Yamamoto Yutsuki, Yamochi-Onizuka Toshiko, Shiozawa Eisuke, Kushima Miki, Nakamaki Tsuyoshi, Tomoyasu Shigeru, Kaneko Kazuhiro, Mitamura Keiji, Hoshino Mitsunori, Ishii Hiroshi, Kusano Mitsuo, Ota Hidekazu
Second Department of Pathology, Showa University School of Medicine, Tokyo, Japan.
Pathol Int. 2003 Aug;53(8):557-62. doi: 10.1046/j.1440-1827.2003.01506.x.
More than one histological type of malignant lymphoma can occur simultaneously in an individual. The entity is classified as either composite or discordant lymphoma. Both types of lymphoma, particularly discordant lymphoma comprised of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue lymphoma (MALT-L) and follicular lymphoma (FL), are rare. We report a case of discordant lymphoma comprising MALT-L in the stomach and FL in the parotid gland. The patient was a 50-year-old Japanese woman who visited the University Hospital of Showa (Tokyo, Japan) because a barium study showed erosive gastric lesions. A gastro-intestinal endoscopy was performed 2 months after the barium study, which showed irregular erosions throughout the stomach body. A gastric biopsy showed MALT-L, and Helicobacter pylori (H. pylori) infection was confirmed. The patient had noticed a painless and elastic hard tumor mass of about 2 cm in diameter in the area of the left parotid gland 6 months before the barium study. We removed the parotid gland tumor and diagnosed it as FL 6 months after the barium study. We were able to diagnose the MALT-L and FL by morphological, immunohistochemical and molecular analyses of paraffin-embedded sections. This appears to be the first reported case of MALT-L and FL occurring together as a discordant lymphoma.
一个个体中可同时出现不止一种组织学类型的恶性淋巴瘤。该实体被分类为复合型或不一致型淋巴瘤。这两种类型的淋巴瘤，尤其是由黏膜相关淋巴组织淋巴瘤（MALT-L）和滤泡性淋巴瘤（FL）组成的不一致型淋巴瘤都很罕见。我们报告一例胃MALT-L和腮腺FL组成的不一致型淋巴瘤病例。患者为一名50岁日本女性，因钡餐检查显示胃糜烂性病变就诊于昭和大学医院（日本东京）。钡餐检查2个月后进行了胃肠内镜检查，显示整个胃体有不规则糜烂。胃活检显示为MALT-L，并确认有幽门螺杆菌（H. pylori）感染。该患者在钡餐检查前6个月就注意到左腮腺区域有一个直径约2 cm的无痛性、质地硬且有弹性的肿块。钡餐检查6个月后，我们切除了腮腺肿瘤并诊断为FL。通过对石蜡包埋切片进行形态学、免疫组织化学和分子分析，我们得以诊断出MALT-L和FL。这似乎是首例作为不一致型淋巴瘤同时出现MALT-L和FL的报道病例。
