small bowel lymphoma is ulcer type (60.0%), followed by protuberance type and multiple lymphoma polyposis type. The most common gross morphology of colorectal lymphoma is protuberance type (83.3%).Conclusion PGIL is more common in elderly patients and slightly more common among females. The clinical manifestations of the disease lack specificity. Abdominal pain and bloating are the most common symptoms. The gross morphology and location of the disease are related to histopathological type, and DLBCL is the most common pathological type.