原发性大肠恶性淋巴瘤临床、内镜与病理特点  

Primary colorectal malignant lymphoma : a report on clinical , endoscopic and pathologic features

作　　者：吴斌[1] 温文[2] 何怀纯[1] 王崇文[1] 

机构地区：[1]江西医学院第一附属医院消化科,南昌330006 [2]江西医学院第一附属医院病理科,南昌330006

出　　处：《中华消化内镜杂志》2000年第1期11-14,I000,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨原发性大肠恶性淋巴瘤(PCML)的临床表现、内镜和病理特点。方法采用血常规及血型检测 ,X线检查 ,内镜检查 ,最终均得到手术和病理证实。结果24例PCML中临床表现以腹痛、体重下降、发热、腹块、便血和大便习惯改变为主。病变位于回盲部9例(37 5 %) ,直肠1例(4 2 %)。内镜下表现为隆起型9/16例(56 2 %)、浸润型4/16例(25 0 %)、溃疡型3/16例(18 8 %) ,与术后分型符合率为81 3 % ,内镜下活检病理与术后病理符合率为62 5 %。肿瘤起源于B淋巴细胞18例(75 0 %)、T淋巴细胞5例(20 8 %)和组织细胞1例(4 2 %) ,病理分型为中心细胞型9例(37 5 %)、小淋巴细胞型5例(20 8 %)、T淋巴细胞型5例(20 8 %)、中心母细胞—中心细胞型3例(12 5%)、组织细胞型1例(4 2 %)、中心母细胞型1例(4 2 %)。结论PCML以腹痛、体重下降、发热、腹块、便血和大便习惯改变为主要临床表现 ,以回盲部发病率最高。内镜及大体分型以隆起型多见。病理特点以中心细胞型多见 ,T细胞型并非罕见。Objective The clinical manifestations , endoscopic and pathologic characteristics of primary colorectal malignant lymphoma ( PCML ) were discussed . Methods 24 patients with PCML received assays of blood for routine and typing , roentgenography ,endoscopy and final confirmation by surgery and pathology . Results The clinical presentations included abdominal pain ( n=22, 91.6%) , loss of weight ( n=20, 80.3%) ,fever (n=17,70.8%) abdominal mass(n=16,66.7%),blood in stools ( n=14, 80.3%), and change in bowel movements ( n=14, 58.4%) . Not a few tumors located at ileocecal region ( n=9, 37.1%) , only one lymphoma situated at rectum ( 4.2%) . Of the 16 cases examined by endoscopy , the scopic typing as protruding , infiltrative and ulcerative lesions accounted for 56.2%( n=9) , 25.0%( n=4 ) and 18.8%( n=3 ) respectively. 81.3 percent of the typing being in line with postoperative naked eye classification . But the coincidence rate of endoscopic biopsy with pathology of resected specimen reduced to 62.5 percent . The tumor might originate from the following organisms : B cell ( n=18 , 75.0%) , T cell ( n=5 , 20.8%) and histocyte ( n=1, 4.2%) , capable of being classified into centrocytic malignant lymphoma ( n=9, 37.5%) , small cell malignant lymphoma ( n=5, 20.8%) , T cell malignant lymphoma ( n=5, 20.8%) , centroblastic centrocytic malignant lymphoma ( n=1, 4.2%) and histiocytic malignant lymphoma ( n=1, 4.2%) .Conclusion Abdominal pain and mass, loss of weight , fever , bloody stools and change of bowel habit constituted the clinical aspects of PCML , which affecting frequently the distal ileum and cecum as protruding growth with centrocytes and T cells as well . Its pathogenesis may be attributed to heredity

关 键 词：大肠肿瘤 恶性淋巴瘤 内窥镜 病理学 

分 类 号：R735.34[医药卫生—肿瘤]