| BackgroundAs a non-Hodgkin’s lymphoma(NHL),gastric mucosa associated lymphoid tissue(MALT)lymphoma is as well one of the marginal zone lymphomas(MZLs)derived from extranodal mucosa associated lymphoid tissue.Its typical clinical manifestations included abdominal pain,abdominal distension,acid reflux,nausea and weight loss.It is essential to execute an endoscopic biopsy before we make the diagnosis of gastric MALT lymphoma,moreover sufficient hematopathology review of biopsy material and immunophenotyping are often needed to confirm the diagnosis.Regarding the cause of the disease,the “Helicobacter pylori theory” is currently acknowledged by most scholars worldwide.As a rare disease,gastric MALT lymphoma has a insidious onset,consequently it’s easily missed and misdiagnosed,rendering treatment difficult.If the disease couldn’t be recognized promptly and treated effectively at early stage,not only the difficulty of treatment will increase but also the cure rate will significantly reduce with the progress of the disease.As a consequence,early detection and diagnosis,timely and reasonable treatment are required to improve the prognosis of the patient.ObjectiveThis study retrospectively analyzed the clinical features of 68 cases with gastric MALT lymphoma in our hospital,aiming to improve the knowledge of gastric MALT lymphoma.It is helpful for timely diagnose,treatment and improving the prognosis of patients.MaterialsRetrospective analysis of the etiology,clinical manifestations,endoscopic features,imaging manifestations,histopathological features,immunohistochemical phenotypes,treatment and prognosis of 68 patients with gastric MALT lymphoma admitted to the First Affiliatde Hospital of Zhengzhou University from June 2010 to June 2018.ResultsAmong the 68 cases,the male-female ratio was 1.72:1,and the infection rate of H.pylori was 71.2%(49/68).The clinical manifestations were abdominal pain,abdominal distension,acid reflux,nausea,vomiting,melena,anorexia and emaciation.The distribution of lesions in endoscopy was different.The lesions located in the gastric antrum accounted for 33.8%(23/68),the gastric body accounted for 19.1%(13/68),the gastric angle accounted for 5.88%(4/68),and the gastric fundus accounted for 4.41%(3/68),36.8%(25/68)of the lesions accumulating two or more sites in the gastric antrum,gastric body,gastric angle,and gastric fundus;endoscopic morphology is divided into three types,including ulcerative type,infiltrating type and mass type,of which ulcer type was 69.1%(47/68),infiltrate type was 19.1%(13/68),mass type was 11.8%(8/68);endoscopic biopsy contributed a low diagnostic rate,and the first biopsy diagnosis rate was 54.4%(37/68).Histopathological examination showed significant lymphoid tissue hyperplasia,reactive lymphoid follicles,and plasma cell differentiation.Immunohistochemical labeling results showed CD20(+),CD79a(+),CD5(-),CD10(-),CD23(+/-),CD43(+/-),cyclin D1(-),CK(-),Ig gene in gene rearrangement detectable was positive,the gene detected monoclonal proliferating B cell population,the number of cell proliferation index Ki-67(+/-),and the positive rate of Ki-67 was 36 cases,accounting for 52.9%(36/68),the value of Ki-67 ranked form 5% to 30%.The upper gastrointestinal angiography showed varying degrees of thickening of the gastric wall,local stenosis,mucosal roughness,visible filling defects and niche;The main features of CT examination included thickening of gastric mucosa,irregular thickening or occupying of the gastric wall,which were localized or diffuse,enhanced after enhancement,and involvement of lymph nodes in different parts and numbers.According to the Lugano staging system of gastrointestinal lymphoma(the improved version of the original Ann Arbor staging system),68 cases with gastric MALT lymphoma in this group,15 cases were in stage I(22.1%),19 cases were in stage II(27.9%),22 cases were in stage IIE(32.4%),12 cases were in stage IV(17.6%),the positive rate of Ki-67 in patients with advanced disease(stage IIE and IV)was higher than that in patients with early disease(stage I and II),and the difference was statistically significant(P<0.05);treatment mainly used H.pylori eradication,radiotherapy,chemical immunotherapy and surgical treatment.Among 68 patients in this group,4 cases were treated with surgery and chemotherapy after operation,2 cases were treated with radiotherapy,2 cases were treated with H.pylori eradication and radiotherapy,4 cases were treated with radiotherapy and chemotherapy,7 cases were treated with H.pylori eradication,and 10 cases were treated with H.pylori eradication,radiotherapy and chemotherapy,39 cases were treated with chemotherapy.All patients were followed up by outpatient review,inpatient review or telephone.The longest survival period was 8 years,the tolal 5-year survival rate was 91.7%.ConclusionGastric MALT lymphoma frequently occurs in middle-aged and elderly people,and men were diagnosed more often than women;H.pylori infection is an important cause of gastric MALT lymphoma;when general treatment is ineffective for the following atypical symptom: abdominal pain,abdominal distension,acid reflux,belching,nausea,vomiting,melena,anorexia,fatigue and emaciation,we should be alert to the occurrence of gastric MALT lymphoma;the main endoscopic type is ulcerative,lesions often involve gastric antrum,gastric body and even multiple parts of the gastric at the same time;the first biopsy diagnosis rate is low,adequate hematopathology review of biopsy material and immunophenotyping are needed to confirm a diagnosis,imaging examination can help to determine organ metastasis and lymph node infiltration,and carry out clinical staging;select appropriate treatment according to H.pylori infection status and clinical stage of tumor,H.pylori eradication,radiotherapy and chemotherapy can often achieve better outcomes,and surgical treatment is required for cases with perforation or acute bleeding. |
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