“肠型恶组”诊断的再评价  

"Malignant histiocytosis of the intestine"-clinicopathologic features and colonoscopic classification of T-cell ileocolonic lymphoma

作　　者：郑家驹[1] 王凤鸣[1] 邢晔陈[1] 贾黎明[1] 王毓明[1] 史肖华[1] 

机构地区：[1]苏州市立医院(北区),215008

出　　处：《现代消化及介入诊疗》2005年第2期96-100,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的进一步认识与重视误诊为肠型恶组—回结肠T细胞恶性淋巴瘤的临床表现、病理学特点及内镜分型。方法临床病例结合内镜、病理学、免疫组化及文献报道,进行分析与讨论。结果肠型恶组与回结肠T细胞恶性淋巴瘤两者的临床症状(依次为腹痛、腹块、血便或黑便及发热与腹泻等)及病理学表现(恶性细胞形态多样化,可呈组织细胞样、异型淋巴样细胞或巨核异型细胞表现)缺乏特异性,诊断往往较困难,并且预后不良。结肠镜表现分蕈状、溃疡蕈状、浸润、溃疡浸润及溃疡等5型。结论旧称的肠型恶组,实际上大部分为大细胞性淋巴瘤;其中原发性回结肠真正的组织细胞性淋巴瘤罕见。临床上易与溃结等炎症性肠道疾病或其它恶性肿瘤混淆。结肠镜联合活检及免疫组化分析是作出正确诊断的重要方法。Objective To clarify clinicopathologic features and colonoscopic classification of malignant histiocytosis of the intestine and T- cell ileocolonic lymphoma. Method Clinical case data were studied with analysis of pathology and immunohistochemical assays of a typical case. Results The clinical manifestations included abdominal pain and mass, hematochezia or melena, moderate to high degree of fever and diarrhea, etc. and pathologic features presented diverse morphologic appearances in which tumor cells appeared histocytic, dysplastic lymphocytic or meganuclear cells. All these were less typical and specific. Thus, the diagnosis was usually difficult before surgery. However, colonoscopic examination presented several characteristic types and could be classified as fungating, ulcerofungating, infiltrative, ulceroinfiltrative and ulcerative. It has been considered that colonoscopy might help make an earlier diagnosis if combined with biopsy. Conclusion The disease previously known as malignant histocytosis of the intestine has been actually recognized as large cell lymphoma, and it is rarely seen if the tumor occurred in the site of ileocolonic area. Clinically, this type of primary lymphoma may be confused with ulcerative colitis or other inflammatory or tumorous disease. Colonoscopy combined with biopsy and immunohistochemical assay is important method for correct diagnosis.

关 键 词：肠型 恶性疾病 腹痛 免疫组化 

分 类 号：R574[医药卫生—消化系统]