Begum S, Sano T, Endo H, Kawamata H, Urakami Y
Department of Pathology, University of Tokushima School of Medicine, Japan.
J Med Invest. 2000 Feb;47(1-2):36-46.
Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach has been demonstrated to be closely linked to Helicobacter pylori (H. pylori) and to be frequently remissioned after the cure of H. pylori infection. Several previous studies have focused on proliferating lymphocytes but little is known about gastric epithelial change and the duration of the remission after the cure of H. pylori infection. We performed a long-term follow-up investigation on the effects of anti-H. pylori treatment on MALT lymphoma and chronic gastritis at the histologic and molecular levels. Forty-eight patients with low-grade gastric MALT lymphoma and 28 chronic gastritis patients in whom H. pylori infection was eradicated were studied. After eradication, 43 MALT lymphoma patients showed complete histologic remission and continuous remission was observed during follow-up for up to 43 months (mean, 17.8 months). As for epithelial changes after eradication, "emptiness of lamina propria" was more pronounced in the mucosa with MALT lymphoma than that with chronic gastritis, and its severity in MALT lymphoma cases significantly decreased during the observation period whereas the glandular area increased. Cystic change of the fundic gland also occurred more frequently in MALT lymphoma cases than chronic gastritis cases. B-cell clonality before eradication analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) was detected in almost all MALT lymphoma cases (43 cases), but rare in chronic gastritis cases (6 cases). After eradication, in spite of histologic regression, 21 MALT lymphoma patients had a persistent monoclonal population during the follow-up period. B-cell monoclonality preceding the malignant transformation was noted in 4 cases. These observations indicate that 1) complete histologic remission of low-grade gastric MALT lymphomas seems stable even if a monoclonal B cell population is detectable in some cases, 2) there may be a stage of disease where monoclonal B cells are present but there is no histologic evidence of MALT lymphoma, and 3) regenerative change of the damaged glands may occur in histologic regressed MALT lymphoma cases.
胃低度黏膜相关淋巴组织（MALT）淋巴瘤已被证明与幽门螺杆菌（H. pylori）密切相关，并且在幽门螺杆菌感染治愈后常可缓解。此前的多项研究聚焦于增殖淋巴细胞，但对于幽门螺杆菌感染治愈后胃上皮变化以及缓解持续时间了解甚少。我们在组织学和分子水平上对抗幽门螺杆菌治疗对MALT淋巴瘤和慢性胃炎的影响进行了长期随访研究。研究了48例低度胃MALT淋巴瘤患者和28例根除幽门螺杆菌感染的慢性胃炎患者。根除后，43例MALT淋巴瘤患者出现完全组织学缓解，随访期间持续缓解长达43个月（平均17.8个月）。关于根除后的上皮变化，MALT淋巴瘤黏膜中的“固有层空虚”比慢性胃炎黏膜更明显，在观察期内MALT淋巴瘤病例的严重程度显著降低，而腺体面积增加。胃底腺的囊性变化在MALT淋巴瘤病例中也比慢性胃炎病例更频繁发生。通过逆转录聚合酶链反应（RT-PCR）分析，根除前几乎所有MALT淋巴瘤病例（43例）均检测到B细胞克隆性，但在慢性胃炎病例中罕见（6例）。根除后，尽管组织学消退，但21例MALT淋巴瘤患者在随访期间仍有持续的单克隆群体。4例患者在恶性转化前出现B细胞单克隆性。这些观察结果表明：1）低度胃MALT淋巴瘤的完全组织学缓解似乎是稳定的，即使在某些病例中可检测到单克隆B细胞群体；2）可能存在一个疾病阶段，其中存在单克隆B细胞，但没有MALT淋巴瘤的组织学证据；3）在组织学消退的MALT淋巴瘤病例中可能发生受损腺体的再生变化。
