十二指肠型滤泡性淋巴瘤2例并文献复习  

Duodenal-type follicular lymphoma:report of two cases with review of literature

作　　者：吴晨霞 黄斌[2] 崔海宏[3] 张宝燕 苏杰 姜春婷 邱岳琳 黄泓列 WU Chen-xia;HUANG Bin;CUI Hai-hong;ZHANG Bao-yan;SU Jie;JIANG Chun-ting;QIU Yue-lin;HUANG Hong-lie(Department of Pathology,903 Military Hospital,Hangzhou 310013,China;Department of Pathology,Xiaoshan lst People's Hospital,Hangzhou 311200,China;Department of Castroenterology,305 Military Hospital,Beijing 100017,China)

机构地区：[1]联勤保障部队第九○三医院病理科,杭州310013 [2]杭州市萧山区第一人民医院病理科,杭州311200 [3]中国人民解放军第三○五医院消化科,北京100017

出　　处：《诊断病理学杂志》2021年第9期751-755,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的报道2例十二指肠型滤泡性淋巴瘤(D-FL),探讨其临床病理学特征、治疗及预后。方法回顾性分析2018—2019年收治确诊的2例D-FL病例的临床特点、组织病理学和免疫表型特征及其治疗和预后,复习相关文献。结果男、女各1例,年龄分别为57岁及62岁,分别因常规体检及上腹痛行胃镜检查后发现。病变部位均为十二指肠降部;内镜下病变呈颗粒状或结节状突起。组织学示小肠黏膜固有层充满密集淋巴细胞样细胞,伴模糊淋巴滤泡样结节形成,细胞体积小-中等,核形不规则,似生发中心细胞;罕见核分裂象。免疫组化示密集淋巴细胞样细胞表达CD20、CD79α及Bcl-2、Bcl-6、CD10;CD21染色显示模糊滤泡样结节存在滤泡树突细胞网,且在结节外围阳性染色更强;Ki-67指数分别为20%及10%。1例经利妥昔单抗和苯达莫司汀联合治疗4个疗程,病变完全消退,随访26个月,内镜检查无特殊;另1例未做任何治疗,随访8个月,复查内镜无进展。结论D-FL为特殊类型滤泡性淋巴瘤,临床病理学特征独特:好发于十二指肠、内镜下肠黏膜呈颗粒状或结节状、组织学及免疫表型常提示低级别滤泡性淋巴瘤、CD21染色常突显滤泡结节外围。大部分病例临床经过惰性,预后良好,少数会出现进展。临床处理可采取长期随访观察,必要时利妥昔单抗治疗/联合治疗或局部放疗。Objective To report 2 cases of duodenal-type follicular lymphoma(D-FL)and to explore its clinicopathological features,treatment modalities and outcome.Methods Two cases of primary D-FL were collected from 903 Military Hospital during 2018-2019.The clinical aspects,histopathological characteristics,treatment modalities and follow-up data were analyzed,with review of literature.Results Patients were 1 male and 1 female,aging 57 and 62 years respectively.Multiple mucosal granules or nodules located at the descending part of duodenum were detected incidentally on GI tract endoscopy for health examination and upper abdomenal pain respectively.Histologically,the mucosal lamina propria was packed with small to medium-sized atypical lymphoid cells,with dim nodular formation.The atypical lymphoid cells were centrocyte-like,with irregular nuclear contour.Mitosis was rarely found.The atypical lymphoid cells were predominantly positive for CD20 and CD79 a,also positive for CD10,Bcl-2 and Bcl-6.CD21 showed a positively stained dendritic meshwork pattern of the dim nodule,with the outline highlighted.Ki-67 proliferation index was low(20%and 10%respectively).The male patient received rituximab monotherapy and bendamustine for 4 cycles,achieving complete remission.No relapse was observed during 26-month follow-up.The other patient adopted a“watch and wait”treatment strategy.No progression was observed after an 8-month follow-up.Conclusion D-FL represents a special type of follicular lymphoma,with distinct clinicopathological features as follows:the duodenum is the frequent site of involvement;granular or nodular mucosal lesions are present on endoscopy,low-grade(1/2)follicular lymphoma shows morphologically and immunohistochemically,positive dendritic meshwork stain for CD21 with the outline intensified.Being indolent,the prognosis of D-FL is generally good,and yet rare cases may develop.Treatments are variable from“watch and wait”strategy to rituximab monotherapy,or rituximab-based chemotherapy,or radiotherapy.

关 键 词：十二指肠 滤泡性淋巴瘤 临床病理 治疗 预后 

分 类 号：R735[医药卫生—肿瘤]