原发性胃恶性淋巴瘤临床和病理特征分析

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1、-2007届临床七年制硕士研究生毕业论文2、3年生存率分别为87.9%、84.8%和81.2%。MALT淋巴瘤和DLBCML的生存率高于DLBCL，IE期病例的生存率高于II1E期以上者，术前LDH正常者生存率较LDH升高者高（p<0.05）。通过本研究发现，PMGL的发病年龄偏高，以老年为主。症状缺乏特异性。影像学检查对PMGL的确诊价值低。PMGL内镜下表现易与胃癌混淆，具有多形性、多灶性和弥漫性特点。胃窦部最常受累。胃镜活检病理检查对术前诊断PMGL至关重要，但确诊率不高。多点式、“挖洞”式活检，

2、结合免疫组化等相关辅助诊断技术可提高术前确诊率。各病理类型PMGL的生物学行为不同，肿瘤形态、浸润深度、临床分期和预后也不同。治疗方案应根据不同的病理类型、临床分期及Hp感染与否而制定。疾病预后主要与病理类型和临床分期有关，本研究提示术前LDH升高者预后不佳。关键词：原发性胃恶性淋巴瘤，临床表现，病理诊断，内镜检查---2007届临床七年制硕士研究生毕业论文THESTUDYOFCLINICALANDPATHOLOGICALFEATURESOFPRIMARYMALIGNANTGASTRICLYMPHOMA

3、ABSTRACTTheaimofthestudyistolearnmoreabouttheclinicalandpathologicalfeaturesofPMGL.Thirty-fivecasesofPMGLwereanalyzedretrospectively,whichwereadmittedinRenjiHospitalintheperiodfrom2000to2006.Allofthecasesunderwentexcisionandthenwereclassifiedhistological

4、lybyroutineHEstainingandimmunohistochemistry,accordingtoclassificationofneoplasticdiseaseofthehematopoieticandlymphoidtissuegrantedbyWHO(2001).ClinicalstagingwasdeterminedaccordingtotheAnnArborclassification.Theclinicalpresentations,laboratoryexamination

5、s,statusofH.pyloriinfections,thetherapyandprognosisofthecaseswerealsoevaluatedindetail.---2007届临床七年制硕士研究生毕业论文AllofthecaseswerediagnosedtobetheB-NHLsthroughpost-operationpathologicalstudy.Threekindscouldbeclassified:MALTlymphoma(5cases),DLBCML(4cases)andD

6、LBCL(26cases).Theageofpatientsrangedfrom45to78,themeanagewas62.8±10.9yearsold.About38%ofthepatientswereover70yearsold.Thesexratioswasalmost1:1.ThemainsymptomofthePMGLcaseswasupperabdominalpain(80%).FewcaseswereaccompaniedwithBsymptoms(20%).Hemorrhage,obs

7、tructionandperforationcouldbeseeninthesecases,whichweretheseverecomplicationsofPMGL.Clinicalstaging:StageIEfor21cases,II1Efor10cases，II2Efor3cases,IVEfor1case.Themalignantlymphomapresentedthreetypesinendoscope:diffusedinfiltration(39%);nodularmass(9%);si

8、ngleulceration(52%).Thelesiondistributedextensively.Themajorityofthemlocatedatantrum.Nocasewaseventuallyconfirmedthroughendoscopy.ThepathologywasthegoldenkeyfordiagnosisofPMGL.Thereweresignificantrelationshipsamongclinical