Domizio P, Owen R A, Shepherd N A, Talbot I C, Norton A J
Department of Histopathology, St. Bartholomew's Hospital, West Smithfield, England.
Am J Surg Pathol. 1993 May;17(5):429-42. doi: 10.1097/00000478-199305000-00001.
Small bowel lymphomas account for 20 to 40% of primary gut lymphomas in Western populations and are among the most common malignant tumours of the small bowel. We studied 119 cases of primary small bowel lymphoma presenting over 4 decades. Two thirds of the patients were men with a peak age incidence in the 7th decade. Common presenting features included abdominal pain, weight loss, small bowel obstruction, and acute abdomen. Tumours were classified using the Kiel European Association for Haematopathology Geneva Workshop scheme and phenotyped on paraffin sections; 66% were B cells, and 34% were T cell. In all cases, the antibodies L26 and polyclonal CD3 reliably distinguished between B- and T-cell tumours. Of the B-cell lymphomas, 62% were diffuse high grade, 20% were low-grade lymphomas of mucosa-associated lymphoid tissue, 11% had both low- and high-grade components, and 7% were other low-grade types. Of the T-cell lymphomas, 83% were high grade, and 49% were enteropathy associated. Most T-cell lymphomas were ulcerated plaques or strictures in the proximal small bowel; B-cell lymphomas tended to be annular or polypoid masses in the distal and terminal ileum. Survival data showed that low-grade B-cell lymphomas had the best outcome and T-cell lymphomas the worst. Adverse prognostic features included perforation, high-grade histology, multiple tumours and advanced stage.
在西方人群中，小肠淋巴瘤占原发性肠道淋巴瘤的20%至40%，是小肠最常见的恶性肿瘤之一。我们研究了40多年来出现的119例原发性小肠淋巴瘤病例。三分之二的患者为男性，发病高峰年龄在70岁。常见的临床表现包括腹痛、体重减轻、小肠梗阻和急腹症。肿瘤采用基尔欧洲血液病理学协会日内瓦研讨会方案进行分类，并在石蜡切片上进行表型分析；66%为B细胞型，34%为T细胞型。在所有病例中，抗体L26和多克隆CD3能可靠地区分B细胞和T细胞肿瘤。在B细胞淋巴瘤中，62%为弥漫性高级别，20%为黏膜相关淋巴组织低级别淋巴瘤，11%同时具有低级别和高级别成分，7%为其他低级别类型。在T细胞淋巴瘤中，83%为高级别，49%与肠病相关。大多数T细胞淋巴瘤为近端小肠的溃疡性斑块或狭窄；B细胞淋巴瘤倾向于在远端和末端回肠形成环形或息肉样肿块。生存数据显示，低级别B细胞淋巴瘤预后最佳，T细胞淋巴瘤最差。不良预后特征包括穿孔、高级别组织学、多发肿瘤和晚期。
