山东地区多中心原发性胃淋巴瘤内镜特征分析

发布时间：2018-03-26 06:30

本文选题：原发性胃淋巴瘤　切入点：内镜　出处：《山东大学》2017年硕士论文

【摘要】：目的:鉴于原发性胃淋巴瘤(primary gastric lymphoma,PGL)内镜下诊断率低,本研究旨在通过分析山东地区多中心病理确诊及内镜下疑诊原发性胃淋巴瘤的内镜资料及病理诊断,提高对内镜医师对PGL内镜下特点的认识,以降低内镜医师对原PGL的误诊、漏诊,从而提高术前诊断率。方法:选取山东8家医院(山东大学齐鲁医院、临沂市人民医院、滨州市人民医院、淄博市第一人民医院、威海市立医院、菏泽市立医院、济宁市第一人民医院、聊城市人民医院等)2008年6月至2015年3月期间行胃镜检查后经病理确诊的PGL但内镜下未考虑PGL及内镜下疑诊PGL患者282例,回顾性分析其内镜资料、病理资料,包括免疫组化切片和HE切片。本研究共入组的282例患者,包括112例内镜下未疑诊但病理确诊患者,设为内镜下未疑诊组;另外170例内镜下疑诊原发性胃淋巴瘤,但病理确诊或排除原发性胃淋巴瘤患者,设为内镜下疑诊组。比较疑诊组与未疑诊组PGL患者内镜下的表现,分析不同内镜下特征与确诊PGL之间的相关性。结果:1.病理类型均为非霍奇金淋巴瘤,未见霍奇金淋巴瘤,其中弥漫性大B淋巴瘤比例最高,约占50%;T细胞淋巴瘤少见;浆细胞淋巴瘤和套细胞淋巴瘤均属于罕见病理类型。2.内镜下未疑诊组与疑诊组比较,发病的中位年龄接近;镜下病变表现恶性征,临床症状为消化道出血,则倾向于PGL的诊断。3.疑诊组与未疑诊组病变部位均以单发为主,且胃体、胃窦多见。病变为弥漫性病变者,或单部位病变且病变仅在胃窦或胃角者,病理诊断为原发性胃淋巴瘤概率增加。4.两组内镜下基本病变形态均包括以下4种:溃疡型、浸润型、肿块型、粘膜皱襞粗大型。未疑诊组与疑诊组均以溃疡型为主(58.9%,39.4%),其次为肿块型(26.8%,24.1%)。数据分析显示:溃疡型病变特别是巨大溃疡,倾向于原发性胃淋巴瘤的诊断;而胃镜下浸润型病变及皱襞粘膜粗大型病变,诊断原发性胃淋巴瘤的概率降低。5.内镜下病变质地质地硬,病理诊断为胃淋巴瘤的倾向性增加。病变质地软、韧、脆等均无差异性。6.胃黏膜相关组织淋巴瘤(MALT)患者Hp感染阳性率较高。胃癌及其他类型胃淋巴瘤患者HP检出率较低。结论:原发性胃淋巴瘤病理类型以B细胞型为主,弥漫大B细胞瘤最多见。40-49岁为发病的高峰年龄段。内镜下病变以单部位为主,单部位中以胃窦、胃体最多;且有4种病变形态:溃疡型、浸润型、肿块型、粘膜皱襞粗大型,溃疡型最多。其中,MALT与Hp感染有明显相关性。内镜对原发性胃淋巴瘤诊断率低,需多点、深挖、多次活检以提高诊断率。
[Abstract]:Objective: in view of the low rate of endoscopic diagnosis of primary gastric lymphoma, the purpose of this study was to analyze the endoscopic data and pathological diagnosis of primary gastric lymphoma diagnosed by multi-center pathology and suspected by endoscope. In order to reduce the misdiagnosis and missed diagnosis of PGL by endoscopers and improve the preoperative diagnosis rate, 8 hospitals (Qilu Hospital, Shandong University, people's Hospital of Linyi City) were selected. Binzhou people's Hospital, Zibo first people's Hospital, Weihai Municipal Hospital, Heze Municipal Hospital, Jining first people's Hospital, From June 2008 to March 2015, 282 patients with PGL confirmed by pathology were examined by gastroscopy, but PGL and suspected PGL were not considered under endoscope. The endoscopic data and pathological data were analyzed retrospectively. In this study, 282 patients were included, including 112 patients without suspected diagnosis under endoscope but pathologically confirmed, and 170 patients with suspected primary gastric lymphoma under endoscope. However, the patients with primary gastric lymphoma diagnosed or excluded by pathology were divided into two groups: the suspected group and the unsuspected group. The endoscopic manifestations of the patients with PGL were compared between the suspected group and the unsuspected group. The correlation between different endoscopic features and the diagnosis of PGL was analyzed. Results 1. All the pathological types were non-Hodgkin 's lymphoma, and no Hodgkin's lymphoma was found, of which diffuse large B lymphoma was the highest, accounting for about 50% of T cell lymphoma. Plasma cell lymphoma and mantle cell lymphoma belong to the rare pathological type .2.Compared with the suspected group, the median age of the disease is close to that of the endoscopic unsuspected group, the pathological changes under the microscope are malignant sign, and the clinical symptom is gastrointestinal hemorrhage. The lesions of the suspected group and the unsuspected group were mainly single, and the gastric body and antrum were more common. The lesion was diffuse, or the lesion was only in the antrum or the horn of stomach. The probability of pathological diagnosis of primary gastric lymphoma increased .4.The basic pathological changes in both groups included the following four types: ulcer type, infiltrating type, mass type, and so on. The mucosal folds were thick and large. In both the unsuspected group and the suspected group, the main types were ulcer type (58.9%), followed by mass type (26.8%). Data analysis showed that ulcerative lesions, especially giant ulcers, tended to diagnose primary gastric lymphoma. However, the probability of diagnosis of primary gastric lymphoma was decreased by gastroscopic invasive lesions and coarse and large lesions of plica mucosa. 5. The texture of endoscopic lesions was hard, the tendency of pathological diagnosis of gastric lymphoma was increased, and the lesions were soft and tough. The positive rate of HP infection was higher in patients with gastric mucosa-associated tissue lymphoma (MALTT), and the detection rate of HP was lower in patients with gastric cancer and other types of gastric lymphoma. Conclusion: the pathological type of primary gastric lymphoma is B cell type. Diffuse large B cell tumors are most common in the peak age group of 40 to 49 years of age. Endoscopic lesions are mainly located in a single site, with antrum and body being the most common, and there are four types of lesions: ulcer type, infiltrating type, mass type, thick and large mucosal fold. The diagnosis rate of primary gastric lymphoma by endoscopy is low, it needs many points, deep digging and multiple biopsies to improve the diagnostic rate.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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