Milanović N, Jelić S, Jovanović V, Kovcin V, Oprić M, Marinković M
Institute of Oncology and Radiology, Belgrade, Yugoslavia.
Neoplasma. 1994;41(6):359-62.
During the period 1984-1989 the authors have observed 20 patients with non-IPSID small intestinal lymphomas, 11 males and 9 females. In 11 patients the first symptoms were abdominal cramps requiring laparotomy, in 4 ileus, and in 5 perforation with peritonitis. Resection of the involved part of the intestine was performed in 17 patients. Lymphoma tissue was present in 4 of 5 retrogradely examined resection lines on macroscopically normal small intestine. According to Working Formulation, 3 patients had low grade, 3 intermediate grade and 14 high grade histology. Affection of extra intestinal/mesenteric structures was found in 18 of 20 patients, with a total of 36 other lymphoma localizations. 8 of 20 had affection of the nasopharynx and/or Waldeyer's ring. According to the Crowther's classification 55% of patients were in Stage IV, 35% in Stage III and 10% in Stage Ib. All patients were treated with chemotherapy, 13 with ProMACE regimen and 7 with CHOP-type regimens. Ten of twenty patients are alive and in complete remission for over 5 years (7 of 11 of Stage IV and 3 of 9 of Stage Ib/III; 8 of 14 with high grade and 2 of 6 with intermediate/low grade histology). Our results point to the fact that in non-IPSID lymphoma of the small intestine, lymphoma involvement of the intestinal wall might be present beyond obvious lymphoma lesions. Most patients with apparently primary small intestinal lymphoma have a widespread disease. Thus, local forms of treatment such as surgery, and/or radiotherapy can not be expected to be curative in the majority of patients. Data from this study suggest that following initial surgery the chemotherapy is the treatment of choice for these patients.
在1984年至1989年期间，作者观察了20例非免疫增殖性小肠淋巴瘤患者，其中男性11例，女性9例。11例患者的首发症状为需要剖腹手术的腹部绞痛，4例为肠梗阻，5例为伴有腹膜炎的穿孔。17例患者进行了受累肠段的切除术。在5例经逆行检查的宏观正常小肠切除线上，有4例发现淋巴瘤组织。根据工作分类法，3例患者为低级别组织学，3例为中级别组织学，14例为高级别组织学。20例患者中有18例出现肠外/肠系膜结构受累，共有36个其他淋巴瘤部位。20例中有8例出现鼻咽部和/或瓦尔代尔环受累。根据克劳瑟分类法，55%的患者处于IV期，35%处于III期，10%处于Ib期。所有患者均接受化疗，13例采用ProMACE方案，7例采用CHOP类方案。20例患者中有10例存活且完全缓解超过5年（IV期11例中的7例，Ib/III期9例中的3例；高级别组织学14例中的8例，中级/低级别组织学6例中的2例）。我们的结果表明，在非免疫增殖性小肠淋巴瘤中，肠壁的淋巴瘤累及可能存在于明显的淋巴瘤病变之外。大多数明显原发性小肠淋巴瘤患者病情广泛。因此，手术和/或放疗等局部治疗方式在大多数患者中预计无法治愈。本研究数据表明，在初始手术后，化疗是这些患者的首选治疗方法。
