Zukerberg L R, Ferry J A, Southern J F, Harris N L
James Homer Wright Pathology Laboratory, Massachusetts General Hospital, Boston 02114.
Am J Surg Pathol. 1990 Dec;14(12):1087-99.
Low-grade gastric lymphomas may be difficult to distinguish from benign inflammatory infiltrates on endoscopic biopsy specimens. Recent reports have suggested that so-called lymphoepithelial lesions (infiltration of lymphocytes into glandular epithelium) are characteristic of primary gastric lymphomas. We evaluated the presence and prominence of lymphoepithelial lesions and other histologic criteria in 25 low-grade gastric lymphomas (21 primary) and 58 benign inflammatory infiltrates to evaluate their utility in distinguishing benign from malignant gastric lymphoid infiltrates. The following features were associated only with lymphomas: (a) prominent (2-3 +) lymphoepithelial lesions (eight of 24 versus none of 58; p less than .0001); (b) Dutcher bodies (three of 25 versus none of 58, p = .05); and (c) moderate cytologic atypia (nine of 25 versus none of 58, p less than .0001). One or more of these features was seen in 18 of 25 gastric lymphomas (72%). Features more often associated with, but not limited to, lymphomas were dense (2-3 +) lymphoid infiltrates (25 of 25 versus five of 58, p less than .0001), rare or questionable lymphoepithelial lesions (11 of 24 versus 17 of 58, p = .01), muscularis mucosae invasion (20 of 20 versus 20 of 47, p less than .0001), ulceration (12 of 24 versus five of 58, p less than .0001), and mild cytologic atypia (eight of 25 versus six of 58, p less than .005). Germinal centers, crypt abscesses, and reactive epithelial atypia were seen with equal frequency in both types of infiltrate. Acute inflammation (2-3 +) was associated more often with inflammatory infiltrates (two of 25 versus 27 of 58, p less than .001). Our results suggest that dense lymphoid infiltrates with either prominent lymphoepithelial lesions, moderate cytologic atypia, or Dutcher bodies are highly suggestive and may be diagnostic of lymphoma. This constellation of findings is present in about 70% of endoscopic biopsy specimens of low-grade gastric lymphoma. In addition, the majority of cases of primary low-grade gastric lymphoma have morphologic, immunophenotypic, and clinical features that justify their inclusion in the category of low-grade lymphomas of mucosa-associated lymphoid tissue, whereas a minority are examples of lymphomatous polyposis of the gastrointestinal tract (centrocytic lymphoma).
低级别的胃淋巴瘤在内镜活检标本上可能难以与良性炎症浸润相区分。最近的报告表明，所谓的淋巴上皮病变（淋巴细胞浸润腺上皮）是原发性胃淋巴瘤的特征。我们评估了25例低级别的胃淋巴瘤（21例原发性）和58例良性炎症浸润中淋巴上皮病变及其他组织学标准的存在情况和显著程度，以评估它们在区分良性与恶性胃淋巴浸润中的作用。以下特征仅与淋巴瘤相关：（a）显著（2 - 3 +）的淋巴上皮病变（24例中的8例，而58例中无；p小于0.0001）；（b）杜氏小体（25例中的3例，而58例中无，p = 0.05）；以及（c）中度细胞异型性（25例中的9例，而58例中无，p小于0.0001）。25例胃淋巴瘤中有18例（72%）出现了这些特征中的一种或多种。更常与淋巴瘤相关但不限于淋巴瘤的特征有密集（2 - 3 +）的淋巴浸润（25例中的25例，而58例中的5例，p小于0.0001）、罕见或可疑的淋巴上皮病变（24例中的11例，而58例中的17例，p = 0.01）、黏膜肌层浸润（20例中的20例，而47例中的20例，p小于0.0001）、溃疡形成（24例中的12例，而58例中的5例，p小于0.0001）以及轻度细胞异型性（25例中的8例，而58例中的6例，p小于0.005）。生发中心、隐窝脓肿和反应性上皮异型性在两种浸润类型中出现的频率相同。急性炎症（2 - 3 +）更常与炎症浸润相关（25例中的2例，而58例中的27例，p小于0.001）。我们的结果表明，伴有显著淋巴上皮病变、中度细胞异型性或杜氏小体的密集淋巴浸润高度提示可能是淋巴瘤，甚至可能具有诊断意义。这一系列发现存在于约70%的低级胃淋巴瘤内镜活检标本中。此外，大多数原发性低级胃淋巴瘤的形态学、免疫表型和临床特征证明它们可归入黏膜相关淋巴组织低级淋巴瘤类别，而少数是胃肠道淋巴瘤性息肉病（中心细胞淋巴瘤）的例子。
