| The concept of mucosa-associated lymphoid tissue (MALT) lymphoma was first proposed in 1983 by Isaacson and Wrigh.It is agreed an independent disease entity according to the new World Health Organization Classification of Lymphoid and Haematopoietic Tissues.Extranodal lymphomas of the MALT account for approximately 8% of all non-Hodgkin's lymphomas and comprises up to 50% of primary gastric lymphomas.The gastric MALToma is the most common extranodal lymphoma,and they are of B cell origin.The gastric MALToma belongs to the low rates of histologic lymphoma,with distinctive hisyology character,immune phenotype and genotype.Most of them are limited to local and progress slowly.The specific connection between its onset and Helicobacter pylori(Hp) and the lymphoma regression after anti-helicobacter therapy are noticed recently,arising great interest in science fields.Our team studied 20 cases of patients with gastric MALToma in Ji Lin University No.1 hospital and the cancer hospital of Ji Lin Province in past ten years. To arise the physician notice and elevate the level of diagnoses and therapy,We retrospectively analyzed the clinical manifestations, laboratory examination and diagnostic and therapeutic modalities. In this project, our team studied 20 cases of patients with gastric MALToma in Ji Lin University No.1 hospital and the cancer hospital of Ji Lin Province for the period from May 1993 to June 2003. The finding is elaborated as follow. (1)During the period of1993-2003,764 cases were diagnosed NHL in Ji Lin University No.1 hospital and the cancer hospital of Ji Lin Province and 20 cases of gastric MALToma were diagnosed according to the new classification neoplasms.the patients(8 men and 12 women)ranged in age from 31 to 78 with a median age of 61 and a ratio slightly male preponderance(male:female ratio 1.5:1).The sex ratio and episode age aren't in accordance with literate reported.This need be testified by big sample further.(2)Clinical data:In 20 cases of gastric MALToma,1 case diagnosed gastric perforation presented hematemesis.Presenting features of primary gastric lymphomas are nonspecific,with abdominal pain,malaise of epigastrium, inappetence and inertia etc,resembling the symptoms of gastritis or peptic ulcer. So the gastric MALToma were often misdiagnosed gastritis,peptic ulcer or gastric cancer etc.(3)Etiology examine:The connection between gastric MALT lymphoma and H.pylori infection is well established recently.None of our data shows the examination of H.pylori infection and the anti-helicobacter therapy.I propose H.pylori should be routinely examined in such patients later.(4)Laboratory examination:4 cases showed anemia,accounting for 20% of our data.Among them,3 cases showed microcytic hypochromic anemia.Chronic blood loss from digestive tract is the common cause of anemia.Of course autoimmune hemolytic anemia perhaps is also one cause.This need further laboratory examination to testify. (5)Endoscopic evaluation of 19 cases: Endoscopic evaluation showed 3 cases diagnosed gastritis,3 peptic ulcer,11 gastric cancer and 2 suspected gastric lymphoma. 57.9% of them are misdiagnosed gastric cancer.This indicates we should elevate the cognition of its general configuration.(6)Pathological data:The specimen after operation showed the location of 8 cases in gastric antrum,3 in gastric body,3 in lesser curvature of stomach,1 in greater curvature of stomach,1 in cardia infiltrating esophagus,4 in diffused infiltrating field.Most gastric MALTomas arise in the antrum or distal body.Macroscopically,the lymphoma infiltrated into mucosa,sub-mucosa, muscular layer and seroma or perigastric region diffusely or locally.According to Ann Arbor,14 cases presented with stage IE and 6 with stage II1E.The histologic features of low-grade gastric MALT lymphoma closely simulate those of the Peyer's patch.the lymphoma infiltrates around reactive follicles in the region corresponding to Peyer's patch marginal zone,spreading diffusely into the surrounding mucosa.The tumor cells may resemble folliclecenter centr... |
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