Cappell M S, Botros N
Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.
Am J Gastroenterol. 1994 Apr;89(4):545-9.
Gastrointestinal lymphoma is a distinct subgroup of lymphoma in HIV-seronegative patients. This study analyzes whether gastrointestinal lymphoma similarly forms a distinct clinical subgroup in HIV-seropositive patients.
Case control study of medical records of 763 human immunodeficiency virus-seropositive patients admitted to three university hospitals from 1986 through 1992, including 22 with non-Hodgkin's lymphoma. Eleven patients (50%) had gastrointestinal lymphoma, and 11 controls had extraintestinal lymphoma.
The clinical presentation in patients with gastrointestinal lymphoma was dominated by gastrointestinal symptoms and signs and gastrointestinal complications. Common symptoms and signs included: change in bowel habits, gross or occult blood per rectum, involuntary weight loss, abdominal pain, abdominal tenderness, peripheral lymphadenopathy, cachexia, and hepatosplenomegaly. Significant gastrointestinal complications during the presenting admission included gastrointestinal bleeding in five, intestinal obstruction in one, and dysphagia from an esophageal stricture in one. Subsequent complications included a walled-off perforating gastric ulcer in one and obstructive jaundice in one. In contrast, the control patients with extraintestinal lymphoma had significantly fewer gastrointestinal symptoms and gastrointestinal complications (p < 0.001 and p < 0.01, respectively, Fisher's exact test). Upper gastrointestinal series or barium enema identified lymphomatous gastrointestinal lesions in all seven patients undergoing these tests. The pathologic diagnosis was made from endoscopic biopsies in six of six patients undergoing panendoscopy, and two of three patients undergoing lower endoscopy. Tumor sites included stomach in six, colon in three, ileum in two, esophagus in two, and duodenum in one. Eight patients had extraintestinal lesions at diagnosis, including four with extraabdominal extranodal lesions. The outcome of gastrointestinal lymphoma was poor with all therapies (mean combined survival = 3.6 +/- 2.2 months), and was not significantly different from that for the controls (mean survival = 4.1 +/- 2.7 months, Student's t test).
This study suggests that gastrointestinal lymphoma in AIDS shares the poor prognosis and aggressive features of extraintestinal lymphoma in AIDS, but has unique localizing features at presentation of predominantly gastrointestinal symptoms and signs, and frequent gastrointestinal complications.
胃肠道淋巴瘤是HIV血清阴性患者淋巴瘤的一个独特亚组。本研究分析胃肠道淋巴瘤在HIV血清阳性患者中是否同样构成一个独特的临床亚组。
对1986年至1992年入住三家大学医院的763例人类免疫缺陷病毒血清阳性患者的病历进行病例对照研究，其中包括22例非霍奇金淋巴瘤患者。11例患者（50%）患有胃肠道淋巴瘤，11例对照患者患有肠外淋巴瘤。
胃肠道淋巴瘤患者的临床表现以胃肠道症状、体征及胃肠道并发症为主。常见症状和体征包括：排便习惯改变、直肠肉眼或潜血、体重非自愿减轻、腹痛、腹部压痛、外周淋巴结病、恶病质及肝脾肿大。入院时显著的胃肠道并发症包括5例胃肠道出血、1例肠梗阻、1例因食管狭窄导致的吞咽困难。后续并发症包括1例包裹性穿孔性胃溃疡和1例梗阻性黄疸。相比之下，肠外淋巴瘤对照患者的胃肠道症状和胃肠道并发症明显较少（分别采用Fisher精确检验，p < 0.001和p < 0.01）。上消化道造影或钡剂灌肠在接受这些检查的7例患者中均发现了淋巴瘤性胃肠道病变。6例接受全内镜检查的患者中有6例通过内镜活检做出病理诊断，3例接受下消化道内镜检查的患者中有2例做出病理诊断。肿瘤部位包括胃6例、结肠3例、回肠2例、食管2例、十二指肠1例。8例患者在诊断时有肠外病变，其中4例有腹外结外病变。所有治疗方法治疗胃肠道淋巴瘤的预后均较差（平均联合生存期 = 加/减2.2个月），与对照患者相比无显著差异（平均生存期 = 4.1加/减2.7个月）（Student t检验）。
本研究表明，艾滋病相关胃肠道淋巴瘤与艾滋病相关肠外淋巴瘤预后不良及侵袭性特征相同，但在表现上具有独特的定位特征——主要为胃肠道症状和体征，且胃肠道并发症常见。
