Sparks Dorothy, Bhalla Amarpreet, Dodge Jessica, Saldinger Pierre
Conn Med. 2014 May;78(5):277-80.
A 52-year-old female presented with hematochezia. A computed topography (CT) scan revealed diffuse proximal gastric thickening with enlarged perigastric lymph nodes. The esophagogastroduodenoscopy (EGD) revealed a diffusely thickened gastric wall with hemorrhagic, friable mucosa, and multiple areas of ulceration. The biopsies showed diffuse amyloid deposition along with transmural proliferation of small- to medium-sized lymphocytes and plasma cells. The gastric mucosa showed lymphoepithelial lesions and chronic inactive gastritis. Immunohistochemical staining of the neoplastic lymphocytes revealed expression of CD20, bcl-2, bcl-10, Ki-67 proliferative index of 5%, and lambda light chain restriction. There was no expression of CD5, CD43, CD10, CD3, cyclin D1, and bcl-6. Immunophenotyping by flow cytometry revealed an abnormal B lymphocyte population with expression of CD45, CD19, CD20, and FMC7. The histomorphological, immunohistochemical and flow cytometric features were consistent with primary gastric amyloidosis associated with extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT lymphoma).
一名52岁女性因便血就诊。计算机断层扫描（CT）显示胃近端弥漫性增厚，胃周淋巴结肿大。食管胃十二指肠镜检查（EGD）显示胃壁弥漫性增厚，黏膜出血、质脆，有多处溃疡。活检显示弥漫性淀粉样沉积，伴有中小淋巴细胞和浆细胞的透壁性增殖。胃黏膜显示淋巴上皮病变和慢性非活动性胃炎。肿瘤性淋巴细胞的免疫组织化学染色显示CD20、bcl-2、bcl-10表达，Ki-67增殖指数为5%，且有λ轻链限制。CD5、CD43、CD10、CD3、细胞周期蛋白D1和bcl-6无表达。流式细胞术免疫表型分析显示异常B淋巴细胞群，表达CD45、CD19、CD20和FMC7。组织形态学、免疫组织化学和流式细胞术特征符合与黏膜相关淋巴组织结外边缘区淋巴瘤（MALT淋巴瘤）相关的原发性胃淀粉样变性。
