Clinical Analysis Of 36 Patients With Mucosa-associated Lymphoid Tissue Lymphoma

Back ground:The concept of mucosa-associated lymphoid tissue (MALT)lymphoma was first proposed in 1983 by Isaacson and Wrigh.It is agreed an independent disease entity according to the new World Health Organization Classification of Lymphoid and Haematopoietic Tissues.The Gastric MALToma is the most common extranodal non Hodgkin lymphoma. The Gastric MALToma belongs to the low rates of histologic lymphoma, with distinctive hisyology character,immune phenotype and genotype.Most of them are limited to local and progress slowly. The specific connection between its onset and Helicobacter pylori(Hp) and the lymphoma regression after anti-helicobacter therapy are noticed recently, arising great interest in science fields.The clinical manifestations of gastric MALT lymphoma are nonspecific,it is difficult to be distinguished from other gastointestinal diseases,such as gastritis or peptic ulcer, which results in frequent misdiag-nosis.The standard chemotherapy regimen for gastric MALT lymphoma is uncertain.Objective:To summarize the clinical,endoscopic and pathologic chara-cteristics of 36 patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. To investigate the treatment strategies of the gastric MALT lymphoma, which may benefit its early diagnosis,early treatment and improve the prognosis.Methods:The medical records of 36 gastric MALT lymphoma patients in The First Affiliated Hospital of Dalian Medical University from Jan.2002 to Dec.2009 were analyzed retrospectively. The records included the clinic- al and pathological features,the presence of H.p,the therapy and the prognosis.Results:1 Clinical data:The average age of the 36 patients was 52.86 years(22-80),and the ratio of sex(male:female) was 1:1.57.The common symptoms were upper abdominal pain,abdominal distension,uneasy feeling-abdomen,acid regurgitation,vomiting and so on.Endoscopically,the lesions observed are large,more extensive,involving multiple sites.The appearan-ces of gastric MALT lymphoma were manifold,and the main pathological changes were ulcerative,bulgy and infiltrative,and the lesions were located mainly in the antrum and body of stomach.The diagnosis rate of biopsy specimen pathology was 36.11%.2 Hp examine:Helicobacter pylori infection was detected in 21 cases. 11 patients were HP positive, and 10 cases were negative, H.pylori infection rate was about 52.40%.3 Pathology and immunohistochemistry:The lymphoma infiltrates aro-und reactive follicles,spreading diffusely into the surrounding mucosa.The tumor cells may resemble folliclecenter centrocyte (centrocyte-like cells), small lymphocytes,or so-calledmonocytoid B cells.The tumor cell have small to medium-sized,moderately,irregul-arnuclei,resembling centrocyte. An important features of gastric MALT lymphoma is the presence of lymph-oepithelial lesions formed by invasion of individual glands by aggregates of lymphoma cells. Plasmacytic differentiation is present in gastric MALToma. 6 cases were treated with immunohistchemical staining, which indicated the tumor cell were B cell origin.4 Therapy and prognosis:Most of gastric MALToma are limited to local.They seldom disseminated and progress slowly.Among 36 cases,32 accepted surgery,surgery combined with chemotherapy were exerted on 14 patients,3 cases received H.pylori eradication therapy.2 cases received H. pylori eradication therapy solely. Surgery combined with chemotherapy and H.pylori eradication was exerted on 1 case.1 case was treated with chemo-therapy solely.Five-year survival rate was 82.35%.Conclusions:1 The clinical symptoms of gastric MALT lymphoma have no spec-ificity.It is difficult to diagnosis early and the rate of misdiagnosis is high.However,the course of the diease is slow and the prognosis is better.It is necessary to improve the understanding of gastric MALT lymphoma.2 Preoperative diagnosis are relied on endoscopy and biopsy.The endo-scopic.featuresare of variety,and the lesions are extensive.Clumpyand deep biopsy with timely immunohistochemistry can improve the accuracy of endoscopic diagnosis.3 The use of curative resection with the post-operative chemotherapy and/or anti-HP to treat MALT lymphoma can aobtain the desired therapeutic effect.