Terada Tadashi
Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
Int J Clin Exp Pathol. 2013 Apr 15;6(5):951-6. Print 2013.
MALT lymphoma of the ileum is extremely rare: only several cases have been reported. A 34-year-old woman presented abdominal pain and melena. Colorectal and small intestinal endoscopes revealed multiple tumors and ulcers of the entire ileum. Biopsy was taken. Histologically, the biopsy consisted of 6 tissue specimens taken from the various sites of the ileum. All the tissue specimens showed infiltration of small atypical cells resembling centrocyte-like cells (CLC). Immunoblastic cells were scattered, though the number was scant. Monocytoid, plasma cell differentiation, and germinal centers were seen. Lymphoepithelial lesions (LEL) were scattered. Some small atypical lymphocyte were destructive the vessels and stromal tissues. Giemsa and Gram stains demonstrated no Helicobacter pylori and any bacteria. Immunohistochemically, the atypical small lymphocytes were positive for vimentin, but negative for various kinds of cytokeratins (CKs), EMA, CEA and CA19-9. The CK highlighted the LEL. They were positive for CD45, and B-cell markers (CD20, CD79a, CD10, CD23, bcl-2). CD138-positive plasma cells were seen in large number. CD68-positive macrophages were scattered. CD30- and CD15-positive immunoblastic cells were scattered. Most of the lymphoid cells were negative for T-cell markers (CD3, CD4, CD5, CD45RO, and CD43) and negative for NK cell markers (CD56 and CD57). The lymphoid cells were positive for κ-chain but negative for λ-chain; thus the light chain restriction was seen. TdT and cyclin D1 were negative. P53 was positive and Ki-67 labeling index was 67%. The lymphoid cells were negative for neuroendocrine markers (NCAM, NSE, chromogranin, and synaptophysin). The pathological diagnosis was MALT lymphoma of the ileum. Post-biopsy imaging techniques including CT, MRI, PET endoscope and gallium scintigraphy identified no tumors and no lymphadenopathy in the body except the ileum. The stomach was free from MALT lymphoma. She was treated by low dose chemotherapy and strictly followed up.
仅报道过几例。一名34岁女性出现腹痛和黑便。大肠和小肠内镜检查发现整个回肠有多个肿瘤和溃疡。进行了活检。组织学上，活检包括从回肠不同部位采集的6个组织标本。所有组织标本均显示有类似中心细胞样细胞（CLC）的小非典型细胞浸润。免疫母细胞散在分布，数量较少。可见单核样、浆细胞分化及生发中心。淋巴上皮病变（LEL）散在分布。一些小非典型淋巴细胞破坏血管和间质组织。吉姆萨染色和革兰氏染色未发现幽门螺杆菌及任何细菌。免疫组化显示，非典型小淋巴细胞波形蛋白阳性，但各种细胞角蛋白（CKs）、EMA、CEA和CA19-9阴性。CK突出显示了LEL。它们CD45阳性，B细胞标志物（CD20、CD79a、CD10、CD23、bcl-2）阳性。可见大量CD138阳性浆细胞。CD68阳性巨噬细胞散在分布。CD30和CD15阳性免疫母细胞散在分布。大多数淋巴细胞T细胞标志物（CD3、CD4、CD5、CD45RO和CD43）阴性，NK细胞标志物（CD56和CD57）阴性。淋巴细胞κ链阳性，λ链阴性；因此可见轻链限制。TdT和细胞周期蛋白D1阴性。P53阳性，Ki-67标记指数为67%。淋巴细胞神经内分泌标志物（NCAM、NSE、嗜铬粒蛋白和突触素）阴性。病理诊断为回肠黏膜相关淋巴组织淋巴瘤。活检后包括CT、MRI、PET内镜和镓闪烁扫描在内的影像学检查未发现除回肠外体内有肿瘤和淋巴结病。胃未患黏膜相关淋巴组织淋巴瘤。她接受了低剂量化疗并严格随访。
