Clinical And Misdiagnosis Analysis Of 68 Cases Of Primary Gastrointestinal Lymphoma

Background:Primary gastrointestinal lymphoma?PGIL?is more common with non-Ho-dgkin's lymphoma,belonging to extranodal malignant lymphoma.The gastrointestinal tract is the most common site of extranodal non-Hodgkin's lymphoma.More common in the st-omach,accounting for 40-50%of all PGIL.Followed by the small intestine?60-65%?,jeju-num?20-25%?and duodenum?6-8%?,and finally the c-olorectal lymphoma?6-12%?.The overall incidence is low,and it is now rising year by year^[1].Domestic and international re-ports on the clinical features and diagnosis of PGIL are still not fully understood.Therefore,the clinical manifestations of PGIL are lack of specificit,and early diagnosis and diagnosis are often misdiagnosed.Increasing the clinical diagnosis rate has become the focus of clini-cal research.Objective:To investigate the clinical features,misdiagnosis and influencing factors of P-GIL.Methods:The data of clinical history of PGIL patients admitted to the ZunYi Medical C-ollege Affiliated Hospital from February 2010 to December 2017 were collected and the d-ata were analyzed retrospectively.Results:1)Among 68 patients with PGIL,44 were males and 24 were females.Males:1.83 fe-males were females,of whom the youngest was 2 years old,3 months old,and the oldest w as 82 years old.The onset age was about 57.03 years old.2)Of the 68 patients with PGIL,18 were PGLs and 50 were PILs.Among them,abdominal pain was the main clinical manifestation of 58 patients?85%?,14 of intest-inal lymphomas were mostly abdominal masses?28%?.Among the 8 cases?44.4%?of gastric lymphoma with black stool,abdominal distension,melena,bloody stool,anemia,na-usea,vomiting,changes in stool characteristics,weight loss,fever,etc.3)All the patients in this group underwent CT examination of the abdomen in 36 cas-es.The newly diagnosed lymphoma was in 7 cases;in 41 cases of digestive endos-copy,14cases were newly diagnosed as lymphoma.The final diagnosis was combined with pathol-ogical biopsy and immunohistochemistry for 68 cases?28 under gastroscopy and 40 after surgery?;4)All 68 patients were primary gastrointestinal non-Hodgkin's lymphoma.Histo-pathological types were diffuse large B-cell lymphoma?DLBCL?,extranodal marginal lymphoma of the mucosa-associated lymphoid tissue?MALT lymphoma?,B cell n-on-type,mantle cell lymphoma?MCL?,bowel disease-related T Cellular lymphoma?EATL?,small intestine T-cell lymphoma was sporadic,rare Burkitt lymphoma;5)In 68 patients with primary gastrointestinal lymphoma,the misdiagnosis rates of gastric lymphoma were 88.9%,intestinal lymphoma were 92%,before the related tests were performed^[2].Based on the clinician's emphasis on PGIL,through pathological and immunohistochemical examinations through radiographic and gastrointestinal endoscopic examinations and surgical examinations,the diagnosis rate has been i-ncreased to over88%.Conclusion:1)primary gastrointestinal lymphoma?PGIL?is more likely to occur in the age of 57,which is good for men.Lesion site:gastric lymphoma has the most involvement in gastric l ymphoma?23.8%?,lower gastric antrum,lower gastric fundus and lower gastric Angle;Int-estinal lymphoma had the most involvement in the colon?26.3%?,followed by the blindne-ss?16.3%?,the small intestine?including jejunum and ileum??15%?,and the duodenum a-nd rectum were 3.8%and 1.3%respectively.Abdominal pain as the main clinical manifes-tations,and at the same time with common symptoms of digestive system:the acid,nausea,vomiting,abdominal distension,abdominal mass,and defecate character change,I have a f ever,emaciation,anemia,such as systemic symptom,clinical manifestations of the lack of s specificity which is one of clinical misdiagnosis of factors.2)PGIL endoscopic examination in clinical diagnosis and the assistance of imaging p-lays an important role,is also the main clinical diagnosis,pathological biopsy,immunohist-ochemical and gene rearrangement is the gold standard for clinical diagnosis.3)Primary gastrointestinal lymphoma is clinically indifferent to clinical manifestations,imaging,and endoscopy.Therefore,it is difficult to distinguish between digestive system c ancer and other digestive diseases,and the rate of clinical misdiagnosis is high.Gastric ly-mphoma is often misdiagnosed as gastric cancer,gastric ulcer,chronic gastritis,and erosi-ve gastritis.Intestinal lymphoma is often misdiagnosed as colon cancer,intussusception,in-testinal obstruction,gastrointestinal bleeding,celiac tuberculosis,intestinal tuberculosis,d-uodenal ulcer,ulcerative colitis,appendicitis,chronic gastritis,pyloric obstruction,and the like.