CAJ | 학술논문

目的分析黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)的临床病理、免疫表型和基因重排特点,提高对该病的认识.方法回顾性分析1984年1月至2003年6月西南医院收治的35例胃MALT淋巴瘤患者的临床资料,对其病理检查标本进行病理形态学分型,采用免疫组织化学法测定其免疫表型和PCR方法检测其免疫球蛋白H(IgH)重链基因重排.应用χ2检验和Mann-Whitney U检验分析结果.结果胃MALT淋巴瘤患者临床表现上腹不适、腹痛等消化道症状,没有特异性表现.40岁以上患者占74%(26/35).32例为低分化,3例为高分化.31例为Ⅰ E期,2例为ⅡE1期,2例为Ⅳ期.病理检查结果发现胃MALT淋巴瘤细胞主要由中心细胞样细胞伴单核样B细胞或伴淋巴浆细胞组成.83%(29/35)的标本呈淋巴上皮样病变,6%(2/35)的标本有滤泡植入表现,33%(11/33)的标本有上皮下浆细胞浸润带.35例胃MALT淋巴瘤标本均为B细胞表型,19例有轻链限制性表达.16例Bcl-2呈阳性表达.增殖细胞核抗原在伴有转化的胃MALT淋巴瘤中呈高表达,提示伴有转化的胃MALT淋巴瘤增殖活性明显高于低度恶性者.33例IgH重链基因扩增出重排条带,阳性检出率为94%(33/35).结论胃MALT淋巴瘤临床表现以消化道症状为主,发病率随年龄增加而升高,病理检查可以进行初步诊断,免疫组织化学检查可以进行鉴别诊断,IgH重链基因重排可以作为辅助检查.
목적 분석점막상관림파조직림파류(MALT림파류)적림상병리、면역표형화기인중배특점,제고대해병적인식.방법 회고성분석1984년1월지2003년6월서남의원수치적35례위MALT림파류환자적림상자료,대기병리검사표본진행병리형태학분형,채용면역조직화학법측정기면역표형화PCR방법 검측기면역구단백H(IgH)중련기인중배.응용χ2검험화Mann-Whitney U검험분석결과.결과위MALT림파류환자림상표현상복불괄、복통등소화도증상,몰유특이성표현.40세이상환자점74%(26/35).32례위저분화,3례위고분화.31례위Ⅰ E기,2례위ⅡE1기,2례위Ⅳ기.병리검사결과발현위MALT림파류세포주요유중심세포양세포반단핵양B세포혹반림파장세포조성.83%(29/35)적표본정림파상피양병변,6%(2/35)적표본유려포식입표현,33%(11/33)적표본유상피하장세포침윤대.35례위MALT림파류표본균위B세포표형,19례유경련한제성표체.16례Bcl-2정양성표체.증식세포핵항원재반유전화적위MALT림파류중정고표체,제시반유전화적위MALT림파류증식활성명현고우저도악성자.33례IgH중련기인확증출중배조대,양성검출솔위94%(33/35).결론 위MALT림파류림상표현이소화도증상위주,발병솔수년령증가이승고,병리검사가이진행초보진단,면역조직화학검사가이진행감별진단,IgH중련기인중배가이작위보조검사.
Objective To analyze the clinicopathological characteristics, immunophenotypes and immu-noglobulin heavy chain gene rearrangement of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Methods The clinical data of 35 patients with gastric MALT lymphoma who had been admitted to Southwest Hospital from January 1984 to June 2003 were retrospectively analyzed. The specimens of the gastric MALT lymphoma were obtained and their pathomorphological classifications were studied. The immunophenotypes and immunoglobulin heavy chain gene rearrangement were detected by immunohistochemistry and polymerase chain reaction, respectively. All the data were analyzed by chi-square test and Mann-Whitney U test. Results The main manifestations of patients with gastric MALT lymphoma were epigastric discomfort and abdominalgia. The percentage of patients with age≥40 accounted for 74% (26/35). The gastric MALT lyrnphoma has low differentia-tion in 32 patients, and high differentiation in 3 patients. There were 31 patients in Ⅰ E stage, 2 in Ⅱ E1 stage and 2 in Ⅳ stage. Pathological examination showed that gastric MALT lymphoma was composed of centrocyte-like cells and mononuclear-like B cells or lymphoplasma cells. Twenty-nine specimens were with lymphoepithelial lesions (83%), 2 with follicular colonization (6%), and 11 with plasma cells segregated beneath the surface epithelium (33%). All the 35 specimens were B cell immunotype. Restrictive expression of κ and λ light chains of the immunoglobulin was found in 19 cases, and Bcl-2 positive expression was found in 16 cases. High expres-sion of proliferating cell nuclear antigen was found in gastric MALT lymphoma with transformed blasts, which indicated that gastric MALT lymphoma with transformed blasts was more active in proliferation than those of low grade. A monoclonal pattern of immunoglobulin heavy chain gene rearrangement was detected in 33 patients (94%). Conclusions Digestive symptoms are the main manifestations of patients with gastric MALT lymphoma. The incidence of gastric MALT lymphoma increases with age. The final diagnosis of gastric MALT lymphoma depends on the pathological, immunohistochemical examination and laboratory test.