Dantoc Marc M, Eslick Guy D, Adams Stuart S, Kalantar Jamshid S
Discipline of Surgery, The University of Sydney, Sydney Medical School Nepean, Level 5, South Block, P.O. Box 63, Penrith, NSW 2751, Australia.
The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
J Gastrointest Cancer. 2012 Sep;43 Suppl 1:S20-4. doi: 10.1007/s12029-011-9282-0.
A 52-year-old male with a 2-year history of typical gastroesophageal reflux symptoms and concomitant weight loss despite good appetite is presented in this paper. Endoscopy showed hypertrophic gastric folds and multiple antral ulcers which were considered benign both histologically and macroscopically. The diagnosis at the time of presentation was moderate chronic gastritis. Eighteen months later, the patient presents with overt adenopathy in all peripheral lymph nodes and was subsequently diagnosed with mantle cell lymphoma (MCL).
On second presentation, the patient underwent a repeat endoscopy with biopsy and immunohistochemical (IHC) testing of gastrointestinal and lymph node tissue. The gastrointestinal endoscopy showed multiple polypoid nodules in the first and second parts of the duodenum and multiple sessile polypoid masses carpeting the colon. Gastric and lymph node biopsies were consistent with a diagnosis of MCL and MLP showing immunoperoxidase staining positive for cyclin D1, CD20 and bcl-2. A repeat IHC testing of the gastrointestinal tissue collected on initial endoscopy also showed a positive expression of the IHC markers consistent with MCL. In retrospect, an earlier detection of MCL was possible when the patient had first presented.
本文介绍了一名52岁男性，有2年典型胃食管反流症状病史，尽管食欲良好但伴有体重减轻。内镜检查显示胃皱襞肥厚和多个胃窦溃疡，组织学和肉眼观察均认为是良性的。初诊时诊断为中度慢性胃炎。18个月后，患者出现所有外周淋巴结明显肿大，随后被诊断为套细胞淋巴瘤（MCL）。
再次就诊时，患者接受了重复内镜检查，并对胃肠道和淋巴结组织进行了活检及免疫组化（IHC）检测。胃肠内镜检查显示十二指肠第一和第二部分有多个息肉样结节，结肠有多个无蒂息肉样肿物覆盖。胃和淋巴结活检结果符合MCL和黏膜相关淋巴组织淋巴瘤（MLP）的诊断，免疫过氧化物酶染色显示细胞周期蛋白D1、CD20和bcl-2呈阳性。对初次内镜检查时采集的胃肠道组织进行的重复IHC检测也显示，IHC标志物的表达呈阳性，符合MCL的表现。回顾来看，患者首次就诊时就有可能更早地检测出MCL。
