Arista-Nasr J, Jimenez A, Keirns C, Larraza O, Larriva-Sahd J
Department of Pathology, Instituto Nacional de la Nutricion, Salvador Zubiran, Mexico City, Mexico.
Hum Pathol. 1991 Apr;22(4):339-48. doi: 10.1016/0046-8177(91)90082-z.
Forty-three endoscopic biopsies from 29 patients with confirmed gastric lymphoma (GL) were analyzed retrospectively to establish the morphologic criteria of greatest diagnostic significance. An average of 10 tissue samples was obtained at each endoscopy. In 44% of the cases, lymphoma was discovered in only one or two of the tissue portions. Eighteen lymphomas were primary, six were probably primary, and five were generalized. The diagnosis of lymphoma was originally suspected or established in 46% of the biopsies. However, a review of the histologic sections indicated that the changes, either diagnostic of or compatible with lymphoma, were present in 75% and 18% of the sections, respectively. Most diagnostic errors consisted of confusion with diffuse lymphoid infiltrates in chronic gastritis and/or peptic ulcer, and less frequently with poorly differentiated carcinoma. In those cases confused with chronic gastritis or peptic ulcer, biopsies showed centrocyte-like cells of the standard type or small lymphocytes which produced: (1) a marked increase in density of the lymphoid infiltrate in the gastric mucosa, (2) massive substitution of gastric glands by lymphoid infiltration, and (3) a collection of lymphocytes infiltrating and partially destroying isolated glands (lymphoepithelial lesion). From 48 biopsies having intense benign lymphoid infiltrates, three were interpreted (by means of a blinded study) as compatible with GL. In poorly differentiated neoplasms (blastic and pleomorphic types), cytologic features were sufficient to diagnose GL or malignant neoplasms; immunohistochemical techniques were useful to define their lymphoid nature. It is concluded that many GLs can be suspected or correctly diagnosed by routine endoscopic biopsy.
对29例确诊为胃淋巴瘤（GL）患者的43份内镜活检标本进行回顾性分析，以确立最具诊断意义的形态学标准。每次内镜检查平均获取10份组织样本。44%的病例中，仅在一两个组织部分发现淋巴瘤。18例淋巴瘤为原发性，6例可能为原发性，5例为全身性。46%的活检标本最初怀疑或确诊为淋巴瘤。然而，对组织学切片复查显示，分别有75%和18%的切片存在诊断为淋巴瘤或与淋巴瘤相符的改变。大多数诊断错误是将其与慢性胃炎和/或消化性溃疡中的弥漫性淋巴细胞浸润相混淆，较少与低分化癌相混淆。在那些与慢性胃炎或消化性溃疡相混淆的病例中，活检显示标准型中心细胞样细胞或小淋巴细胞，其表现为：（1）胃黏膜淋巴细胞浸润密度显著增加；（2）淋巴细胞浸润大量取代胃腺；（3）淋巴细胞聚集浸润并部分破坏单个腺体（淋巴上皮病变）。在48份有强烈良性淋巴细胞浸润的活检标本中，有3份（通过盲法研究）被判定与GL相符。在低分化肿瘤（母细胞型和多形型）中，细胞学特征足以诊断GL或恶性肿瘤；免疫组化技术有助于确定其淋巴细胞性质。结论是，许多GL可通过常规内镜活检怀疑或正确诊断。
